Nursery Management: Emotional Well-Being - How to cope

Dealing with the death of a child – even when this has not taken place in the setting – is a huge emotional challenge for a manager. In the case of Jacky Avins, the manager at Little Growbags Nursery, getting a call saying a four-year-old girl who attended her setting had died was an overwhelming experience. Following the call, she took a ‘few deep breaths’ and, mustering some ‘strict self-control’, walked back into the setting from the office. ‘I recall it took all my strength and all my experience to date,’ she said. ‘I spoke to the staff two at a time, until I had spoken to them all; our students included. I can’t really remember what I said but there were lots of hugs and tears.I also quickly reminded them about confidentiality issues, but said I felt they needed to be able to talk to their families, providing they asked [them] not to discuss it with anyone else. We agreed a ground rule that if they got overwhelmed, the office was the safe place to go for a few minutes while they composed themselves.’ The child had died from an undiagnosed health condition, away from the nursery.

While child death seems rare, it is not uncommon. In the year ending 31 March 2015, 3,515 children died in England. The vast majority, around four in five, died because of a known health condition, according to statistics from the Department for Education. A third of these children died at birth, or in the first 27 days of life.

Children living in poverty are more at risk of death than better-off children. The risk of a child dying is also higher if they live in households where parents have never worked.After death in infancy, road traffic accidents and house fires are a major cause of death of children.

GRIEF

The loss of a child is one of the most devastating things a parent can face. The mental anguish provoked by such a loss is heightened by a feeling that it is unnatural; there is a sense of unfinished business when a life is cut so short.

When a child has a life-limiting condition, parents can experience anticipatory grief – where they imagine their lives following the inevitable death of their child. But being aware that a child’s life is limited by a medical condition does not always diminish this grief.

Bereavement has often been described as a process, as in Elisabeth Kubler-Ross’s work from 1966.The stages she identified were denial, anger, bargaining, depression and acceptance.Kubler-Ross’s model was widely adopted, but, as she pointed out in later work, the stages she described are not applicable to everyone. A bereaved person won’t necessarily pass through each emotion. Some parents never accept the death of their child.

LEGAL REQUIREMENTS

The death of a child must be confirmed by a doctor. If the death is unexpected or unexplained, a post-mortem will be held. A post-mortem may be ordered by a doctor to determine more about how the child died where the cause of death is known. If the cause of death is not known, a post-mortem would usually be ordered by a coroner, who may or may not then decide to hold an inquest. An inquest will be held if the death follows an accident or is violent or suspicious.

If the death of a child happens in a childcare setting, Ofsted also must be informed. Even if the child dies away from the setting, if there are suspicious or unexplained circumstances, Ofsted is still likely to be involved.

INFORMATION AND SUPPORT

This requires careful management and great sensitivity. The circumstances surrounding the child’s death will influence the response of other parents. If a child has died because of a life-limiting condition, the response is more likely to be one of quiet sorrow. However, if the death has been unexpected, other parents may be very anxious and fearful about the possibility of, for example, an infectious illness that could affect their children.

The level of support you give to the child’s family will depend on how the child died. If a child has died in suspicious circumstances, you might not be allowed to be in touch with the family. In these circumstances, police and press become involved. Having a suitable press statement ready can be helpful to ensure you have the best chance of accurate reporting – especially important if the death is likely to have a negative impact on your setting.

The level of support also depends on the intimacy of your relationship with the family. There might also be cultural and religious influences at play. Parents who hold strong religious views may find comfort in their beliefs, or they may feel let down and angry with their god. Some religious practices will influence the funeral arrangements. It is important not to make assumptions about such beliefs, but to find out what the parents’ wishes are.

How you decide to inform the children in your setting will depend on their age and stage of development, and the manner and cause of the child’s death. Standard activities such as circle time can be useful, but obviously they should have other opportunities too.

It is important not to overload them with information, but to let them ask questions and for such questions to be answered using plain language. Clichés such as ‘falling asleep’ as a term for dying should be avoided as such terms can be confusing and even alarming to young children. Taking the opportunity to frame explanations within their experiences of bereavement, such as the loss of a pet, may be helpful.

Babies and pre-verbal children are likely to pick up on the emotions of adults and older children. Keeping to the normal routine will give children the security they need, and play opportunities can be therapeutic. Storytelling can be helpful too; there are many useful books. Michael Rosen’s Sad Book is I think particularly useful for helping children to understand their emotions following death.

ATTENDING THE FUNERAL AND REMEMBRANCE

Attending a child’s funeral can be one of the last acts of love that you can perform for the child. The prospect of doing this may be overwhelming for some practitioners, especially if they have never attended a funeral.

It has become more acceptable for a funeral to be a celebration of life and parents may take the opportunity to share joy at the child’s life as well as loss. It is important to approach the parents and express your wish to attend and ask if they are happy for you to do so.

Following discussions with her staff, Jacky took the decision to close the nursery for the afternoon of the funeral to give the staff the opportunity to attend. She gave notice to the other parents and they were very understanding of her decision.

There is no right way of remembering a child. The planting of a tree or dedication of a bench may be the right way for some settings. Jacky and her staff created a memory board to celebrate the child’s life in the nursery, and afterwards the content was put into the child’s learning journey.One practitioner said completing the learning journey of her late key child was one of the saddest things she had ever done. But she realised what an important thing it was when she saw how grateful the parents were when it was given to them as a memento of their daughter.

CARING FOR YOURSELF AND YOUR STAFF

Eventually, following all this turmoil, life will start to return to normal. But the aftermath can leave you drained, especially if you have been the person who has carried the main responsibility for leading and managing the event. At this point, it is important to be kind to yourself and find ways to rebuild your energy.

A manager’s own experiences and intuition can be invaluable in these circumstances, but it is also important to remember that emotional support, such as counselling, can be hugely helpful, especially if he/she has been deeply involved in supporting a staff team and the families at the setting. It can leave a manager with a confusing mix of emotions, as although coping with the death of a child is one that fills most people with dread, the event can be strangely uplifting.

Ms Avins says, ‘I found myself in the near impossible situation of trying to deal with my own emotions at the same time as managing the situation. The staff were brilliant, they supported each other and me. We had to carry on as normal for the sake of all the other children we were looking after, and everyone did this brilliantly.’

Jackie Musgrave is senior lecturer at The University of Worcester. This article is adapted from her book, Supporting Children’s Health and Wellbeing, published by Sage

FURTHER INFORMATION

Erica Brown has written resources to drawn on to gain greater understanding of how to support bereaved children, including, Brown E and Warr B (2007) Supporting the Child and the Family in Paediatric Palliative Care. Jessica Kingsley Publishing.This book includes information about the religious influences on death and funerals.

Child Bereavement UK offers comprehensive guidance and resources for families and professionals, https://www.childbereavementuk.org

NICE guidelines, https://www.nice.org.uk/guidance/GID-CGWAVE0730/documents/short-version-of-draft-guideline

Rosen M (2004) Sad Book. Walker Books

Musgrave J (2017) Supporting Children’s Health and Wellbeing, Sage

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