Attitudes toward death education for young children

Abstract

A state-wide study was conducted to determine early childhood educators' perspectives of death education for young children. The results of this study generally indicate that teachers are (a) convinced of the need for self-development, (b) willing to cooperate with parents of children who have experienced significant loss, (c) attempting to respond to children's concerns related to death, and (d) exploring the possibility of initiating a more systematic approach to death education as a component of the early childhood curriculum. There was no significant correlation between the respondents' attitudes and the variables of age, sex, race, teaching experience, income, religion, and education. Several experiences and concerns of early childhood educators are analyzed.     

Parental attitudes toward death education for young children

An exploratory study was conducted to ascertain perceptions of parents toward the role of early childhood educators in teaching young children about aspects of death education. A secondary objective was to contrast perceptions of parents with those of teachers toward death education for young children utilizing data from a previous study. Although parents of young children generally agreed with statements depicting the need for early childhood educators' self-development, communication with children, interaction with children's parents, and curriculum planning, they expressed significantly less support than teachers for death education as a part of early childhood education. Moreover, although parents acknowledged the importance of children acquiring an ecumenical understanding of and respect for others' beliefs about death, they did not wish teachers to share their personal philosophical or religious beliefs about death with young children. Parents also exhibited a more protective attitude than teachers relative to children's questions and expressed concerns about death.     

Maternal concern, social support, and health-related quality of life across childhood

Mothers play a critical role in child and family health yet little is known about the concerns and health-related quality of life (HRQOL) of mothers beyond early childhood. The purpose of this study of 234 mothers of children up to 18 years of age was to examine relationships among maternal concern, social support, and HRQOL. Mothers reported a low level of concern, but concern was a significant predictor of HRQOL. The health burden for mothers was demonstrated primarily in the mental health components of HRQOL. The effect of social support was minimal and limited to the mental health domain of HRQOL. Results suggest regular assessment of maternal concerns and mental health coupled with education regarding coping strategies to support HRQOL for all mothers.     

Bereavement support for children.

The death of a parent is one of the most significant and stressful events children can encounter. Surviving children may experience psychiatric problems and social dysfunction during their childhood and possibly throughout their adult lives. Children surviving a sibling's death may develop behavioral problems, because no one can fill the emptiness that remains in their lives, especially if their relationship was close. It is vital to recognize the trauma experienced by children who have suffered the loss of a loved one. Adults need to know when a grieving child needs help. Literature supports the need for education and counseling for grieving children. School nurses can be instrumental in meeting these needs for school-age children by performing early, comprehensive assessments, educating school administration regarding the benefits of bereavement support, initiating appropriate referrals, and providing bereavement support.     

Integrated preservice pediatric team education: The Transteam experience

The need for interdisciplinary preservice educational programs for professionals serving infants and young children has been well-established. Physical and occupational therapy education, however, provides entry-level education to prepare clinicians for practice as generalists. Requirements of accrediting agencies and focus on licensure examination pass rates as evidence of program efficacy support this generalist focus, in spite of the fact that significant numbers of both disciplines practice in pediatric settings. In addition, education to develop skills as a member of a professional team is lacking from most curricula.This paper describes an interdisciplinary preservice education program funded by the Department of Education. Professions included were nursing, early childhood education, early childhood special education, and occupational and physical therapy. The program consisted of a two semester course sequence plus fieldwork experiences in team-based settings for children. The curriculum was based on competencies in early intervention and inclusive education practices, transdisciplinary team skills, and evidence-based practice. Outcome asssessment demonstrated significant changes in students' knowledge related to program objectives from the start of the program to the end. Such programs demonstrate it is feasible to integrate specialty knowledge into the entry level curriculum for occupational and physical therapists.     

The impact of prescribed psychotropics on youth

Many psychotropics prescribed to children are unlicensed or off-label. This article uses the two most prescribed psychotropics (MPH and SSRIs) to illustrate various concerns about their impact on youth. Many mental illnesses begin in childhood or early adulthood, warranting a treatment of some kind. However, commentators have argued that prescribing is influenced by five myths: (1) children are little adults; (2) children have no reason to develop depression or anxiety; (3) psychiatric disorders are the same across adults and children; (3) children can be prescribed lower doses of the same drug; (5) drugs are preferable to alternative treatments and are more successful. Several lines of evidence suggest that these are incorrect assumptions. We update readers with recent research in relation to these myths, concluding that researchers should clarify child/adult differences for psychotropics, attend to the growth of "cosmetic" use of psychotropics in children and adolescents, and address concerns about the diagnostic validity of mental illness in the current DSM classification system.     

Early prevention of childhood disability in developing countries.

The concept of prevention, while implicit in most early intervention efforts, has not been comprehensively articulated as a basis for conceptualizing early intervention services. The growing recognition of the importance of early identification and intervention for infants and young children, and involvement of the family, are factors which contribute to conceptualizations of services which are preventive in nature. This recognition parallels broader concerns for family support programmes which have a preventive focus and seek to enhance the development of children and families. The purpose of this paper is to present a comprehensive framework for the provision of child and family service by conceptualizing early intervention in terms of levels of prevention. Specifically, the concept of primary, secondary, and tertiary levels of prevention will be presented as a framework suitable to encompass the preventive function of community based rehabilitation. The relevance of early prevention is based on the premise that the condition of childhood disability can be prevented at primary, secondary, and tertiary levels. Viewed in this way, the problem or condition of developmental delay or disability in children can be addressed at each of the three levels to effect a reduction of its expression, its duration or extended impact. Primary, secondary, and tertiary prevention can be implemented in the context of community based rehabilitation to address these goals: (a) enhance development and minimize the potential for delay; (b) minimize the need for special education and related services; and (c) minimize the likelihood of institutional or other restrictive care outcomes.     

A school-based intervention to teach third grade children about the prevention of heart disease

Coronary heart disease continues to be a leading cause of death in adults. Because many risk factors for heart disease make their first appearance in childhood, early intervention is an attractive strategy for this disease. A convenience sample of 58 third grade children participated in a year-long, quasi-experimental study to compare a school-based educational program, HeartPower!, to the standard health education curriculum. Variables examined included knowledge, hypercholesterolemia, obesity, sedentary lifestyle, hypertension, exposure to cigarette smoke, and parental participation. The students who participated in the HeartPower! Program showed improvement (p < 0.05) in their knowledge of healthy lifestyles. Modest improvements in hypertension and exposure to tobacco smoke were observed. These results indicate that focused instruction on important health issues may be preferable to a broad approach.     

How social myths about childhood, motherhood and medicine affect the detection of subtle developmental problems in young children

Focus by child health professionals on the well-being of young Australian children and their families has intensified in the past decade, with particular attention drawn to the importance of the early detection and intervention of developmental problems. While many children with developmental difficulties are detected in the preschool years, those with more subtle forms of developmental problems are often only noticed by their mothers, passing unnoticed by professionals until the children begin school and fail socially or academically. This study aimed to ascertain ways in which child health professionals may utilise the experience of mothers to improve early recognition and diagnosis of subtle developmental and behavioural problems in children. French philosopher, Roland Barthes (1973) proposed that myths play an important social role in defining underlying social values that affect how people interpret what others say or do. This paper explores how the social myths of childhood, motherhood and medicine impact upon the early detection of children with subtle developmental problems. In particular, it examines how social myths affect when and how mothers become concerned about their children's development, from whom they seek advice, and the responses which mothers receive in regard to their concerns. Mythical notions of the 'blameless child', 'boys will be boys' and 'children who look OK are OK', and the constituted myth of motherhood, are all shown to affect when mothers become concerned about their children's development. What mothers do about their concerns and the responses they receive from child health professionals are also influenced by these myths. The myth of medicine is also examined to determine how it affects communication between mothers and doctors, the roles and responsibilities of doctors, and the value placed on a mother's concerns by doctors.     

The attitudes and life experiences of university death education students

The purpose of this study was to investigate a pertinent research question in the field of death education: Who are the students? More specifically, what are some similarities and differences in students who become involved in university-level death education and students who do not? Three groups of university students, a death education-enrolled group (N = 33), a death education completed group (N = 38), and a control group (N = 65) were compared on a wide range of personal variables, life experiences, attitudes toward death, and attitudes toward life. The findings revealed that the students involved in death education reported becoming aware of death at a younger age and in their upbringing had experienced more frequent family discussions about death. Both death education groups (enrolled and completed) were compared with the control group on the attitude measures. Both groups were more conscious of death than the control group, and more students from the death education groups expected to die from a specific cause (i.e., cancer), which seemed to involve an awareness of the process of dying. These findings support the assumption that although death-related experiences were similar for both groups, students who enroll for death education have experienced less death denial in their childhood background and are themselves less death-denying.     

Diagnosis and treatment of hypertension in children and adolescents

PURPOSE: To provide nurse practitioners (NPs) with updated information regarding the etiology, diagnosis, and treatment of childhood hypertension. DATA SOURCES: Extensive review of the scientific literature regarding hypertension, including the latest NIH recommendations. CONCLUSIONS: Hypertension affects more than 350,000 American children. While the majority of hypertension in early childhood occurs from secondary causes, the incidence of essential hypertension in later childhood and adolescence is rising, raising concerns as elevated pressures in childhood "track" into adulthood. Early detection and treatment of elevated childhood pressures represent important steps in reducing long-term cardiovascular risk. IMPLICATIONS FOR PRACTICE: NPs must be able to accurately differentiate between primary and secondary hypertension in childhood. Secondary hypertension requires prompt diagnosis and treatment, and controlling primary childhood hypertension has lifelong implications. Given the familial predisposition to hypertension, it is important for adult NPs to be aware of the risks faced by children of hypertensive patients.     

Management of community-acquired pneumonia in HIV-infected children

Pneumonia is a major cause of childhood mortality and morbidity worldwide, particularly in low-income countries. Often, these are also the countries most affected by the HIV epidemic. Pneumonia is the leading cause of death in HIV-infected children and a major cause of hospitalization and healthcare utilization. A broader spectrum of organisms, such as Pneumocystis jiroveci and Gram-negative bacteria, cause pneumonia in HIV-infected children compared with uninfected children. Etiologic organisms have higher rates of antimicrobial resistance in HIV-infected children. Polymicrobial disease is more common in HIV-infected children and associated with an exponential increase in mortality rate. HIV-infected children develop more severe pneumonia and have a worse outcome than HIV-uninfected children. HIV-exposed but HIV-negative children are also at higher risk of severe pneumonia and death compared with HIV-unexposed children. Although case-management guidelines for childhood pneumonia have led to an overall decrease in global childhood morbidity and mortality, HIV-infected children continue to have unacceptably high treatment failure and case fatality rates despite adherence to these guidelines. Standard guidelines require adaptation for use in high HIV-prevalence areas. Specific preventive interventions, including chemoprophylaxis for P. jiroveci pneumonia or for TB and early initiation of highly active antiretroviral therapy, may significantly reduce the burden of pneumonia in HIV-infected children.     

Neonatal predictors of school-based services used by NICU graduates at school age.

BACKGROUND: Ill or premature newborns are at increased risk for ongoing morbidity throughout childhood. Federal legislation now mandates that states provide early intervention, special education, and disability accommodations for children with special needs. Because all children born prematurely do not require all services, targeting services to the children with greatest risk is essential. This study examined whether neonatal characteristics could predict special school-based service use (speech, occupational, physical therapy, special education) in later childhood. METHODS: Subjects were 53 children, ages 7 to 11 years, graduates of one Midwest Level 3 neonatal intensive care unit (NICU). Neonatal data were used to calculate Neurobiologic Risk Scores (NBRS), a sum of illness factors related to brain damage. Birth weight, length of NICU stay, and NBRS were compared to the children's school performance on standardized tools and to report cards. RESULTS: Most children studied were not receiving special school services. The NBRS and parent report of child competency were related (p = 0.01). Length of NICU stay correlated with teachers' reports of children's academic performance (p = 0.04), and to use of special school services use (p = 0.03). As the NBRS score increased, report card performance decreased. CONCLUSIONS: Neonatal characteristics predicted school-age service use. This is important for nurses because predicting which children are most likely to need special services can aid in tracking children at high risk for prompt assessments and referrals. Parents, healthcare providers, educators, advocacy groups, and funding agencies need accurate outcome data to influence health, educational, and social policy decisions.     

Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded Services

ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations.
DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews.
RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change.
PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it.     

Death education: knowledge, attitudes, and perspectives of Irish parents and teachers

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for the inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.     

Childhood immunizations. Policies, problems, and remedies

Attaining full immunization coverage, particularly for those younger than 2 years of age, is a critical investment in the well-being and future of this nation's children. Unfortunately, not all children receive this health protective intervention equally or on a timely basis. The measles epidemic of 1989-1991 caused much concern to providers, parents, and government officials and focused the spotlight on this major healthcare issue. Those involved began to question the adequacy of federal immunization laws and the effectiveness of existing immunization programs. This article examines both significant former healthcare policy/legislation focused on childhood immunizations and current concerns regarding childhood immunizations in the United States, and offers a broad range of suggestions for future policy/practice modifications to address these concerns.     

Fear of personal death in adulthood: the impact of early and recent losses

This study examines the association between the loss of significant others and fear of personal death in adulthood. The sample consisted of a group of 86 Israeli adults who had experienced a significant loss in childhood or adolescence and a matched group of 86 subjects who had not experienced any early loss. Participants in each group were further divided according to the experience of a significant loss during the previous 2 years and completed a multidimensional scale measuring fear of personal death. Whereas early loss was positively related to the interpersonal component of fear of death, recent loss was positively related to the intrapersonal and transpersonal components of this fear. These associations were found to be moderated by the identity of the lost person, the age of the subject at the time of the early loss, and the subject's gender. The discussion emphasizes the complexity of the meanings and antecedents of fear of death in adulthood.     

Teacher intervention with elementary school children in death-related situations

Review of recent research in death education reveals a dearth of information in at least two areas: (1) what forms death education already is taking with elementary school children in actual death-related situations and (2) what influence the teacher's attitude toward death may have in such death education. This paper describes a study that deals with both issues and provides a basis for the future work of classroom teachers as therapeutic agents with children in grief.