Understanding Of Death

[Anna Ploof]

Provisionaldeath counts deliver the most complete and accurate picture of lives lost to COVID-19. They are based on death certificates, which are the most reliable source of data and contain information not available anywhere else, including comorbid conditions, race and ethnicity, and place of death.

The National Center for Health Statistics (NCHS) uses incoming data from death certificates to produce provisional COVID-19 death counts. These include deaths occurring within the 50 states and the District of Columbia.

Provisional data are not yet complete. Counts will not include all deaths that occurred during a given time period, especially for more recent periods. However, we can estimate how complete our numbers are by looking at the average number of deaths reported in previous years.

Death counts should not be compared across states. Some states report deaths on a daily basis, while other states report deaths weekly or monthly. State vital record reporting may also be affected or delayed by COVID-19 related response activities.

When COVID-19 is reported as a cause of death on the death certificate, it is coded and counted as a death due to COVID-19. COVID-19 should not be reported on the death certificate if it did not cause or contribute to the death.

Getting high quality cause-of-death information can be challenging, especially during emergencies. Certifiers may be faced with heavy workloads, may not have access to complete information about the death, or may not be well trained in how to prepare quality cause-of-death statements.

Cause-of-death information is not perfect, but it is very useful. Current estimates indicate that about 20%-30% of death certificates have issues with completeness. This does not mean they are inaccurate. However, higher quality information can provide an even better picture of what is happening.

Most kids will encounter death at some point in their early years. Whether they lose a family member, a friend, a neighbor or a beloved pet, children often experience deep feelings of grief and worry. Parents and other grownups close to them may be mourning, too. This makes it especially hard to offer the support children need to understand and cope with the death.

1. The person they lost is not coming back. Even though television and cartoon characters may die in one show and return the next week, death is irreversible. As much as a child might wish things could be different, death means their loved one will not return.

2. They are not suffering. Once people die, their body stops working permanently. They no longer feel physical pain, hunger, loneliness or any other difficult emotion.

4. Your child is not to blame. Explain the cause of death in simple and clear terms, without unnecessary details. Understanding the cause of death helps a child be less likely to think their loved one died because of something your child did, said or thought. It will also make it less likely that they will blame the person that died and be ashamed of the death.

Even though infants and toddlers may not understand death, they do sense the suffering of grownups around them. Taking care of yourself while you are grieving will help your child. Accepting help from friends, neighbors and family may give you more energy to keep daily routines going, which helps little ones feel safe and loved.

Try to offer your little one extra snuggles and attention. And if they have questions, keep your answers simple and direct. "Yes, I feel sad right now, but I know that our family and friends are here for me."

Because they think in literal terms, avoid using vague phrases such as, "Your grandparent has gone to sleep (or gone on a long journey)." This might make your child feel afraid to fall asleep or travel anywhere, fearing they might not return.

Although most elementary schoolers will understand the concepts of death (children generally learn this concepts between 5-7 years of age on average), but still struggle to accept the harsh realities after a personal loss. Knowing something is different from accept it.

Offer simple, honest explanations that help them understand death as a natural outcome. Kids this age may need help finding words to express their own feelings, and with younger ones, you may need to answer the same questions many times.

Depending on how close they were with the person who died, teens may hide out in their rooms, refusing to eat or socialize with family and friends for a period of time. Some may experiment with drinking, drugs and other risky behaviors.

Model ways to clear your mind and spirit with walks, workouts, music, journaling, making art or talks with good friends. Calming techniques such as yoga, meditation or deep breathing can be helpful, too.

Adults may feel relieved that "at least our loved one is no longer in pain" or "at least other people survived the accident." However, these comparisons do not help children express or cope with their feelings.

Children may feel comforted by helping you pick out a floral arrangement, a picture or a special object (such as a collectible or piece of clothing) for display at the memorial. You can invite older kids to help with greeting visitors or asking them to sign the guest book.

This person can help ensure that your child participates only to the level your child wishes and help answer questions and explain things as they happen. If the person who died is very close to you, you may find it very difficult to provide this level of support to your child while you are grieving yourself.

Remember that these symptoms of loss do not mean you have failed your child. After someone close to them dies, kids must make their own way toward healing and acceptance. Setbacks will happen, but supporting your child without judgment or stigma can help them feel better, one day at a time.

Arwa Nasir, MBBS, MSc, MPH. FAAP, is a Professor of Pediatrics at the University of Nebraska Medical Center and Chair of the AAP Committee on the Psychosocial Aspects of Child and Family Health.

Children and young people can grieve just as deeply as adults, but they often show it in different ways. They learn how to grieve by copying the responses of the adults around them and rely on adults to provide them with what they need to support them in their grief.

Young children in particular have a limited ability to put feelings, thoughts and memories into words. They tend to 'act out' with behaviours rather than expressing themselves verbally. They will gradually gain the language of feelings by listening to words that you use. Showing your grief will also encourage them to express theirs.

It is now well recognised that very young children, including babies, do experience grief, they just show it differently. When someone familiar dies, the overriding response in the under 5s is a sense of loss. Being too young to understand the cause, and lacking the vocabulary, they express their distress through their behaviour. Even a very young baby, with clearly no concept of what being dead means, will pick up on an emotionally-charged atmosphere and will probably have a reaction of some sort.

Babies have no understanding of the concept of death yet, long before they are able to talk, they are likely to react to upset and changes in their environment such as the absence of a significant person who responded to their needs for care and nourishment on a daily basis. They may also be impacted by any emotional changes in a bereaved parent or main carer.

When it is a parent or main carer who has died, this loss will be particularly felt through the inevitable changes such as an upset routine, a different carer, and unfamiliar surroundings with strange sounds and smells.

From around the age of eight months, babies begin to develop a 'mental image' of the person who has died and have a sense of 'missing them'. Babies at this age may cry more or become more withdrawn; they may lose interest in toys or food and, as they develop motor skills and language, may call out for or search for the person who has died. You can help by giving lots of comfort and reassurance, and by keeping to normal routines as much as possible.

Young children are interested in the idea of death, for example in birds, insects and animals. They can begin to use the word 'dead' and develop an awareness that this is different to being alive. However, children of this age do not understand abstract concepts like 'forever' and cannot grasp that death is permanent.

Their limited understanding may lead to an apparent lack of reaction when told about a death, and they may ask many questions about where the person who has died is and when that person will come back. They may struggle with the concept of someone not being alive and may need reassurance that dead people feel nothing and therefore are not able to feel cold or pain.

Children at this age may expect the person to return. Young children tend to interpret what they are told in a literal and concrete way, therefore it is important to avoid offering explanations of death such as 'lost', 'gone away' or 'gone to sleep' that may cause misunderstandings and confusion. Provide honest answers to their questions but do not feel you have to tell them everything in detail or all at once. Information can be built on over time.

A young child is capable of taking in information from the adults around them and will be aware that something significant has happened. Under fives can, and often do, react strongly to their own grief, but also to the grief of significant adults involved in their day-to-day care.

Children may have disrupted sleep, altered appetite, or less interest in play. There may be regression in skills such as language or toilet training, or they might become anxious about the dark when going to bed.

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