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Chapter 12: Children: 12-1 One Child and Death
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
12-1 One Child and Death
In the film, And We Were Sad, Remember? (1979), the sound of a ringing telephone
wakens a young girl named Allison during the night. Her father is calling her mother from a
hospital in another town to report that his mother just died. After the call, Allison’s mother
explains that Grammie’s heart had stopped and she is dead. Allison’s mother says she will
drive to Grammie’s home tomorrow and asks whether Allison and her younger brother,
Christopher, would like to go with her to Grammie’s funeral. She explains what a funeral is,
and Allison says she wants to attend. When Christopher wakes up, Allison asks if he would
like to go with her to the “fumeral.”
A day or two later, Allison’s father tells her that he has arranged for her and Christopher to
stay with an adult friend during the funeral and to have a fun adventure. Allison replies that
her mother had told her she could go to the funeral. She insists she wants to attend and
urges him to let her do so. He is quite reluctant, finally agreeing only that he will think about
it and decide later. Allison says that whenever he says he will think about things, it usually
means “no.”
When the family and friends are all gathered at Grammie’s home, Allison and her cousin get
into an argument while they are playing with their dolls and acting out a scene involving
illness and death. Allison wants to cover the doll that has “died” with a blanket. Her cousin
says she has been told that dying is like going to sleep. If so, the doll will still need to
breathe and it won’t be able to do so if the blanket covers its face. The children take their
dispute to Allison’s father, who only tells them to stop fighting, put the dolls away, and get
ready for bed. When Allison insists that he settle their dispute, he replies in exasperation:
“Little girl, you don’t have to worry about that for a hundred years!”
Chapter 12: Children: 12-1 One Child and Death
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
© 2019 Cengage Learning Inc. All rights reserved. No part of this work may by reproduced or used in any form or by any means graphic, electronic, or mechanical, or in any other manner – without the written permission of the copyright holder.
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Chapter 12: Children: 12-2 Children, Developmental Tasks, and Death
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
12-2 Children, Developmental Tasks, and Death
At one time in Western society, children were essentially thought of as miniature adults
(Ariès, 1962). After infancy, when they became able to move about more or less
independently, their clothing and much of their behavior were modeled along adult lines. As
sensitivity to developmental differences grew, that viewpoint was abandoned in most
Western societies, although the Amish (whom we met in the vignette near the beginning of
Chapter 3) still follow some of these practices. Nevertheless, most researchers view
childhood as different from other eras in human development and make distinctions
between different eras within childhood.
In general, childhood is the period from birth to puberty or the beginning of adolescence
(Oxford English Dictionary, 1989)—roughly, the first 10–12 years of life. Within this period,
most developmental theorists (like Erikson, 1963, 1968) divide childhood itself into four
distinguishable developmental eras (infancy, toddlerhood, early childhood (also called the
play age or preschool period), and middle childhood (also called the school age or latency
period)) : infancy, toddlerhood, early childhood (also called the play age or preschool
period), and middle childhood (also called the school age or latency period). (Note that the
term child can also include the unborn fetus; thus, some writers (e.g., Martorell, Papalia, &
Feldman, 2014; Newman & Newman, 2014;) view the prenatal period extending from
conception to birth as the very first era in the human life course.) For Erikson, normative
developmental tasks (to develop trust versus mistrust in infancy, autonomy versus shame
and doubt in toddlerhood, initiative versus guilt in early childhood, and industry versus
inferiority in middle childhood) within childhood are to develop trust versus mistrust in
infancy, autonomy versus shame and doubt in toddlerhood, initiative versus guilt in early
childhood, and industry versus inferiority in middle childhood (see Table V.1).
According to this account, infants who develop a sense of basic trust will become confident
and hopeful because they will believe they can rely on people and the world to fulfill their
needs and satisfy their desires. Toddlers—often depicted as willful agents in the “terrible
twos”—who develop their own legitimate autonomy and independence will learn self-control
and establish a balance between self-regulation and external dictates. In early childhood,
the developmental conflict between initiative and guilt will appear in the form of a challenge
to cultivate one’s own initiative or desire to take action and pursue goals, but to balance that
with the moral reservations that one has about one’s plans. Combining spontaneity and
responsibility in this way promotes a sense of purpose or direction in a child’s life. In middle
childhood, the developmental conflict between industry and inferiority involves developing
one’s capacities to do productive work, thereby achieving a sense of competence and selfesteem rooted in a view of the self as able to master skills and carry out tasks.
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Of course, normative development varies within specific groups of children. Some
youngsters advance in these developmental processes more rapidly than others. Some are
delayed in their development by various physical or psychosocial factors, such as congenital
anomalies, mental or emotional disabilities, or extreme external conditions involving
starvation or war. Some are influenced more than others by the social, cultural, economic, or
historical contexts in which they find themselves. In short, human development is not an
absolutely uniform, lockstep process. In particular, although chronological or age markers
(which are relatively easy to determine and appear to be objective) are often used to mark
out and evaluate a child’s development, in fact development is not primarily a matter of
chronology but one of physical, psychosocial, and spiritual maturation. Thus, some persons
who are adult in age and body remain at the developmental level of a young child and must,
in many ways, be appreciated and treated primarily with the latter perspective in mind. Still,
broad normative patterns in childhood development are influential in typical types of deathrelated encounters, understandings, and attitudes during childhood.
Chapter 12: Children: 12-2 Children, Developmental Tasks, and Death
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
© 2019 Cengage Learning Inc. All rights reserved. No part of this work may by reproduced or used in any form or by any means graphic, electronic, or mechanical, or in any other manner – without the written permission of the copyright holder.
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Chapter 12: Children: 12-3 Encounters with Death during Childhood
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
12-3 Encounters with Death during Childhood
“‘The kingdom where nobody dies,’ as Edna St. Vincent Millay once described childhood, is
the fantasy of grown-ups” (Kastenbaum, 1972). In fact, the realities of life during childhood
include both deaths of children and deaths of others that are experienced by children.
Chapter 12: Children: 12-3 Encounters with Death during Childhood
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
© 2019 Cengage Learning Inc. All rights reserved. No part of this work may by reproduced or used in any form or by any means graphic, electronic, or mechanical, or in any other manner – without the written permission of the copyright holder.
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Chapter 12: Children: 12-3a Deaths of Children
Book Title: Death and Dying, Life and Living, 8th ed.
Printed By: Khalid Alahmdi (kaav2b@mail.missouri.edu)
© 2019 Cengage Learning, Cengage Learning
12-3a Deaths of Children
Children between birth and nine years of age made up approximately 12.7% of the total
U.S. population in 2014. In that year, this group experienced 29,402 deaths (see Table
12.1), representing less than 1.1% of the more than 2.6 million deaths in the United States.
Table 12.1
Number of Deaths during Childhood by Age, Race or Hispanic Origin,
Sex: United States, 2013
Under 1 Year
Both
1 to 4 Year
Males Females
sexes
5 to 9 Year
Both Males Females
sexes
All origins
23,215 12,886
Caucasian
14,883
and
Both Males Females
sexes
10,329
3,830
2,172
1,658
2,357
1,357
1,000
8,297
6,586
2,592
1,452
1,140
1,683
965
718
10,341
5,801
4,540
1,876
1,060
816
1,176
680
496
Hispanic
4,772
2,627
2,145
769
421
348
531
301
230
African
7,076
3,900
3,176
1,009
583
426
537
314
223
896
487
409
134
73
61
95
53
42
360
202
158
95
64
31
42
25
17
Americans,
total
NonHispanic
Caucasian
Americans
Americans
Asian and
Pacific
Island
Americans
American
Indians
and Alaska
Natives
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Source: Kochanek et al., 2016.
Infant Deaths
More children die during infancy than throughout the remainder of childhood despite a slow
but steady decline in the numbers of infant deaths over many years. In 2014, 23,215 infants
died during their first year of life in the United States (see Table 12.1). About half of all infant
deaths in 2014 were the result of five principal causes: congenital malformations, disorders
related to short gestation and low birth weight, newborns affected by maternal complications
of pregnancy, sudden infant death syndrome (SIDS), and accidents (Kochanek, Murphy, Xu,
& Tejada-Vera, 2016). These have been the leading causes of infant deaths for many years,
despite the huge reduction in deaths from SIDS since the 1990s (see Focus On 12.1).
Focus on 12.1
Sudden Infant Death Syndrome
Sudden infant death syndrome, or SIDS, has long been the leading cause of death
in infants from one month to one year of age (Corr & Corr, 2003b). Formally, SIDS is
“the sudden death of an infant under one year of age which remains unexplained
after a thorough case investigation, including performance of a complete autopsy,
examination of the death scene, and review of the clinical history” (Willinger, James,
& Catz, 1991). Typically, an apparently healthy baby dies suddenly with no advance
warning. Such a death is shocking because it involves a very young child and
because it runs counter to the general pattern of our encounters with death.
Identification of this entity as a syndrome and its recognition by the World Health
Organization as an official cause of death is significant in many ways. A syndrome is
a recognizable pattern of events whose underlying cause is unknown. Whenever the
SIDS pattern is identified, we know the infant’s death did not result from child abuse
or neglect; nothing could have been done to prevent the death, and there are ways
to distinguish SIDS deaths from those caused by child abuse (AAP, 2006).
Since there is no way to screen for an unknown cause of death, SIDS deaths have
been thought to be unpreventable. Thus, it has been said that the first symptom of
SIDS is a dead infant. SIDS strikes across all economic, ethnic, and cultural
boundaries and is not distinguishable from risk factors that put all babies in danger.
The single demographic variable that appears to be critical for SIDS is the fact that it
occurs only in infancy—with a noticeable peak in incidence around two to four
months of age and during colder months of the year in different parts of the world.
This suggests some association with infant development and environment, but does
not explain SIDS.
In the early 1990s, new research (e.g., Dwyer, Ponsonby, Blizzard, Newman, &
Cochrane, 1995) suggested that infants might be at less risk for SIDS if they were
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placed on their backs (supine) or sides for sleep, rather than on their stomachs
(prone). This recommendation ran contrary to familiar advice that favored sleeping
prone to reduce the risk that an infant might regurgitate or spit up fluids, aspirate
them into an airway, and suffocate. It is now believed that any risk of suffocating in
this way is far less likely than that of SIDS. Accordingly, as early as 1992, the
American Academy of Pediatrics (AAP) concluded it was likely that infants who
sleep on their backs and sides are at less risk for SIDS when all other
circumstances are favorable (e.g., sleeping on firm mattresses and without soft toys
nearby).
Even though the reasons for that are still not yet fully understood, the AAP (1992)
recommended that “healthy infants, when being put down for sleep be positioned on
their side or back.” Subsequently, in June 1994, the federal government initiated the
“Back to Sleep” campaign (Willinger, 1995). Dramatic and sustained reductions in
SIDS deaths followed. The numbers of these deaths fell from approximately 5,400
deaths in 1990 to 1,545 in 2014, a reduction of more than 70%.
As a result of huge declines in numbers of SIDS deaths, another AAP task force
(2005) withdrew approval for sleeping on an infant’s side, noting that “the AAP no
longer recognizes side sleeping as a reasonable alternative to fully supine [on back]
sleeping.” Recognizing that a change in sleep position alone will not settle all
problems, in 2011, an AAP task force announced a new policy statement in which
the AAP,
is expanding its recommendations from focusing only on SIDS to focusing
on a safe sleep environment that can reduce the risk of all sleep-related
infant deaths, including SIDS. The recommendations described in this
policy statement include supine positioning, use of a firm sleep surface,
breastfeeding, room-sharing without bed-sharing, routine immunizations,
consideration of using a pacifier, and avoidance of soft bedding,
overheating, and exposure to tobacco smoke, alcohol, and illicit drugs.
In 2012, the name of the Back to Sleep campaign was changed to “Safe to Sleep” to
encompass both SIDS and other sleep-related causes of infant death, such as
“Sudden Undetermined Death Syndrome” (SUDS). Although the ultimate cause(s)
of SIDS/SUDS remain unknown, many believe they result from the convergence of
three risk factors: a vulnerable infant, a critical developmental period, and outside
stressor(s). Nevertheless, much has been learned about risk factors and their
reduction. Thus, parents and professionals are advised to place infants on their
backs for sleeping on a firm mattress in a “naked” bed (one without loose blankets,
quilts, pillows, or other objects), while avoiding overheating, maternal smoking
during pregnancy, exposure to smoke in the infant’s environment, and bed sharing
(as a potential cause of suffocation) (see Moon & Hauck, 2015; Shapiro-Mendoza et
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al., 2014; Trachtenberg, Haas, Kinney, Stanley, & Krous, 2012). Use of a pacifier
seems to be helpful.
Recently, Baby Boxes have come into vogue to support the Safe to Sleep campaign
by providing non-toxic, chemical-free, and environmentally safe sleep spaces for
infants. Baby Boxes derive from a 75-year-old tradition in Finland of giving safecertified boxes filled with childcare supplies and educational materials to expecting
and new parents, but perhaps their most important feature is the use of the Baby
Box as a bassinet in which the infant can sleep on his or her back in an environment
without dangerous elements.
Information for parents and providers, researchers, and health care professionals
about SIDS and similar forms of infant death, risk reduction, and the Safe to Sleep
campaign can be obtained from the National Institute of Child Health and Human
Development and the Centers for Disease Control and Prevention.
Overall death rates for all children under one year of age in the United States in 2014, along
with those for members of selected subgroups in the population, are shown in Table 12.2.
The more precise overall infant mortality rate (based on live births) was 5.82 per 1,000 in
2014. Although, as we noted in Chapter 2, this is a record low for the United States,
according to The World Factbook (Central Intelligence Agency, 2016) this infant mortality
rate is still higher than that of two dozen other industrialized countries in the world.
Table 12.2
Death Rates (Per 100,000 in the Specified Population Group) during Childhood
by Age, Race or Hispanic Origin,
and Sex: United States, 2014
Under 1 Year
Both
1 to 4 Year
Males Females
sexes
5 to 9 Year
Both Males Females
sexes
Both Males Females
sexes
All origins
588.0
638.6
535.0
24.0
26.7
21.3
11.5
13.0
10.0
Caucasian
505.5
551.3
457.6
21.8
23.8
19.6
10.9
12.2
9.5
501.6
549.9
451.0
22.6
24.9
20.2
10.8
12.2
9.4
Americans,
total
NonHispanic
Caucasian
Americans
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Under 1 Year
Both
1 to 4 Year
Males Females
sexes
Hispanic
African
471.0
5 to 9 Year
Both Males Females
sexes
Both Males Females
sexes
508.3
432.1
18.7
20.1
17.2
10.2
11.4
9.1
1,042.7 1,125.4
956.3
37.1
42.2
31.9
15.6
18.0
13.2
6.8
Americans
Asian and
362.0
384.3
338.6
13.4
14.3
12.5
7.6
8.3
461.9
509.7
412.5
30.8
41.0
20.4
10.7
12.6
Pacific
Island
Americans
American
Indians
and Alaska
Natives
Source: Based on Kochanek et al., 2016.
Deaths of Children after Infancy
Table 12.1 also shows number of deaths in the United States in 2014 among children
between one and four years of age and between five and nine years of age. In both cases,
accidents, congenital malformations, malignant neoplasms (cancer), and homicide (assault)
were the leading causes of these deaths. In fact, accidents are the leading cause of …
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