Ill Child’s Spirituality Could Ease Pain : Dying: Experts say that a child’s religion can play a role in their treatment, just as it can for adults.

Death was near for the 11-year-old boy, but his parents worried that the sick child had no sense of what it meant to die.

With his mother in the room, a doctor undertook a wide-ranging talk with the boy, touching on the Big Bang Theory and the David and Goliath story.

At one point, the child asked the doctor if she prayed. The boy said that every night, he said a prayer: “Now I lay me down to sleep, I pray the Lord my soul to keep, if I should die before I wake. . . . “

As the boy recited the prayer, he listened intently, said Dr. Diane Komp, a pediatric oncologist and professor at the Yale University School of Medicine in New Haven, Conn. He lived the next day--his last--without pain, she said.

“I think when he listened to himself talking, that was more important than what anyone could say to him,” Komp said.

Experts in the field of pain management in severely ill children say a child’s religious or spiritual nature can play a role in easing physical and emotional pain.

Last month, health care professionals working on behalf of the World Health Organization announced draft guidelines for easing pain in children with cancer. They include incorporating a child’s spiritual background into care.

“We’re advocating holistic care for children. In holistic care, you would take into account the spiritual background, the religious background, the cultural and ethnic background of the child and its family,” said Susan Fowler-Kerry, who teaches nursing at the University of Saskatchewan in Saskatoon and was a co-editor of the new guidelines.

The guidelines, which also recommend treating children with morphine and codeine when necessary, are expected to be formally released within six months.

“I think we have a lot to learn from kids and how they view the world and dying,” said Fowler-Kerry.

“Kids live largely in a much more spiritual dimension than we do,” said the Rev. Tom McDonnell, a Roman Catholic priest who does missionary work with children in Nairobi.

He said children can ask pain to go away for a while or transfer it to a doll.

“What the child understands about God, what the child understands about death, often takes away physical pain,” Komp said.

Komp encourages families to heal troubled relationships when a child is gravely ill. Children who see their parents in distress often express it in physical pain, she said.

“We need to understand the meaning of the pain to the person who is experiencing it,” said Dr. Richard Patt, an anesthesiologist and deputy chief of pain and symptom management at the University of Texas M.D. Anderson Cancer Center in Houston. “It’s kind of tough to find out things like this in 10 minutes.”

Sometimes, said Fowler-Kerry, health care workers are too caught up in the fast pace of disease treatment to hear patients’ spiritual concerns.

Those can range from the need of Hutterite women in western Canada to wear their caps at all times to a dying toddler’s visions of a pain-free existence with Santa Claus.

Fowler-Kerry recalled a Canadian Indian woman whose leg was going to be amputated--a dilemma for someone who believes the body must be buried whole.

“Their concern was, ‘What’s going to happen to my leg after it’s cut off?’ ” she said. “They wouldn’t get to that higher spirituality without one leg. . . .”

“With children it’s the same kind of recognition. If those cultural differences are important to the parents, they’re also going to be important to the child.”

Fowler-Kerry told the story of a 2 1/2-year-old boy whose mother didn’t want the hospital staff to tell him he was dying. But as Fowler-Kerry rocked the child in her arms, she said he found a way of saying he already knew.

“I’m going to see Santa Claus,” the tot said, describing how he would run and jump and play with lots of toys when he saw Santa. It was two months before Christmas.

“It won’t hurt anymore when I’m with Santa Claus. . . . All the ‘owees’ are going to go away,” he told Fowler-Kerry. “What he’s telling me is, he’s going to die.”

Fowler-Kerry said the boy’s mother told her, “Maybe he’s trying to make it easier for us.”