Following the Loss of a Child

An autopsy is a medical examination of the body of a person who has died. The purpose of an autopsy is to answer questions about the person’s illness or the cause of death. Autopsies help advance medical science by allowing doctors and scientists to better understand many kinds of disease and accident-related injuries.

For many families, information from an autopsy can bring closure; but for some families, an autopsy can be a difficult decision and may seem unnecessary. Rest assured that whether an autopsy has been performed or not, you and your child will always be treated with the utmost dignity and respect.

Specially trained physicians called pathologists perform autopsies. This procedure takes place in the Michigan Medicine Morgue Suite. Family may request that certain parts of the body remain untouched, which is called a partial or limited autopsy. Autopsies are typically performed soon after the person has died and do not typically delay the funeral arrangements.

Around the time of death, a member of the care team will ask the patient’s parent/legal next of kin to sign a form giving or denying permission for an autopsy. In the case of a suspicious or sudden death, an autopsy may be required by law.

There is no charge to families for an autopsy when the child has been a patient at Michigan Medicine. If the child died outside of Michigan Medicine, the funeral home you are working with may charge for the transportation to and from the hospital for the autopsy to be completed.

A final pathology autopsy report may take up to 10 weeks due to the detailed studies performed on tissue samples and blood. These reports are not automatically sent to the family but can be provided if requested by a parent/legal next of kin. It can be very helpful to meet with a medical provider to review the autopsy report. These reports are very medical and scientific in nature which can be difficult to read about your loved child. The Office of Decedent Affairs/Children’s and Women’s Bereavement Program can assist the family in arranging a meeting to discuss early findings or review the final autopsy results with the medical providers and can help the family receive a copy of the written report.

Anatomical donation is the donation of a whole body after death for research and education. Donated bodies primarily benefit medical education and research. There are very specific eligibility criteria for anatomical donations. Children under the age of 18 are not able to be accepted into the Michigan Medicine Anatomical Donation program.

Even if a patient has “preregistered” or “enrolled” in an Anatomical Donation Program, the family will need to call after the patient has died. The program will then review the medical record and determine if donation is possible.

Some programs require a funeral home for assistance. The funeral home will file the Death Certificate, complete the Burial Transit Form, and provide transportation. Fees for these services vary from $500 to $1,000.

• A burial is a ceremonial act of burying the deceased person who is buried in a casket, or wrapped in a shroud (cloth). Caskets have a wide variety of costs and the amount you have or choose to spend does not speak to the amount of love you have for your child. You can discuss options (including financial limitations) with your funeral director. Most people are buried in established cemeteries, but burial on private property is sometimes possible in Michigan. If you have questions about this, please discuss with your funeral director. There are costs associated with purchasing a gravesite at the cemetery and purchasing a headstone.
• A cremation is the burning of the remains. The ashes are returned to the family in a container provided by the family, funeral home, or crematory. Some families choose to keep the remains while others prefer to bury or release them at a favorite place or spiritual location. It’s not uncommon for cremations to be accompanied by a funeral or memorial service, and the body can still be viewed at the funeral home before the cremation happens.
• A direct cremation is often the least expensive option for a family. The body is transported directly to the crematory from the hospital and does not go to the funeral home. A funeral director is required for this arrangement since the body still has to be transported and the death certificate needs to be filed. This choice eliminates the cost of visitation, embalming, casket, and a cemetery plot. However, it also eliminates the opportunity for a viewing. A cremation may also take place after the body has been viewed by family and friends at the funeral home.
• A mausoleum is another option for a final arrangement. This is an above ground structure constructed as a monument to hold a deceased person or persons.
• A home funeral is an option when a family chooses to keep a body at home after death, as opposed to having the body immediately transported to a funeral home. Home funerals are not widely available in Michigan but there are some people who may be able to help with this process. Ask the funeral home if they will help with this arrangement or visit The Dying Year website for more information. 
• A green burial or natural burial indicates that there is no embalming. The body is buried in a casket or shroud that easily degrades in the earth. Some cemeteries are setting aside areas for natural burials which might be a natural meadow without the use of pesticides, and boulders may be used as headstones. These cemeteries would not use a concrete vault.

Funerals and memorial services are rituals used to provide an opportunity for family and friends to help say goodbye. Rituals can help guide us when we don’t know what to say or do and helps us acknowledge that the death is real. Rituals can also provide an opportunity for family and friends to share memories so that healing can begin. If you find the process too overwhelming, enlist the help of friends or other family members who can assist you with the arrangements and can help you decide how much or how little you and your family want to participate in the actual funeral or memorial service.

• A funeral generally takes place with the body present and prior to the burial or cremation.
• A full service funeral is often referred to by funeral providers as a "traditional" funeral, usually includes a viewing or visitation and formal funeral service, use of a hearse to transport the body to the funeral site and cemetery, and burial, entombment, or cremation of the remains. It is generally the most expensive type of funeral. In addition to the funeral home's basic services fee, costs often include embalming and dressing the body; rental of the funeral home for the viewing or service; and use of vehicles to transport the family if they do not use their own.
• A memorial service usually takes place after the burial or cremation. Some families choose to have a memorial service immediately, others choose a special date, such as a birthday or holiday, while others plan the memorial service at a later time when they feel ready.

When you call a funeral home of your choosing, you will likely speak with a Funeral Director. This person is obligated by law to provide you prices over the phone. It is not unloving to compare prices or to limit services provided by the funeral home if cost is a concern for your family.

Have the following information and items available for the Funeral Director:

Vital statistics for the death certificate including:

• Full name of your child
• Parents’ full names and maiden names if applicable
• Social security number
• Place of birth
• Education level in years

When you meet with the funeral director, you may be asked about publishing an obituary. This is something you and your family may write or something the funeral director will write from the information you share about your child. There are also many online memorial websites where friends and family from near and far can pay their respects and send messages of love and support. It is not necessary to decide immediately if you want to publish an obituary in the newspaper or online, you can decide this on your own timeframe.

Although funerals generally take place in a funeral home or place of worship, you may discuss more non-traditional options with the funeral director. A memorial service may take place anywhere and with whomever you are comfortable. A clergy person or funeral director may lead the service, but it can also be a family member or friend who will listen to and follow your wishes. While some families choose a traditional service, other families plan their own service that can include all things most important to the family.

Selecting clothing is a very personal choice. This choice may be helpful to make based on how you want to remember your child or how the spirit of your child can be best honored. Some families select more formal “dressed up” clothing, others select more frequently worn “play clothes” and others have chosen special dress up clothes the child enjoyed or uniforms (such as a t-ball team uniform) from activities they were involved in. It may feel best to purchase new clothing for your child to be dressed in so that you do not have to part with any items. There is no right or wrong choice.

Any child old enough to love is old enough to mourn. While you know your children best, if a sibling wishes to participate in some way, it is generally good to include them. Perhaps they would like to share a picture, read a story, or write a letter to be read by them or someone else. Maybe they would just like to be a part of what the adults are doing. Allowing children to be involved in the arrangements as much as they would like can most often be helpful in their grieving.

There is no timeline for when a memorial has to be completed. While many families like to have an event arranged close to the time of the loss, others may wait a few months to a year after the loss when they have had time to discover what feels like the best way for them to honor and remember their child.

Please do not put additional pressure on yourself to have the “perfect” memorial planned. If after you have had a memorial you later think of something that would have felt even more “right”, you can have another memorial. Memorials do not have to be limited to one time.