Child & Infant Deaths. Sample Answers

Chris Parker

IFD College. 2018

1. Know the terminology used to describe the age or gestation period of a foetus, infant or child.1.1 Describe the age range/gestation period associated with each of the following:

Pre-24 weeks gestation – Death at this stage is regarded as a non-viable foetus, abortion or miscarriage.

Post 24 weeks gestation - Also referred to as a stillbirth Stillbirth – Born without life. Deceased in utero. The birth of an infant that has died in the womb

(strictly, after having survived through at least the first 28 weeks of pregnancy, earlier instances being regarded as abortion or miscarriage).

Neonatal – The period from birth to one month Perinatal - The period immediately before and after birth. The perinatal period is defined in diverse

ways. Most commonly, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.

Baby - An infant from the Latin word ‘infans’, meaning "unable to speak" or "speechless" is the more formal synonym for "baby", the very young offspring of a human. In common use a baby may be defined as a child between birth and 2 years when the term toddler is more often used.

Child - The dictionary definition is a person between birth and full growth. However, the legal definition as described by the UN Convention on the Rights of the Child defines a child as everyone under 18

Young adult _ The dictionary definition is a teenager or a person in the early years of adulthood.

1

2. Be able to comply with the relevant regulations, legislation, codes of practice and own funeral business' policies and procedures for identification of the child.2.1 Describe the identification procedure you follow when receiving the remains of a child.

When being collected from the place of death a pre-prepared name band will be placed on the child’s wrist or ankle. This will have been prepared from the information taken at the first call. The information and spellings will be checked with those present when the collection takes place, for example. Parents or hospital staff. On return to our premises the information is recoded in the mortuary book, on the location board and on the refrigerator door.

2.2 Check the identification on the body against a range of documents

The identification is checked at various stages against any or all the following: first call sheet, registrars certificate for burial or cremation, certificate of stillbirth or non-viable foetus, arrangement sheet, Cremations certificates 4 and 5 or coroner’s order for burial,

2.3 State which documents are used in 2.2.

Statutory and legal documents.

Registrars certificate for burial or cremation,

Certificate of stillbirth

Certificate of non-viable foetus,

Cremations certificates 4 and 5

Coroner’s order for burial,

Medical Certificate of cause of death (Form 11)

Form 14

Form E1

Funeral Director’s Documents/articles

First call sheet

Arrangement Form

Mortuary Book

Wristband

Coffin breastplate

2

3. Be able to comply with regulations and legislation relevant to the circumstances of the child’s death.3.1. List all documents required by the relevant authority for both a burial and a cremation in the following circumstances: (a) Pre-24 weeks gestation; (b) Post 24 weeks gestation; (c) Stillbirth; (d) Neonatal, perinatal, baby and child (e) Young adult.

Documents required are as follows:(a) Pre- 24 week gestation, non-viable foetus, also called pregnancy remains

Cremation. Definition: human foetus of less than 24 weeks gestation that has at no time since delivery

shown any visible sign of life Although not covered by The Cremation (England and Wales) Regulations 2008, pregnancy remains may be cremated and most crematoria are willing to provide this service. If they are willing to cremate they will require only a certificate of non-viable foetus which is obtained from either a Doctor or Midwife. BurialOnly a certificate of non-viable foetus is required. Local arrangements for burials will apply.

Some cemeteries will allow an interment in a children’s section. Churchyard burials will be in the gift of the incumbent.For Scotland; as in England/Wales

(b) Babies born dead after the 24th week of pregnancy are defined in law as stillbirths and must be registered as such. This includes late terminations that take place at gestations exceeding 24 weeks. Common law requires that stillborn babies must be buried or cremated.Documents required for the cremations of a stillborn child:Registrars certificate for stillbirth or Coroner’s form 6: Application for Cremation: Funeral Director’s Preliminary Application: Instructions for cremated remains.Documents required for the interment of a stillborn child:Registrars certificate for stillbirth or Coroner’s form 6: Application for intermentSCOTLAN D For Cremation in Scotland:Registrars Certificate of Registration of StillbirthForm A – Application for CremationCrematorium Prelim FormFor Burial in Scotland:Registrars Certificate of Registration of StillbirthApplication for interment

(C)Stillborn babies, see above

(d) The term neonatal denotes the age of an infant from birth and within the first month of life. Statutory documents will be as required for an adult, as below:

For cremation: Doctors Cremation certificates 4 and 5 (in England and Wales) and Registrars certificate of burial or cremation or Coroner’s Certificate Form 6 SCOTLAND Form A. Application for cremation, Funeral Director’s Prelim Form, Form 14, and in cases where the death has been reported to the procurator fiscal, a Form E1

3

For BurialRegistrars certificate of burial or cremation or Coroner’s Order for Burial and appropriate

cemetery application. Grave or lair deeds. In the case of a death reported to the Procurator Fiscal then form 14 is required.

SCOTLANDForm 14, Lair/Title Deeds, Application for Interment

For clarity of the procedures in Scotland see attached flowchart at Appendix

(d) PerinatalOccurring during or pertaining to the phase surrounding the time of birth, from the twentieth week of gestation to the twenty-eighth day of newborn life. Thus, an infant who dies within the perinatal period may be either a stillborn child or a neonatal death and documentation is as listed above. (e) Baby child and young adultOne definition of the above terms can be found at ref: https://www.verywellfamily.com/difference-between-baby-newborn-infant-toddler and is as below:“Infants are babies from two months to one year old. Toddlers are babies from one year to four years of age. Others may have different definitions of these terms. For example, some people may consider toddlers to be 18 months old to 3 years old, and a 4-year-old might be considered a preschooler” A child becomes a teenager at age 13 to 20 an age period which is overlapped by the term ‘young adult’ from age 16 defined by the age of consent or age 18 defined by adult status and electoral voting rights. In all of the above documentation is as listed in (d) above

1

2

3.2. Describe how documentation may differ when the cremation or burial is a shared or contract one arranged by a third party.

Shared funerals are only a legal option for products of pregnancy or stillborn babies. Shared funerals are usually ones arranged and paid for by the hospital trust and are most commonly put out to tender amongst local funeral directors. In those circumstances the documentation, a certificate of non-viable foetus or certificate of stillbirth will be supplied by the hospital to the funeral firm undertaking the contract.

3.4. Describe the procedure when the death has been sudden.

Any death which is sudden and/or unexpected must be reported to HM Coroner or in Scotland to the Procurator Fiscal. In those circumstances, the Coroner of Fiscal may order a post mortem examination and/or an inquest depending on the circumstances. Still-births are often referred. The procedures regarding certification are as above in answer to outcome 3(d)

1 Human tissue Authority, https://www.hta.gov.uk/sites/default/files/Guidance_on_the_disposal_of_pregnancy_remains.pdf Very Well Familyhttps://www.verywellfamily.com/difference-between-baby-newborn-infant-toddler2 http://www.iccm-uk.com/iccm/library/FBCA%20ICCM%20Joint%20Guidance.pdf

4

4. Understand the registration process and documentation specifically relevant to the death of a child.4.1. Describe the registration process and state where it will take place in own area.

Registration of infant deaths is dependent on whether the infant was alive at birth. In the case of a still-birth the still-birth must be registered as such. The informant can be the Mother; legitimate Father; Occupier of the house where the stillbirth occurred; any person present at the birth: someone who is responsible for the stillborn child or, if found, the person who found the infant’s remains. The time in which a still-birth has to be registered is 42 days, longer than the normal period in which registration has to take place. The registrar will issue a certificate for burial or cremation (still-birth)

If the child has lived, even momentarily, then the registration procedure is the same as for an adult. (see below))

If you are registering a death in England or Wales you’ll get:

A green certificate for burial or cremation, which should be given to the funeral director. A certificate of registration of death (form BD8) Copies of the death certificate.

If you’re registering a death in Scotland, you’ll get:

A certificate for registration of death (form 14), which allows the funeral to go ahead. A ‘ death (form 334/SI), which is used for updating benefits records. An extract of the entry recorded in the Register of Deaths. This is the Scottish equivalent of

the death certificate, and is used when settling the estate.

If you’re in Northern Ireland, you’ll get:

A GRO21 form, which is equivalent to the green certificate and should be given to the funeral director.

A certificate of registration of death (form 36/BD8), which is used for updating benefits records.

Copies of the death certificate.

In my region of West Kent the main office of the Registrar of Births Deaths and Marriages is situated in Grove Hill Road, Tunbridge Wells. Appointments are always necessary and informants should telephone to arrange one. Registration can take place there or in the County library in Tonbridge, High Street. There are other satellite offices in libraries around West Kent and the informant should arrange the most convenient with the main office when they book their appointment. There may, at some times during the year, be a delay of up to 2 weeks and families should be made aware of this.

SCOTLAND

For Stillbirth

The death must be registered with 21 days at any registrars office in Scotland. It should be the child's mother or other parent who registers the stillbirth. The other parent can only do this if:

5

• they're married or in a civil partnership with the child's mother

• the other parent is a man, there's a signed declaration that he's the father

If the other parent is a woman and they're not married or in a civil partnership, the other mother can only register the stillbirth if:

• she jointly signs the register with the birth mother

• she and the birth mother sign declarations (these are available from the registrar) that she is the parent

• a court declares that she is the parent and the mother registers the stillbirth

In cases where the child has lived, even momentarily, the procedure is as for an adult

4.2. For each of the following list the documents required by the registrar, when registering a death or stillbirth. (a) Pre -24 weeks gestation; (b) Post 24 weeks gestation; (c) Stillbirth (d) Neonatal, Perinatal, Baby and Child (e) Young adult.

(a) For some parents, the sadness of a pregnancy loss before 24 weeks is increased by the fact that there is no documentation that acknowledges the loss of their baby. Therefore there is no legal requirement to register. The miscarriage association recommend that health trusts issue a certificate of some description to parents who wish to acknowledge the existence of their infant and loss.

Reference: https://www.miscarriageassociation.org.uk

(B and C) Registration of a Post 24 weeks infant born dead and a still-born child the Registrar will require a certificate of still-birth issued by a Doctor or midwife or if neither was present a statutory declaration from the informant – who can be any of the following: The Mother; legitimate Father; Occupier of the house where the stillbirth occurred; any person present at the birth: someone who is responsible for the stillborn child or, if found, the person who found the infant’s remains.

6

5 Be able to advise parents on how their child is cared for during the funeral process.5.1. Describe the following: (a) how and where the child will be cared for within own funeral business; (b) the arrangements for dressing and viewing the child, either in chapel or at home.

In our business the infant or child would be cared for in our mortuary and chill area, the body being moved into our chapel of rest to facilitate any chapel visits. It is necessary to keep the remains in a cool place to ensure that any deterioration is minimised. If the child is to be kept at home we would advise parents to keep the room where the child is resting to be kept as cool as possible with windows closed to prevent insects coming into the room. During times when the child is not being viewed we would recommend that the body be covered with a light sheet or net.

Arrangements for dressing the child would be made with the parents and free access given to facilitate this together with whatever assistance they require. If the parents don’t wish to dress the infant themselves we will do it for them and ask for clothing to be supplied. If none are available we will obtain suitable garments. Viewing for any child in our chapel will always be as free and open as we can possibly make it, as often and for as long as they want, including any out of hour visits.

Some FDs can provide a “CuddleCot” made by Flexmort or similar which can be loaned to parents.

3

5.2. List the potential/possible difficulties if the child’s remains are kept at home prior to disposal.

Keeping the remains at home may be challenging from a practical perspective. There may not be a separate room in which the child may rest and thus a reduced temperature may not be possible. The weather may be such that an optimal temperature may not be achieved. In these circumstances, the remains may deteriorate quickly becoming discoloured and malodorous. This will be extremely distressing for the family and could exacerbate their grief.

Pets and small siblings may also cause difficulties due to their naturally inquisitive nature.

Other difficulties may be of a more emotional nature with not all members of the family happy to have the body at home.

5.3. Describe how a naming ceremony can be arranged.

A naming ceremony can be simply arranged with a civil celebrant as they are trained to offer this service. The service can be either in the hospital, at the chapel of rest or in the family home. Some faith leaders are also willing to conduct such a service and discussion with the family will determine where and by whom.

5.4. Explain how a naming ceremony may benefit the grieving process.

A naming service may give great comfort to a family, particularly if the infant was stillborn or pre 24 weeks gestation. A non-viable foetus cannot legally be registered and for many parents this denial of

3 http://flexmort.com/cuddle-cots/

7

their child’s existence is very painful. A naming ceremony in these circumstances acts as a rite of passage and a validation of a life, however brief.

5.5. Describe ways in which bereaved parents, siblings and close relatives may be provided with additional services, in line with own company procedures.

There are many additional services that can be offered to families to memorialise their child. Photographs, hand and footprints are quite commonly done in hospital but, if not, can be arranged by us. Ashes into glass and memorial jewellery may be appropriate even when there are very few cremated remains. Relatively new services available in the sector are fingerprints immortalised into jewellery. Unique genetic material (extracted and purified from blood or saliva) and DNA samples are now available to keep.

Pendant Paperweight Locket

4

i

4 https://www.digitaltrends.com and https://www.cremationsolutions.com/information/fingerprint-jewelry-information/fingerprint-jewelry-and-how-we-make-it

https://ashesintoglass.co.uk/?gclid=CjwKCAjwj4zaBRABEiwA0xwsP1yTiA7axowgzMVzfBX4nJmvGvLO5zXi4JrmjbImuoSmNKfZKKwI4hoCO9QQAvD_BwE

8

6 . Understand empathy when advising parents on funeral arrangements for their child.6.1. Describe how to: (a) arrange the funeral of a child; (b) support the bereaved parents.

Arranging the funeral of a child requires the utmost care and compassion. This, after all, is a death which is outside of the expected order. Families need, above all, time and clear information. The death of a child is one of the most traumatic deaths for any family to deal with, denial, guilt and shock will all play a part in their ability to process information and make informed choices, thus it is vital that extra time is given to them. They should never be rushed into making decisions which they may not be ready to make and may regret making. Repeating the decisions made and going back over the arrangements will help as will committing decisions to paper so that they are better able to cement those choices into memory. Re-assuring them that decisions can be changed is also important, the decision to cremate their child today could be changed after a sleepless night or talking to friends and family. They may dither back and forth between a final resting place and we should all be aware of that possibility, patient and prepared to make changes if and when they occur. Reassuring them that time is not an issue and there is no rush, better by far to delay by a few days to be certain of a satisfactory outcome is in our interests as well as theirs.

It is equally important to recognise the effects of the death on the wider family, parents are generally well supported, less often siblings, and rarely, the wider family. The following was written by a grandmother following the loss of her daughter’s child.

“It's a pain that often goes unrecognised. Here, with unflinching honesty, one woman reveals the silent agony of being granny of a stillborn babySix years ago, Claire Henson was at daughter Natasha's side when she gave birth to a stillborn daughter – Angelique. Although the baby died in the womb, Natasha still had to go through labourClaire knew her grief had to take second place to her daughter's. She experienced a double loss: the pain of the death of her grandchild magnified by the pain of her daughter. Though Natasha has since had two daughters, Claire has never got over the loss of her first granddaughter and the pain of what might have been.

5 6.2. Outline special arrangements or procedures that may be put in place to support the bereaved family.

If the infant is collected from home we always ask if a parent or other family member would like to bring the child to our vehicle. The memory of somebody taking your child away is best avoided, whilst giving the child into our care has a very different emotional and psychological impact.

Giving the family every help and support to be as involved as they wish to be in every other aspect of the funeral is also hugely beneficial. This may be washing, dressing placing the child into a coffin or carrying the coffin on the day of the funeral. Involving siblings will aid their grief journey. Siblings and other children are often overlooked and it is important to recognise that they too will be grieving. Something as simple as helping to choose clothing, drawing pictures to put into the casket or even decorating a cardboard coffin can all be hugely beneficial.

If the child is to be cremated there will be environmental restrictions on items placed into the coffin which don’t apply for a burial. However the inclusion of personal items are often a great comfort. Any restrictions should be clearly explained to a family at the earliest opportunity and reinforced in any written confirmations.

5 http://www.dailymail.co.uk/femail/article-2699253/Its-pain-goes-unrecognised-Here-unflinching-honesty-one-woman-reveals-silent-AGONY-granny-stillborn-baby.html#ixzz58JgUWNPH

9

The student should be able to give information about bereavement support available for parents, siblings and the wider family and community, such as school friends.

Some FDs may have a book list or actual resources that can be loaned to families to help support grieving children.

Trainer should ensure that students know where they can get support for themselves and colleagues.

6.3. Summarise possible negative effects of a shared or contract funeral.

Whilst a shared funeral may be the optimal solution for a family with limited funds, or for parents who simply want to forget and move on, there are negative aspects that should be discussed with the parents before the final decision is made. In the case of a share burial, it may not take place immediately as borough authorities charged with the burials may wait until they have several sets of remains before they go ahead. The idea that an infant will be interred with others may comfort some, but be distressing to others. The inability to mark the spot in any way may also have a negative impact of their emotional wellbeing,

In the case of a cremation it will be impossible to separate cremated remains, thus there will be none for the family to keep. Not all crematoria allow any kind of service, although some do, but in a shared capacity with other parents.

6.4. Describe how a child’s grieving may be different to that of an adult.

A child’s grief will ultimately depend largely on their age and understanding of death. Grief is a process that takes time and children may not exhibit all of the same emotions as an adult or may exhibit them in a different way. For example where an adult may show anger, a child may exhibit bad behaviour or tantrums. Some children seem fine, at least initially, and may even behave better than they did before the death. For example, they may become quieter and calmer. This can be a sign that they’re hiding their feelings, putting on a brave face or simply trying not to upset others.

Children will also experience fear: fear that they too may die or their care giver may die. For many children, even young teenagers, this could be their first experience of death and brings into question the whole issue of human mortality.

6.5. Identify how a child’s grief may impact upon its relationship with: (a) parents; b) siblings; (c) home; (d) school.

(a) A child’s relationship with their parents might circulate around the parent’s relationship with the deceased. A young child may feel jealous of the dead sibling since all focus is now on that dead child. They may mistakenly believe that the parents had wished it was them who had died instead, or they may experience a type of survivor guilt.

(b) A child’s relationship with other siblings could involve some jealousy around who was closest to the deceased child. For example “I was her favourite” if the deceased was an older child. 1An older child may take parental responsibilities for younger siblings to help grieving parent.

(c.) A child’s relationship with home may alter following a death. If the death is of a parent then home may no longer feel like a happy and nurturing environment. A surviving parent may be struggling to adapt to a single parent roles, with all of the associated social and financial implications whilst also trying to work through their grief. There may be little space to support a grieving child, who still needs to be taken to their normal out of school activities and be helped with

10

homework. Home may no longer feel ‘normal’ If the death was that of a similar age sibling then the child has lost a companion. Even when the death is that of an infant home will be a sad place, full of memories which evoke an emotional response which a child may not understand or be equipped to cope with. Following the death of my grandchild’s ‘other’ Granny, she avoided visiting her Grandfather because the house was, in her words, ‘full of Granny Pam”

(d) A school age child who has experienced a close bereavement may find school either very challenging or a place to escape the pervading grief. It is good practice to suggest to parents that they immediately notify a child’s school of the circumstances so that behavioural changes can be accommodated and the child supported. Children may experience severe separation issues and be afraid to go to school in case somebody dies while they are gone which could result in poor attendance. A poor sleep pattern might result in difficulty getting up and a resultant lateness for school. They may experience difficulty in concentration thus making school work difficult. Regressive behaviour, such as bedwetting or thumb sucking could make a child the target of school bullies.

6

7. Be able to provide parents with information regarding the choice between burial and cremation

7.1. Record the arrangements at own local crematorium for the cremation of a child.

See appendix 1

6 Journal of Family therapy. Lorna Bowlby West 1983

11

7.2. Record the arrangements at own local cemetery for the burial of a child.

See appendix 2

7.3. Explain the financial choices between cremation and burial and methods of payment

In some cases parents can apply for a funeral expenses payment for a child from the Department of Work and Pensions Social Fund Form SF200child. This is a shorter form than the standard SF200 used to claim a similar payment for the funeral of an adult. Payment is dependent on the applicant, the person responsible for the funeral payment, being in receipt of one or more of the following benefits:

Income Support Universal Credit income-based Jobseeker’s Allowance income-related Employment and Support Allowance Pension Credit The disability or severe disability element of Working Tax Credit Child Tax Credit Housing Benefit Support for Mortgage Interest

Students should be able to include details of costs and understanding of their own company policy for children’s funerals.

Kknowledge of concessions or otherwise offered by their local Crematoriums, cemeteries and suppliers.

7

8. Know how to complete all documentation required for the funeral arrangements of a child8.1. Complete documents required for both burial and cremation in each of the following circumstances, indicating where parental signatures are necessary: (a) Pre 24 weeks gestation; (b) Post 24 weeks gestation; (c) Stillbirth; (d) Neonatal; (e) Perinatal; (f) Baby; (g) Child; (h) Young adult

(a) Below is an agreement between the local NHS Trust and the Borough Council who own both Cemetery and Crematorium and which would be signed by a representative of the Trust. In this area shared funerals are arranged by the funeral company holding the contract for HM Coroner’s work which is tendered for to the County Council

7 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/718434/SF200-child-funeral-expenses-payment-claim-form.pdf

12

This is a copy of the application for a shared burial or cremation, arranged by the Trust. These documents were obtained from the Borough Council’s website.

A family wishing to have a private services will be required to complete the following form completed by either a medical practitioner, a registered nurse or registered midwife, and submit together with the certificate as shown below:

13

Parents are required to sign the statement of truth on page 4

8

9. Explain the current legal definition of cremated remains/ashes for the benefit of parental understanding.

9.1. Describe ways in which crematoria may change the cremation process to retrieve infant ashes.

The Institute of Cemetery and crematorium management (ICCM) have issued guidelines to assist crematoria to sensitively cremate the remains of infants.ii

8 http://kentandsussexcrematorium.com/forms-and-documents

14

They include:Use of a cremation tray, sometimes called a baby tray greatly increases the chance of ash retrieval.

Using a lower heat setting: not placing the coffin (or coffin on tray) directly under a burner, as this is an area where major turbulence is created and ashes could be blown away and lost

An element of manual control is adopted where the cremator programme allows this intervention, in order to reduce turbulence i.e. amount of air is reduced.

Ash recovered from a baby cremation should is not reduced in a cremulator/ash processing machine. A number of cremation authorities have a small mortar and pestle where reduction can be effected in a more caring and sensitive manner which also avoids any loss of ashes

9.2. Summarise the procedure in own funeral company for the recording and release of cremated remains.

In my company the following procedure applies: Cremated remains returned to us are logged into a register. The certificate of cremated remains is filed in a loose leaf folder. Each certificate has a note attached giving the details of the applicants name and address. When a client calls to collect the remains a member of staff checks that they are either the applicant,

or we have previously been notified that they will be collected by somebody else in which case we ask for proof of identity.

The person collecting is asked to sign a receipt which is then placed in the folder in place of the Certificate.

9.3. Record relevant practice for the cremation of infants of the crematorium your own business uses.

Following a visit to my local crematorium I discovered that they do not make use of the ‘baby tray’ option. They follow the guidelines of the Institute of Cemetery and crematorium management (ICCM) and use a baby setting. They often successfully retain a very small amount of ashes. However we do always make families aware that there is a risk that none will be retained

NB Learners should make a visit to their own crematorium to discover local practice and write a report of their findings.

9

10. Know about burial sites and permitted memorials.

10.1. List the places in relevant locality where children’s remains, or cremated remains may be interred.

In my area we have several burial sites which may be used and one crematorium garden specifically designed for child and infant remains. Our local crematorium has a dedicated area for infant remains which is supported by Sands, the sudden and neo-natal death society.

10

9 http://www.iccm-uk.com/iccm/index.php?pagename=foetalremains

15

Both the Tunbridge Wells and Tonbridge cemeteries have dedicated areas for children’s graves. The one in Tonbridge is poorly kept and our company is currently engaged in a project with the Borough Council to improve the facility.

10.2. Describe the memorials permitted in each place listed in 10.1

The regulations for Tonbridge cemetery state:“An approved headstone, kerb or monument memorial may be erected and planting with annual bedding plants may take place. General Graves should not exceed 0.6m (2’) in width and 1.5 (5’) in height except in the case of a double grave when a width of 1.3 (4’) will be permitted. The regulations for Tunbridge Wells are as follows: Height of Monuments – Kerbstones shall not exceed 300mm (1ft) in height, other monuments, gravestones and tablets shall not exceed 1065mm (3ft 6in) height including any base above ground level, except by special permission of the Council at its discretion. (viii) Thickness of Monuments – All monuments and headstones shall be at least 75mm (3in) in thickness from front to back and all kerbings shall have a cross section size of not less than 150mm by 75mm (6 ins by 3 ins) except for a child’s grave (1200mm by 600mm) (4ft by 2ft) where the kerbing shall have a cross section of not less than 125mm by 50mm (5 ins by 2 ins).

NB Learners should give similar information from their own local cemetery.

10.3. Summarise the rules and regulations relating to children’s graves in each of the places listed in 10.1.

In the dedicated children’s section of Tonbridge Cemetery the council will allow an approved headstone, kerb or monument memorial to be erected and planting with annual bedding plants may take place. Children’s graves can be provided in other plots subject to consultation with the Registrar in which case the regulations which apply to that section must be made very clear to families who may wish to place toys etc. and which may not be permitted in the area chosen.

Exclusive rights of burial in a children’s grave is leased for a period of sixty years. The lease may be renewed for successive periods beyond the sixty year term for the fee current at that time.

11

10.4. List additional items which are allowed to be placed into a coffin for both burial and cremation.

If the coffin is to be buried there are less restrictions than with a cremation. The addition of soft toys, blankets, photographs and pictures from siblings is not unusual.

If the coffin is to be cremated there will be the usual restrictions on any item which will produce toxic emissions. Also restricted are items made from plastic, glass or leather or which contain batteries. However, in reality, the

10 https://tunbridgewellssands.org/memorial-garden/

11 http://kentandsussexcrematorium.com/wp-content/uploads/Rules-Regs-Cemetery.pdf https://www.tmbc.gov.uk/__data/assets/pdf_file/0019/13294/CemeteryRegulations.pdf

16

emissions from one small soft are likely to be negligible and some crematoria will allow this. The UK cremations regulations state that: The coffin or chamber shall consist only of readily combustible wood such as poplar, thin pine, or American whitewood or such other material which has been tested and approved by the Funeral Furnishing Manufacturers Association (FFMA) If painted, only water based paints must be used. No metal fittings, except those specially adapted for cremation, may be used. There must be no cross pieces or cleats on the bottom of the coffin and sawdust, charcoal, pitch, cotton wool or sealing materials which would cause smoke shall, on no account, be used.

10.5. State how each item listed in 10.4 may effect coffin size and environmental regulations

Clearly the size of the coffin or casket will dictate to some degree the additional items placed in it. However it should be noted that some families may wish to place a collection of items and this should be discussed at the time of arranging so that the correct size of coffin may be used. It is always best to be very clear about this at the earliest opportunity rather than have to tell a family that things they wish to put with their child can’t go in because the coffin or casket isn’t large enough and which may cause them additional distress. Contents added to a cremation coffin may produce toxic emissions which contravene the regulations, or as in 10.4 above cause smoke.

11. Know how to arrange or oversee a funeral service for a child or infant in accordance with the wishes of the parents.

11.1. List types of vehicles which may be used.

Much is dependent on the age of the child. In the case of an infant families may opt for an estate car in preference to a hearse as a very small coffin or casket can be a bit lost on the deck of a hearse. However if the child is to be buried there may be large numbers of floral tribute and this should be considered. At all times the vehicle used should be the choice of the parents. In some situations parents may wish to have the coffin of a very small infant, stillborn child or non-viable foetus sat between them in a limousine or other vehicle. For older children the whole range of funeral vehicles may be appropriate.

17

11.2. Describe how the close family may be involved in the ceremony.

Being involved with the ceremony, in many case, aids the grief process and families may be involved in the following ways:Washing and dressing the child.Decorating a coffinHaving the child’s remains at home prior to the ceremony.Transporting the coffin to either cemetery or crematorium in their own vehicle.Carrying the coffin into the chapel or to a gravesideLowering the coffin into a grave.

11.2. List the types of additional services which may be appropriate and locally available.

Pretty much any additional service available for an adult’s funeral would also be available for a child, although not all would be appropriate and would depend on the child’s age. Services might include, musicians, choirs, floristry, released balloons if permitted or doves, and funeral reception. Appropriate for a child would be hand and foot prints as a picture or cast ornament, fingerprints and DNA. Where ashes are retrieved the ashes into glass or jewellery would also be available.

12. Understand the reasons for and the outcomes of the Bonomy enquiry (conducted by the Scottish Government into infant cremations in 2013/2014

12.1. Summarise the circumstances which led to the Bonomy enquiry.

In December 2012 a local Edinburgh newspaper reported that the ashes of babies who were stillborn or who had tragically died within days of being born were kept by Mortonhall crematorium in Edinburgh – and later buried in cardboard boxes on land behind the crematorium. In a vast number of these cases the families had been told that there were no ashes. This practice had been taking place for 45 years since the crematorium

18

opened. 12

12.2. List three of the outcomes of the Bonomy enquiry.

Many of the recommendation contained in the report relate to crematoria. Those that relate to our profession are:

1. The report recommended a national code of practice for infant and baby cremations and said an independent inspector should be appointed to monitor working practices at crematoria.

2. A statutory definition of ashes and regulation of cremation of babies of less than 24 weeks gestation.

3. Appropriate training for all funeral staff who are involved in any way with child and infant funerals/

1314

12.3. Describe why each of the outcomes listed in 12.2. are necessary.

1. Having an independent Inspector is one way to ensure that all crematoria, whether or not they are members of the ICCM comply with the outcomes of the report. With Crematoria owned across the UK by a local authorities, conglomerates and privately owned companies, there is a risk that standards may be varied. This a way to protect the consumer and ensure standardisation and good practice.

2. A definition set in law leaves no room for the personal opinion of different professionals. The risk was that the definition may change between Crematorium staff and funeral staff leaving grieving parents with a confused interpretations.

3. All staff should be appropriately trained for whatever task they are undertaking. If that task requires specialised training, then that should be available.

12 https://www.edinburghnews.scotsman.com/news/mortonhall-scandal-grieving-parents-refused-babies-ashes-as-mass-grave-at-crematorium-revealed-1-267531513 https://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-2787761514 http://www.cremation.org.uk/content/files/National%20Committee%20on%20Infant%20Cremation%202014-15%20Report.pdfhttps://www.gov.scot/Publications/2016/07/6426/1

19

i

iiAppendix 1

Death Certification in Scotland Guidance for the Funeral Industry can be found at https://www.iccm-uk.com/iccm/library/Scottish%20Death%20Certification%20A5%20Booklet.pdf

Appendix 2Diversity: It should be at least mentioned to students that parents may not be a heterosexual couple. Same sex couples should be afforded the same service empathy and consideration.