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Children of different ages deal with illness and death differently. It’s important to consider the child’s age when deciding how to talk about coping with sickness and death. Here are general guidelines for when the loved one who is dying is a parent but can also be applied for other loved ones. These suggestions can help you and the other adults in their lives decide how to best approach each of your children.
Infants and children under the age of 3 don’t understand death in the same way adults do. Still, they need to be told that the parent is very sick, but not with something that you get over, like a cold or sore throat. The goal is to take advantage of the time the parent has left with the child. It’s also important to try to keep the child’s routine as normal as possible so that they feel loved, safe, and cared for. It helps children to know that Mom or Dad will be in bed more as death nears and won’t be able to play or even talk much. Remind them that it doesn’t mean that the parent is mad or doesn’t love them. Gentle cuddling, hugging, or holding hands may be possible.
Answer any questions the child asks as honestly as possible; in words they can understand. As the child gets older, they’ll be able to understand in more detail what happened with the parent.
Generally, children younger than 5 are not able to understand that death is permanent and that everyone dies. Children at this age may expect someone who has died to come back. It often takes time and growing up for them to realize that the parent they loved will not return.
When death is very close, the child should know that soon the parent will die. Help them understand by using phrases like, “Soon their body won’t work anymore.” “They won’t feel or breathe anymore.” or “Their heart will stop.” If you say things like “Mommy will go to sleep,” the child will realize at some point that Mommy didn’t wake up. Children told these kinds of stories can become afraid to go to bed at night – it’s important to tell the truth and use the right words.
Some ideas for talking with children in this age group:
Children this age are better able to understand death, including that death is permanent. Some children may see it as a monster, ghost, or some other such creature. Death often takes the form of an outside person who can come to catch them and if they run fast enough, they can escape. Children in this age group worry about monsters under the bed, witches, or devils, and it can be hard to reassure them that such creatures don’t exist. They may also think that the other parent or another loved one could have prevented the illness or death from happening.
Children at this age may come up with their own explanations of things, like why a sick parent won’t play with them (“Mommy doesn’t love me anymore because I told her I hated her.”) It’s important to explain changes right away. (“Mommy can’t play with you because she’s sick. She loves you a lot and still wants you to have fun.”) Once children believe their own interpretation, it can be hard to change their minds, and it requires lots of repetition and reinforcement.
Be patient trying to convince a child that a parent has really died. Don’t be hard on yourself if it seems like you can’t get through a child’s normal defense against such a difficult reality.
Here are some tips that may help:
If the child shows severe anxiety, becomes fearful, is afraid to go to school, blames themselves, acts depressed, or shows low self-esteem, consider an evaluation by a mental health professional.
Children in this age range want reassurance that their parent loves them. Some want to hug the parent or hold their hand. Some are comforted by exchanging gifts or cards with the parent. These small gestures can become treasured memories for the child.
Children this age may have feelings of sadness and loss during terminal illness and after a parent’s death. They may even feel embarrassed about their outbursts of strong emotions. They can understand more about serious illness and the finality of death, if they are given clear information all along. This doesn’t mean that the child won’t fantasize about Mom or Dad coming back from death – this is normal. But if given simple explanations about death, they will, with time, understand that the parent will not come back from death and that death is permanent. They’ll also understand that all living things die.
The child will need concrete, basic information about the parent’s illness and treatment to understand what’s going on. Understanding comes slowly, over time, when the truth has a chance to sink in and the child can more easily tolerate the loss.
Teenagers have an adult understanding of death but might not have adult coping skills. They may have a particularly tough time with the loss of a parent. This is easier to understand if you keep in mind what a teen needs to accomplish in growing up. The major task of the teen years is to achieve a separate identity from their parents and discover themselves as young adults. The struggles that go on between parents and teens are a normal and necessary part of gaining a new identity.
Teenagers often behave in unpredictable ways – one day they feel independent and the next they retreat into the safety of childhood. As every parent of a teenager knows, it can be a delicate balancing act between giving a teenager enough independence to learn and experience the world while trying to protect them from what they’re not yet mature enough to handle. These struggles go on in every household.
Teens are old enough to know that their lives will greatly change due to their parent’s illness and death, and they struggle to deal with this threat. They may cope in ways that are hard for parents to understand, such as refusing to talk about the illness or trying to take control. Others may adapt, try to get closer to parents, and/or try to restore order to the home.
As the parent gets sicker, the teen may want to sit with them for short times each day. Some teens may want to be as far away as possible from their sick family member and thoughts about their death. Most want to spend time with the parent, but still have some time to be a kid. It’s OK for the teen to help, but they should not oversee their parent’s care.
Some tips on helping teens:
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Cancer.Net Helping Grieving Children and Teenagers | Cancer.Net. Accessed at https://www.cancer.net/coping-with-cancer/managing-emotions/grief-and-loss/helping-grieving-children-and-teenagers on May 20, 2022.
Muriel AC. Preparing children and adolescents for the loss of a loved one. In: UpToDate, Givens J & Armsby C (Ed). UpToDate, Waltham, MA. Last updated September 2021. Accessed on October 25, 2021.
National Cancer Institute. Grief, Bereavement, and Coping with Loss. National Institute of Health. 2013. Accessed at https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-pdq#_62 on May 20, 2022.
The British Psychological Society. Talking to Children About Illness. 2020. Accessed at https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy. pdf on May 20, 2022.
Kennedy, V.L. & Lloyd-Williams, M. (2009). How children cope when a parent has advanced cancer. Psychooncology, 18, 886-892.
Last Revised: September 15, 2022
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