Children age 3 to 5

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 working with children in this age group:

  • Give very simple explanations of what’s happening and repeat them often.
  • Check on the child’s understanding of what’s happening. Remember that the child may be able to say back to you what they heard the first time or two, but this doesn’t mean they understand it.
  • The child will probably show more fear and anxiety when away from the main caregiver. The child will need a consistent substitute caregiver when the main one can’t be there, and will need to be assured that they will always be cared for.
  • Get your relatives, nanny, or day care providers to help maintain the child’s routine and provide daily care. Be sure the caregivers know about the family situation.
  • Have a parent or trusted adult who is a regular part of the child’s life spend time with the child every day.
  • Offer choices when possible.
  • Do not tolerate biting, hitting, kicking, or other aggressive behavior. Teach the child how to express feelings in healthy ways.
  • Teach acceptable expressions of angry feelings such as talking, drawing, or pounding a pillow (things that don’t hurt the child or other people).
  • Encourage doll play and other play to rehearse or repeat worrisome or painful experiences, or ask the child to draw pictures about mommy or daddy. Use play and artwork to help the child understand what’s happening in the family,
  • Create opportunities for physical activity.
  • Plan short visits with fun activities that include the parent. Be sure that the child understands which of the usual things they cannot do. Laugh together when possible
  • When the parent must be away for care (in the hospital or inpatient hospice), caregivers can use video, phone, and other means so the child can see and hear their parent in real time. Arrange in-person visits when possible. Explain any differences in how the parent looks or sounds ahead of time
  • Do not try to persuade the child using reason or logic.
  • Use dead animals or insects to show the child that there’s no movement, and that living creatures don’t come back after death. You can also point out that the animal doesn’t feel pain after death. Another way is to compare the body to a seashell. You can help the child understand that at one time there was a living animal in the shell, but now only the shell (body) is left with no life in it.
  • Give simple explanations for crying and sadness. For example, “I just feel a little sad and a little tired today. It makes me feel better to cry and get it all out of my system. Now I feel better.”

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.

Last Revised: March 20, 2015

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