Talking to Children and Teens about Illness & Death-Kansas City Hospice

Talking to children and teens about illness and death can be a daunting prospect for many adults. With a little preparation, you may find yourself more comfortable with this emotional conversation.

Talking to children and teens about illness and death

A Child’s Understanding

Helping a child deal with major life changes can be difficult. Children may not fully understand, but as family members, each child should be included, at their level, in talks and activities during the illness or death of a loved one.

Children’s emotional and intellectual development affects their understanding. Most children understand illness at some level and it’s important for them to know what is happening.

How to help:

Provide honest, age-appropriate information
Listen to them
Explain how you feel
Tell them it’s normal to be sad
Explain that adults may be upset and crying
Perhaps talk about family beliefs on afterlife

Each age group requires a different approach to illness or loss. (See Developmental Stages) Remember, each child is unique. One may seem unfazed by the news, while another will show intense emotions. Whatever the reaction, children need to understand the situation if they are to successfully grieve and cope with the loss. You can help by beginning the conversation.

Beginning the Conversation

Depending on attention span, the talk may be brief, but meaningful. So, find a time without too many distractions.
Start with, “I want to share something important.” Be truthful and honest. Avoiding the difficult parts only causes confusion and makes the situation more of a mystery.

Keep in mind that younger children can’t stay focused for long. After you’ve worked up the courage to talk, your preschooler may ask “what’s for dinner” a minute later. Older children may not have much to say either. Give them time to come back later with questions or thoughts.

It may be helpful to ask young people what they think will happen. You can explain the illness, its possible outcome and that someone may die. Give enough information for them to understand it’s serious.

Ask if there is anything they want to say to or do for their loved one. Children often have incredible ideas that can make this time very special.

Addressing Fears

Young children who have experienced the illness or death of a loved one often worry they will also get sick or that their caregiver will. Children of all ages also worry about what will happen to them during this time. Children need the security of knowing an adult will care for them.

Assure them you plan to be there and that they won’t be left alone
Be clear and direct when speaking, so younger children won’t assume their actions or thoughts caused illness or death
Let them visit and help you provide care
Let them know how they can be most helpful, like spending time with their loved one, sending notes or homemade pictures, and other expressions of love

Including young people can help prevent fears in the future. Understanding grows from seeing, doing and taking part in the care.

For a Sudden Illness or Death

Because there’s no time to prepare or say goodbye, young people may have more difficulty with a sudden illness. Their questions and feelings will begin when you give them the news.

Use basic information – it’s not necessary to include every detail
Let them know their feelings are okay and normal
Include them in visitation and funeral if they’re comfortable
Reassure them they will be cared for
Let them know that any questions or concerns they have are important to adults around them
If there was no chance to tell the person who died how they felt about them, suggest writing a letter to leave in the casket or on the grave

It’s helpful for everyone to express thoughts and feelings, and it’s not too late to do that during or after the funeral.

When There are Questions

Most young people have questions.

Answer only what they’re asking
Don’t criticize questions, no matter how simple or unusual they may seem
Be sure children know they aren’t at fault
Listen closely and make sure there’s an adult available to answer future questions at any time
Answer as best you can when asked “why?” An “I don’t know” might be the best and most honest response
Perhaps explain religious beliefs, including your clergy if helpful

This might be the time to teach a child what it means to physically die. Explain that the heart stops, the person stops breathing and they can no longer talk or feel. Don’t describe death as being like sleep. This may cause children to develop a fear of sleeping.

The concept of illness or death is often difficult for youth to grasp. The lifelong impact can be an issue addressed at every developmental stage. How quickly healing occurs is personal. However, youth have the ability to bounce back and often find comfort in knowing the truth. Providing tools to cope allows them to move forward as vital members of a recovering family. Take time to equip yourself so the emotional road ahead may be as smooth as possible for everyone involved.

Preparing for Memorial Services

Deciding whether young people will attend a memorial service or funeral depends on age, the family and the young person’s desires.

Give detailed explanations of what happens before and during a service
Be sensitive to reactions in discussing the funeral – there may be fear, even panic in anticipating the event
Some families allow youth to decide whether to attend (if they don’t attend, plan carefully who’ll be with them and bring them back to the family circle afterwards)
Talk about what will happen at the funeral, what the funeral home will look like and how people will behave
Ask if there are any questions and answer those questions calmly and accurately
Before the funeral or visitation, arrange for an adult — someone who is not emotionally involved with the death — to be available to take charge of children if they decide not to attend at the last minute.
They may have more questions or need to take a break – some children cannot last through an entire visitation or funeral

There are many ways to include the whole family in planning the funeral and making it meaningful.

Memory Table – gather items the person loved or with sentimental value. Bring these to the funeral home to place on a memory table.
Collage – use photos, magazine pictures or other items to represent their life.
Letter, Memories in the Casket – place notes, letters and sentimental items in the casket. If children place a toy, explain it cannot be returned.
Sensory Memories – what do you see, hear, smell or taste when you think of them? Example: Uncle Joe always had cinnamon candy, so let children pass out his favorite candy.
Music – be creative and pick what is meaningful to your family. Let young people help you decide. Some may wish to sing or play music.
Written Memories – have children draw a special border design and have it photocopied. Then let them hand it out at the funeral for people to write messages to the deceased to be given to family or placed in the casket.
List of Favorite Things – ask young people to list favorite things about the person who died or write a poem, letter, note or memory to read at the service or have an adult read.
Memorial Activities at Graveside
Decorating – flowers, objects, notes and messages
Remembering – reading, stories or a family circle
Later Visits – place stones, change decorations
Special Day Visits – birthdays, anniversaries, anniversary of death
Letting Go Activities
Balloons — release balloons, maybe with messages
Bubbles — use to blow away difficult feelings and symbolize messages of love
Fire — light and blow out candles, burn messages to let go of difficult feelings
Incense — scent may symbolize messages or feeling

Developmental Stages

Three to five years old

Don’t understand “forever” – death is seen as temporary or reversible.
Separation caused by illness is very frightening.
Need reassurance their emotions are normal.
“Magical thinking” – may believe thoughts or actions are connected to illness or death.

Ages six to nine

Begin to understand that death is final, but think it happens only to other people.
Very curious about illness and want details about physical changes that occur.
Think illness is a scary creature or person who takes people away.
Might fear death is contagious.
May believe their thoughts cause events.
Worry harm might come to their caregivers – what will happen if caregivers become sick.

Ages nine to 12

Many have experienced death of a relative or loss of a pet.
Know death is final and comes to all plants and animals.
May be extremely interested in the physical process of dying, but still see death as distant from themselves.
Worry about the effects the loss will have on their immediate future.
May fear that the loss will make them different from their friends and school peers.

Teens

Forging their own identities – most do so by pushing their parents away and that is normal.
Death of parent can cause confusion and guilt.
Death is fascinating, frightening and particularly threatening for adolescents.
Don’t like anything that makes them feel different from their peers.
Loss may make teens feel more childlike and dependent, but may feel required to step into adult roles.

Talking to Children and Teens about Illness and Death

A Child’s Understanding

Beginning the Conversation

Addressing Fears

For a Sudden Illness or Death

When There are Questions

Preparing for Memorial Services

Developmental Stages

Three to five years old

Ages six to nine

Ages nine to 12

Teens

Recommended Reading

General:

For teenagers:

Books for helpers:

Grief & Bereavement Programs

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