How Do You Help Children Cope With a Parent’s Terminal Illness and Possible Death?

When a parent is diagnosed with a terminal illness, it is best to talk with your children soon afterward. Doing so may help children cope more effectively with the end-of-life process, particularly if their parent has been ill for a long time. 

Medical experts recommend open and honest dialogue about what will happen, so parents can readily address their child’s fears. Although the discussion should be age-appropriate, language ought to remain clear and concise. Creating a safe space in familiar surroundings may also help a child better cope with learning about their parent’s illness.

Here are a few recommendations for initiating the conversation:

• Be specific about your or your loved one’s illness and what the decline may look like. Depending on the child’s age, you may reference a specific diagnosis or you may simply say something like “Dad is very sick.”
  
  
• Ask questions to determine how much the child already knows or suspects. Something open-ended like “Have you noticed that Daddy has been sleeping a lot lately?” gives the child a chance to talk about what they’ve noticed and their fears about what it may mean.
  
  
• Reassure the child that they will not get sick too and that you or the other parent will be there for them.
  
  
• Explain to the child that the illness is not their fault, as children sometimes tend to blame themselves for catastrophic events.
  
  
• Try to remain composed, but don’t hide your feelings or pretend everything is fine.

Maintaining the child’s normal routine and preserving family time as much as possible may also help them cope more effectively.

Talking to children about death

According to a paper published in the journal CA: A Cancer Journal for Clinicians, how well a child manages bereavement may depend upon how skillfully the surviving parent guides them through their loved one’s terminal illness, including expectations around the death. While little research exists on how to best nurture a child through such a difficult time, experts at Children’s Hospital of Philadelphia offer some communication strategies for explaining death to a child. 

Below are a few key points to assist parents through these difficult conversations.

• Use accurate terms to describe what happened, e.g. the person died or they are dead. Depending on the age of the child, you may need to clarify this in very simple terms, such as “Their body no longer works and they are not going to be here with us anymore.” Avoid vague euphemisms such as, “passed away” or “gone to sleep,” which can confuse and frighten a young child.
  
  
• If the child is asking questions about the death, ask clarifying questions before providing an answer: “What makes you curious about that?” or “What made you think about that?” Listening to their responses may help you better understand the child’s fears and be better prepared to reassure them. 
  
  
• If you don’t know an answer to a question a child asks, be honest and tell them you don’t know, but you will try to find out. 
  
  
• Children learn best by watching and listening to adults, so model honest communication and express your feelings openly. Let the child know that you are sad and miss the loved one who died very much. Talk about good times and memories and encourage the child to share their thoughts. Displays of intense emotion should be saved for private time, but crying in front of your children shows them that they can express their feelings too. 
  
  
• Don’t overload a child with information. Answer their questions honestly and thoroughly, then give them time to just  “be kids.” They will let you know when they are ready to talk some more. 
  
  
• Keep in mind that a child’s understanding of death is influenced by their age. Here is a brief overview of children’s perception of death at various developmental stages: 

Toddlers

Toddlers are not able to comprehend death and do not grieve in the same way as adults. However, they can sense the emotions of those around them and may feel uneasy, confused, or scared if others are sad and upset. Honesty is the best policy when discussing death with a toddler. For instance, you could say something like “Grandma has died, and we won’t be able to see her again.” Let your toddler know that it is normal to feel sad when someone you love dies. Even though they may not fully understand what has happened, they should be encouraged to express their emotions and share their concerns. 

Preschoolers

Children aged 4 to 6 don’t fully grasp the concept of death, perceiving it as temporary and reversible. They are also prone to magical thinking and may blame themselves for the loved one’s death. For example, if they felt angry at mom or dad and they are suddenly gone, they may believe their anger caused the parent to disappear. Open and honest communication with your child is crucial at this time. It’s important to explain that death is permanent, and no one is to blame. Don’t shy away from difficult questions such as, “Will I die?” or “Will you die?” Offer meaningful, yet reassuring, explanations such as, “Everyone dies someday. But I plan on us staying together for a long, long time”.

School age children

Between ages 6 and 12, children develop an understanding of death through personal experiences, like seeing a dead insect or bird. In this way, they slowly learn that death means the absence of life. With that said, younger children may still need help grasping death’s permanence. You may need to explain in very concrete terms that the person they love is no longer alive and  can no longer eat, drink or move. Encouraging the child to attend the funeral or visitation can reinforce that death is irreversible and a natural part of the cycle of life. 

Teenagers

Teens generally comprehend the notion of death (although they often presume they are invulnerable), recognizing that it is an irreversible loss. They grieve and mourn as deeply as adults, but because they strive for emotional independence, they may express themselves more openly with peers than with you. In some cases, especially if the teen had a difficult relationship with the parent who died, they may act out in disturbing and even self-destructive ways. This is normal, but it’s important to set boundaries as to what is acceptable and what is not. Let the child know you are there for them, but at the same time emphasize that any behavior that puts them in harm’s way is not an acceptable outlet for their grief. 

Seek out support

Helping children navigate the complex landscape of the terminal illness and eventual death of a parent is an almost insurmountable task, especially if you are also caring for your ailing spouse. It’s important to recognize that you can’t do it all alone, and to reach out to the community and health care resources for help. If your loved one is in hospice, the hospice provider may be able to refer you to an agency or organization that can provide respite assistance or emotional support. School counselors may also play an important role in helping a child who is struggling with their emotions both in and out of the classroom. You might also consider taking your child to a mental health professional who can provide a listening ear and help the child practice ways to cope with what is happening. 

Age-appropriate books may also be a wonderful way to help your children express their fears and feel less alone. See our Healing Library to find books for adults and children who are struggling to make sense of serious illness, loss and grief. 

Sources

“Current Approaches to Helping Children Cope with a Parent’s Terminal Illness”. American Cancer Society Journal. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.56.4.197

“Explaining Death to a Child”. Children’s Hospital of Philadelphia. https://www.chop.edu/health-resources/explaining-death-child 

“Telling a child someone is dying”. Marie Curie. https://www.mariecurie.org.uk/help/support/diagnosed/talking-children/children