Starting discussions about death with children can be very difficult, especially when children are quite young. This young mother is likely experiencing immense angst because of her disease and in addition to her own emotions, must also tell her children she is dying.

The best way to help this young mother is to guide her through initial and subsequent discussions with her children by focusing on some key considerations. Suggest that she set the stage for her discussions by limiting distractions. She might also choose a time of day when her children are more alert and attentive.

Suggest that she think about how she will describe her illness to her children in view of their ages. She should use the name of illness, state that she is very sick and briefly describe what is happening to her body. Likely the illness is not contagious, so she needs to assure her children that they will not get sick. She also needs to let them know that they did not cause the illness and that no one can do anything to make her feel better, not even her doctors.

Explanations should be brief, concrete, specific and simple. She should say that she will become sicker, will have less energy and will die from her disease. Using the words “death” and “dying” is important. Doing so will help her children understand that it is all right to use these words to describe what is happening.

Sometimes adults find having a support person with them helpful when talking with their children. This may provide emotional support or assistance in explaining the illness to the children. This mother may need someone who can help answer the children’s questions and who can take over if she finds the discussion too difficult. Encourage her to choose the right person: someone intuitive and well known to the children. She should discuss that she wants to approach the conversation openly and honestly, and that she will signal her support person if she needs help.

Emphasize the importance of informing her friends and family about her approach. Many people avoid talking about illness and death, especially around the person who is dying. If this mother starts the conversation and asks her friends and family to also be open and honest about her situation, this will likely make the experience much easier for her children. It also acknowledges that others will be involved in conversations with the children as time goes by.

This mother will need to consider the developmental level of her children when discussing her illness and death. Three- to six-year-olds have a limited understanding of body functions and the permanency of death. Children at that age also tend to be magical thinkers, have intense imaginations and may believe that their thoughts or actions have caused the illness. Young children are able to absorb and recognize the emotions of those around them, and probably have a sense that their world is changing.

These children are at very different stages in their comprehension, development and ability to concentrate. Three-year-old children are still developing language skills and may need her to explain some words. Three year olds have a very limited attention span, compared with a five year old. This mother likely can anticipate how her children react to news or stressors, and whether she should talk with them together, or spend time with each of them individually.

Three-to-six-year old children will process conversations over time, establishing their own pace for receiving and thinking about information. They will likely ask questions repeatedly and frequently as they try to make sense of a situation they may not understand. They will likely process what is happening through play and art. It would not be unusual for children of this age to speak about their mother dying while playing with other children.

If her children are in school or daycare, alerting the teachers and staff about the illness is also important. This will allow the school to report or address any issues or changes in behaviour that may arise. It will also help teachers and staff be more aware of her children’s interactions and observe how they are coping as her illness progresses.

As she becomes more ill, encourage her to have the children around her so they can be a part of the experience as much as possible. Emphasize that she needs to prepare them for the inevitable changes in her condition and ensure that someone can explain what is happening to her if she is unable to communicate. The children will likely adapt well if they are kept informed and are a part of the process as their mother dies.

Reference

Himelstein BP, Hilden JM, Morstadt Boldt A, Weissman D. Pediatric palliative care. NEJM. 2004;350:1752-1762.