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Children can often sense when things are wrong around them. It is important to be as open as possible about what is going on, so that the children may continue to trust those around them. Knowing what is going on can also help them worry less, process their emotions better, and cope better with the changes. While most of the information here focuses on a parent of a child dying, it could also apply to any loved one in the child's life.

Children can often sense when things are wrong around them. It is important to be as open as possible about what is going on, so that the children may continue to trust those around them. Knowing what is going on can also help them worry less, process their emotions better, and cope better with the changes. While most of the information here focuses on a parent of a child dying, it could also apply to any loved one in the child's life .

Children's possible reactions to learning a parent is dying

Children of different ages have different understandings of death and what it might mean to them. It is important to keep this in mind as you support children who are facing the death of their loved one.

• Some children refuse to believe that their parent is seriously ill and demonstrate this (act out) in their behavior.
• Some act out their sadness and anger by refusing to go along with the family rules.
• Sometimes children withdraw and isolate themselves from others in the family and/or their friends.
• They may refuse to listen to an explanation of what’s going on or pretend nothing is wrong.
• Children may regress, meaning that they do things the way they did when they were younger.
• They might have trouble leaving the parent to go to school, have temper tantrums, or change toileting habits that had been under control.

Children who have a parent who is dying from cancer also can feel:

• Anxiety or depression
• Fear
• Anger
• Responsibility for the parent’s illness
• Fear about the future, their own health, and the health of other members of their family
• Abandonment, especially if the parent is away a lot more than usual for treatments and other procedures
• Increased responsibility around the house

When should children be told that a parent is dying?

Children, especially young ones, have trouble understanding that death may happen in the future. But they can understand that the cancer is causing your body to not work well and that one day your body may stop working. Many factors influence when a child needs to be told that a parent probably is going to die.

The first depends on what the child has been told over time about the situation. Hopefully, they’ve been given truthful information from the start about the cancer and how it affects the family. Children need to be told the truth bit by bit over time, depending on how sick the parent is. This way they have a chance to adjust to what they can understand while still going about their everyday lives.

Talking to children about death

You’ll want to have some uninterrupted time and a quiet place. Consider having the other parent, or another trusted adult with you. If you don’t have someone to help you, ask your social worker, nurse, or doctor who might help you explain things to your child.

Talking to children and preparing them for the death is important, but it’s even more crucial if the child has only one parent. The child knows that the parent provides all or most of their care and will probably worry who would do it if they weren’t around.

This is a tough talk to have with your child, and you may have to rehearse before you can do it without getting very emotional yourself. When you’re ready, give yourself some uninterrupted quiet time with your child. You can open the subject by saying that you know that children often worry about who would care for them if a parent couldn’t, or if their parent died. This lets the child know that you won’t be shocked or upset with them if they ask questions. You can see how the child responds to this statement before you explain your back-up plans. Again, if you don’t think you can handle this talk on your own, get help. Don’t feel that you must do everything by yourself.

• Be as honest as you can about what’s going on
• Let them know that it is okay to feel angry, confused, sad, or scared.
• Reassure them that their feelings are normal
• Reassure them you have planned so they will still be cared for
• Encourage them to open up about their feelings and ask questions any time
• Be clear in communicating with them and use words that they can understand
• Reassure them that they will always be loved and taken care of even when you are not there anymore
• Give teenagers space and time if they need it, and remind them that it is okay for them to continue with the usual activities they enjoy.

Start by asking how they think things are going

It helps to get an idea of how your kids think things are going. An open-ended question like “How do you think I’m doing now?” is a good way to start. Often children sense that things are becoming more serious just by the way you’re acting, by the way you look, or by how much or little you’re able to take part in normal family activities. This usually is a gradual process. They may notice relatives or friends are helping more, or family life seems to revolve around trips to the hospital and there’s less time for the family to enjoy their usual activities.

Ask your child if they’ve noticed any changes, and what they think these changes mean. Don’t assume that you know what’s going on in your child’s mind. You must ask.

Use the right words

It’s tempting to avoid them, but it’s important to use the words “die” and “death” rather than “pass on,” “go away,” “go home,” “go to sleep,” or other terms that make death sound nicer. Younger children often don’t understand what these nicer-sounding words really mean and may not fully understand what you’re trying so hard to say.

Since a child’s understanding is based on what they can directly experience, death should be explained in terms such as these.

• Death means that we’ll no longer see the person we love except in our hearts and minds.
• Death means the person will no longer be physically there in our lives.
• They’ll no longer be with us as they were before, but we’ll still have memories of them.
• Be sure to explain that when a person dies, they don’t feel anymore; the heart doesn’t beat anymore; the person doesn’t breathe.
• Since young children don’t understand that death is final, be sure to say that death is not like a trip; you don’t come back from being dead. Also, make it clear that death is not like sleeping.
• Using a simple story book is a good way to help explain this. Talk to your health care team, ask a local librarian, or check the resources section to get recommendations.

Depending on their age and many other factors, some children may not be able to really grasp that a parent is dying, and their first reaction is often one of disbelief. They might also feel angry. Reassure the children that this is normal. Children might also wonder who will take care of them when their parent dies. If you have plans already, be sure to share them with your children so they know what to expect.

Be prepared to repeat this conversation

Young children will probably not understand what death is and what it really means the first time they hear it. You may have to repeat this discussion many times for them to fully understand. If a child doesn’t want to believe what you’ve told them, they may ask the same questions repeatedly, often as if the conversation had never happened. They might do this hoping that the answer will be different the next time, hoping that somehow what they’ve been told isn’t true.

Although this is painful for the adult, it’s a key part of preparing the child. In time, the child will accept the reality. This process is how the child comes to accept that life can and will go on without the parent.

Reassure children they will still be cared for

A lot of parents fail to plan for what will happen to their children if they die. It’s important to make those arrangements and let your children know about them in age-appropriate ways. If a family doesn’t have relatives or friends who are logical choices as caregivers, there are social service agencies that can help find possible caregivers. This is a very painful issue to deal with on top of the cancer, but it’s something that should be done. It’s one way a parent can reassure their children that they will always be cared for – no matter what happens. If the children are older, you might want to get their input on who would become their caregiver.

Parents should share the plan with their children in an open and honest way. If a single-parent household, the children should be told the back-up plan in case the parent dies. If a two-parent household, the children should be told what changes to expect. Planning and talking to them about it lets them know how important they are to you. They should also be assured that they will always be cared for, if a parent dies. They should also be reassured that it is OK to ask questions and express their feelings.

Help children open up about their feelings

Depending on their age and personality, children often try to protect their parents from knowing their true feelings. It is ok to cry in front of your children because it can give them permission to cry. Give a name to it, explain that you are letting your feelings out and that it is healthy to do this.  Asking your children if they are angry and reassuring them that feeling this is way is normal could open the door to a helpful and healing discussion. Underneath the anger or emotion being displayed, there’s often a deep sadness which needs to be recognized and shared to move on. While these feelings can be painful to express and to listen to, getting them out into the open can take away some of their power and help people feel closer.

Teenagers might have a harder time expressing their feelings. They also should be encouraged to talk to their parents, guardians, or a trusted adult.

Keep the child informed as the loved one nears death

No matter the age of the child, preparing a child for the death of someone they know can be hard, especially when it is a parent. Given the fact that cancer can last many months or years, children will have been around for much of their parent’s experience. Hopefully, the child will have been kept well informed all along and will understand when their parent is nearing death. Still, this is usually a hard time for many families because different people in the family will have different coping styles and emotions.

As a parent becomes sicker, there’s a natural tendency to protect the child from the signs of advanced disease. Parents don’t want their child to see them vomiting, in pain, or not able to eat, for example. They might not want the kids to realize that they are too sick to pay much attention to them. But it’s impossible to protect them from everything, and it is better to keep them as informed as possible. Shielding children from these realities may slow down their adjustment to the situation.

Young children do not need to be there when a parent dies, but it’s important for them to stay in their home where they feel the most secure, if it is possible. It may be tempting to have a child stay with another relative during this time, but that can create other problems for the child. Children who have had this experience often resent it. Some of those children said, after they were older, that it made them feel excluded from their family. They felt that their relationship with their parent was not considered important. Some said that it seemed like the family assumed that they could not cope with such a scary and terrible thing as death, so they were sent away.

If a parent is in the hospital, children should be allowed as much contact with them as possible, if it is safe to do so. The same applies to a parent who is dying at home.

Children should also be encouraged to keep taking part in whatever activities they enjoy normally. As noted before, children and teens cannot and should not be expected to keep a vigil at their parent’s bedside.

If the child is older, adults should follow the child’s cues about how much time they want to spend with a dying parent. If a parent is at home, give them an activity they can take part in regularly with their sick parent, such as playing a favorite game that the parent can easily manage (such as a board game), or helping with homework if possible. Some children enjoy reading to their parent or cuddling and watching TV together. These brief periods of time will be sweet memories for the child in the future. Those feelings of closeness will be important when the parent is no longer physically there to comfort the child.

Teens may want to help with some of the sick parent’s care. Their comfort level in doing so will depend on their relationship with the parent, school demands, and their social needs. Since teens are in a phase of their lives when they are naturally separating from their parents, finding the right balance between time spent with a sick parent and time spent on other aspects of their lives can seem challenging.

Teens can help around the house, and it’s natural to depend on them to pitch in during a crisis. In fact, teenagers get satisfaction from being trusted enough to help when the family is in upheaval. It’s important to ensure the teen is still able to have time with friends, take part in school activities, and have parts of their lives separate from the family. It’s good to check in every now and then to see if the balance between home and the rest of their lives is being maintained.

Older children and teens might want to be there when a parent is dying. If the parent is OK with that, this should be supported. Some conflicting feelings are normal since there’s fear and uncertainty involved. It might be useful to ask someone from the medical team to describe what’s most likely going to happen.

Spiritual and religious beliefs may help comfort children

A family’s cultural, spiritual, or religious beliefs are often very important in how they understand death and cope with it. For example, if people believe in life after death, death may be seen as a new beginning. Sharing your beliefs with your children can help them process the news and death better. Your clergy person may be able to help you and your child through these discussions.

Consider involving people at your child’s school

It’s important that parents speak to the child’s teacher and/or school counselor about the illness and death of the parent. The school staff can then watch your child and let you know if they notice any problems. If a child is troubled, it will often show up in the school setting, and a teacher who isn’t aware of what’s going on in the child’s life isn’t prepared to help them to cope with it.

Sometimes older children don’t want anyone outside of the family to know what’s going on. They worry about what their peers will think. In general, children don’t like being different from their friends, and those concerns need to be heard. It’s important for you to try to get the child to talk about what they’re feeling. But try to respect their desire for privacy, too.