Explaining death and dying to children

Filed under: Development/Milestones: Babies

An article in the current issue of CA: A Cancer Journal for Clinicians recently noted what we all thought: the death of a parent or loved one is one of the most stressful events a child can face. An honest word, a smile, and time spent together with a sick mom, dad, or loved one can help kids get through such trying times.

With proper education and preparation, things can be done to mitigate the damage, according to a review of the data on the issue.The article provides an update on current approaches to helping children in three different age groups: ages 3 to 5, 6 to 8, and 9 to 11. In particular, the article stressed including the children in the dying process, as was appropriate for the age. The experts note that children tend to be most anguished in the final days of their parent's or loved one's life, rather than after the actual death. Experts encourage "open communication" with children between the ages of 3 and 5, but stress that this doesn't mean full expression of intense grief in front of the child. One 3-year-old was fearful of going into her father's hospital room because her parents tended to cry together. So, a social worker helped structure the visits and also helped the parents control their emotions so the child could have more pleasurable visits. Kids aged 6 to 8 were more likely to have "anticipatory anxiety" rather than the anticipatory grief more common to adolescents and adults. They sensed something was going to happen and worried that the family would not survive it. One 8-year-old boy with a terminally ill father worried that his grandparents and mother would also die and that "the whole word would end, and nothing would be there."

This age group also benefited from pre-planned hospital visits and described the importance of a final hug, squeeze of the arm and affirmation of love, perhaps even more than a final good-bye. One 7-year-old put herself to sleep for months with the memory of her mother squeezing her hands before she died. After the parent's death, children in this age group tended to swing between regular activity and grief. Kids grieve and approach anticipatory or post-death grieving very intermittently and allowing for that kind of 'I'm going to play with my friends' is really healthy, appropriate and to be expected. Receiving information was also important, especially for kids aged 8 to 11, who have a need for "carefully sequenced" information about their parent's condition. Without adequate information, one 11-year-old boy felt that his father was mad at him. Once the situation was explained to him, he no longer believed this to be the case.The authors concluded with several recommendations for helping children of all ages during a parent's or love one's terminal illness, including planning visits during long hospitalizations; viewing communication as a process with proper "dosing" of information, rather than a one-time event; and allowing children and adolescents to experience their grief intermittently.Hopefully, none of you will need this information in the near future. However, you are likely to remember some of the key points in the article; they could prove invaluable.

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Start by teaching him that it is safe to do so.