Talking to children about death

Living with a diagnosis of terminal cancer can be daunting and can lead to a sense of hopelessness and uncertainty. After coming to terms with the diagnosis, it is important for adults to communicate with children and young people about what is happening, what to expect and how to best take advantage of time left together.

On this page:
> Modelling grief
> Being open and honest
> Finding the right words
> Balancing hope with reality
> Helping children grieve
> Support organisations

Modelling grief

Adults may wish to protect children from the truth or from observing adults who are sad and crying. However, children often sense when something is happening and hiding the truth can increase their anxiety and distress.
Children can learn how to process their own grief by watching adults who are also feeling sad and grieving.

Being open and honest

Open and honest explanations about living with cancer, cancer treatment, dying and death help children cope better.
With many advanced cancers, the outcome (prognosis) is fairly clear and people are given some indication of how much time they may have left to live. However, it is not unusual for people with advanced cancers to survive beyond a few months, sometimes for many years.
If death is likely in a short time, it is important to be open and truthful about death. Avoid remarks such as ‘death will be peaceful’ as this may not be true.
Adults can find talking to children about themselves or their partner very challenging and can get help and guidance from social workers or health professionals within cancer centers or palliative care services.
Open conversations about death can provide families with an opportunity to show care for each other and resolve any issues or problems. Older children in particular may benefit from an opportunity to discuss old arguments and make amends.

Finding the right words

Explaining cancer to children can be one of the most difficult things a parent can experience. Use a normal tone of voice and give short and simple explanations and responses that the child will understand. If you do not have the answers to their questions, tell them you will find out and get back to them.
Explain that it is ok if they wish to be involved in their parent’s care. Discuss changes in family roles and how they can help but do not overload them with responsibilities and tasks.
Keep children up to date with information and repeat information to ensure they understand. Prepare them by explaining how the illness might affect the person in the days ahead and what treatment they may have. For example, their skin colour, lips and nails may be different to usual, and they may need a lot of medicine.
Encourage children to ask questions and share their feelings. Tell them it is okay to feel sad, upset, or angry and that you’ll always love them.
Use straightforward words and terms children can understand such as “death” and “dying” instead of “passed away”, “went to sleep” or “resting” that can be confusing.

Balancing hope with reality

Having a diagnosis of advanced cancer does not mean giving up hope. Some people with cancer live for years with ongoing treatment and symptom control.
Many families hope they will have good days and find ways to make the most of their time together. For example, if your loved one is feeling ok, plan a special family outing to the beach, a sporting event or theatre performance.
Accept offers of help from family and friends that will allow you to have more time and energy with your family.
Spend meaningful time together whether at home or hospital. For example, switch off mobile phones during mealtimes to avoid distractions during your time together.
As the illness progresses, you can still share hope with children while acknowledging the reality of the situation and help prepare them for loss.

Additional reading:
> Talking to Children about Advanced Cancer and End of Life: The Importance of Honesty and Compassion provides useful information on common reactions, frequently asked questions and finding the right words and explanations for children, teenagers and young people.
> Living with Advanced Cancer, Cancer Council provides a valuable insight into ways to speak with children about advanced cancer and the impact it may have on their lives.

Helping children grieve

When a loved one dies, children need a supportive and safe environment in which to experience their grief. Children who experience a major loss may grieve differently than adults.

Make sure children know that they do not need to hide their emotions and that they have your permission to mourn.
Accept and affirm their feelings. Do not try to correct how they feel or suggest how they ‘should’ feel. Children who are unable to express their feelings and have limited understanding may revert to earlier behaviours such as bed-wetting, may ask insensitive questions about the deceased, may invent stories about dying or may pretend death has not occurred.
Coping with children’s grief can be stressful for a bereaved parent. Take extra time to talk honestly with them about death and the person who has died. Help them work through their feelings and remember that they are looking to adults to model suitable behavior.
Many children worry that they will forget the person they loved. To help, give them a photo or personal item belonging to their loved one that they can keep for themselves.

Additional reading:
> Bereavement and Grief – Mental Health America
> Helping Children Grieve for a Loved One -Catherine Wilson

Support organisations

There are also a number of organisations and valuable resources which specifically focus on supporting children and teenagers faced with a cancer diagnosis in the family. Beyond the counselling support offered by Pancare you may like to access the following resources.

CanTeen

CanTeen Australia provide a range of valuable information and support, specifically focusing on the experience of children when a loved one has cancer
https://www.canteen.org.au/

Headspace

For older children, headspace provide holistic and tailored mental health support to young people aged 12 – 25 years
https://headspace.org.au/

Cancer Council

Cancer Council’s ‘Talking to Kids about Cancer’ also provides a comprehensive guide which may be useful when talking to children about a cancer diagnosis and advanced stage cancer

Seek immediate help when:

You are unable to perform the daily normal activities
You have persistent grief

Losing a loved one can change a person’s life. Grief, when experienced fully with the proper understanding, good handling and availing of resources when needed, will become bearable with time.

Learn more:
> Grief, bereavement, mourning: How to cope with the death of a loved one

Speak to our Specialist Support Team for Emotional Support.

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