10 things you need to know when talking to children about illness, death and dying

All of us experience grief at some point in our lives. Sadly, for the families that use Chestnut Tree House, children are often confronted with the concepts of death and dying earlier than usual.

We are here to support the whole family, including siblings. Here, family counsellor Erika gives her advice on approaching the subject with children aged five to 11.

Ten things you need to know when talking to children about illness, death and dying

1. Share information with them. They often know something is wrong, and if you don’t include them, they may worry or make incorrect assumptions.
2. Use clear, simple language. Ambiguous phrases for death, such as “gone to sleep” can lead to misunderstandings and fear. Explain that death is final and that a dead person cannot feel or think anymore.
3. Encourage discussion. Use open questions (such as “what do you think?”) to prompt more than a yes/no response. Through open discussion, the child may reveal information that you wouldn’t think to ask.
4. Start by asking them to tell you what they already know and understand. This will tell you how to support them.
5. Be open and honest. If a child asks a question, it generally means they are ready for the answer. Be open and honest, using age-appropriate language
6. Make the child feel comfortable. Get down to their level but minimise direct eye contact. Children feel more relaxed if you sit alongside them or play a simple game while talking.
7. Check they understand. Children may simply repeat information they have heard, so ask them to explain it and allow them time to process what they have heard. Children understand and retain information better if it’s presented in short, frequent burst rather than one long session.
8. Name and label emotions to help children express their feelings. Modelling this as adults demonstrates that it’s okay to have these feelings (“I am feeling sad and angry today because…”).
9. Help the child feel involved. Informing them about what is likely to happen next as appropriate. This provides security and a sense of control.
10. Typically, children “puddle jump” in and out of emotions (for a more detailed explanation of this theory, watch this video). They still need to play. If they seem light-hearted it doesn’t mean they don’t care or understand – it’s normal behaviour and helps protect them psychologically.

It’s often easier to initiate difficult conversations while doing an activity together and avoiding direct eye contact.

Keep things age-appropriate

Until the age of about six, children may not understand that death is permanent.

They may ask repetitive questions and need the same information to be repeated many times. They may seem blank or confused in the moment and show their distress through tears or behaviour later.

Children tend to cope with difficult emotions by moving in and out of them, often quickly and with no obvious triggers. This is known as “puddle-jumping” – they skip in and out of “puddles” of differing emotions. They may be tearful, then angry, then laughing – all in rapid succession. This is a normal defence mechanism: it doesn’t mean they don’t understand or care. It can help to follow their lead and mirror their emotions.

Starting difficult conversations

Children tend to share more in an informal setting, so it can help to sit alongside them, avoiding direct eye contact and having an activity to engage in such as travelling in the car, watching TV or playing a board game. When talking to a child, it is important to try and gauge what they already think or believe as this can help you decide where to start. Try to use clear and simple language, and repeat or summarise your main points. Ask them to repeat the information in their own words as this helps them to process what they have heard and allows you to check for any misunderstandings.

It can be helpful to keep to familiar routines, as they can be comforting and reassuring for a child when everything else feels uncertain and strange. Try to involve children in any decision which directly affect them; knowing what is happening can allay their fears and anxieties and help them feel they have a measure of influence over what is happening in their life.

Externalising anger

If a child is feeling angry, they may not express this verbally but through their behaviour. You can help the externalise this anger by suggesting that they kick and punch items such as a pillow, duvet or beanbag, kick a football against the wall, or stamp on and hit recycling materials with a bat or a stick. Screaming into a pillow or turning up music loud in the home or the car and screaming can also be therapeutic, as can screaming into an open outdoor space. You are aiming to normalise and validate their feelings and demonstrate safe healthy ways to express them.

Aim for emotional honesty

Answer children’s questions as openly and honestly as you can. Some questions may be difficult to answer, and, in these cases, it is okay to say: “I’m not sure about that, can I have a think and come back to you?” Agree a time to answer them and make sure you stick to it.

When they do ask a question, try to avoid making assumptions about what they are asking or why as you may be incorrect.

Explore it first by saying something like “That’s a very good question, can you tell me what you think first to help me answer it better?”

Try to keep the language clear and simple and check they understand the vocabulary you are using, such as “What do you understand about that word?”

The most important thing is that parents are open and honest, including talking frankly about their own emotions. Just by showing that it’s okay to feel sad, you are modelling a healthy response to grief.