Understanding Child Development — and How to Talk About Death

Very young children do not understand the permanence of death or cause and effect. They may ask for weeks or months whether a dead parent will return.

They're especially concerned about separation from a primary caregiver.

Anticipate that the child needs reassurance he or she will be cared for.

Children this age need consistent substitute caregivers.

Use play and art to explain what's going on.

Children 6 to 8 years old understand a dead parent will not come back but may worry that their thoughts or words caused the illness or death. Explain changes in a parent's behavior or function that a child sees. Tell the child it's all right to ask questions and express strong emotions.

Those 9 to 11 need detailed information about the illness and treatment. Name the disease and give detailed information about causes, symptoms, treatments, and side effects. Try to be hopeful, but not unrealistic.

Kids this age avoid strong emotions and are able to compartmentalize their feelings and use distraction.

The child may want to help with a parent's care, but don't leave them in charge.

Help the child remain active in extracurricular activities.

Young teens 12 to 14 are ambivalent about dependence and independence. They may withdraw emotionally and may appear callous toward the sick parent's needs, especially if they interfere with time with friends.

Those 15 to 17 respond more similarly to adults but the duration of their grief is shorter. They can feel easily overwhelmed by the surviving parent's emotional dependence and grief.

For adolescents of any age, don't minimize the gravity of the situation. If the prognosis is not good, don't say, "She will be fine" or "Your mother will get through this. She's a fighter."

At diagnosis, you can say the chances of responding to current medicines are good or better than they were a few years ago, if that's true.

If the initial treatments don't work, you can say the doctors are trying experimental treatments that may or may not help. You can say you hope that the treatments will slow down or reduce the cancer. Acknowledge that you understand it's very difficult to live with not knowing what will happen.

Let them know when death is approaching so they have time to plan and make better decisions.

When death is near, say: "It is time to say goodbye" to Mom or Dad.