How to talk to children about death

No matter how difficult the treatment of a child with cancer is, it is a chance to save him or her. This is the path to recovery, after which life goes on. Hope for this gives strength to endure everything.

Only when even the smallest chances are exhausted, a decision is made to stop treatment and switch to palliative care so that the child can live his or her life painlessly. It is difficult to talk about this, but it is worthwhile to make parents feel better.

In this blog, we will tell you how to behave during this period, talk to your child about death, and what words and actions to avoid.

The decision to suspend treatment is made by the doctor, and this is one of the most dramatic moments in his practice, as he recognizes that in this case medicine is powerless.

It is difficult to inform parents about this. And, as a rule, this does not happen without preparation: observing the tests, the specialist reports disappointing dynamics of the disease during the treatment process, thus preparing the family for the worst.

The American psychiatrist Elizabeth Kubler-Ross, author of the 5 Stages of Grief theory*, believed that gradually informing parents about what is happening to their child is necessary to help them go through these stages to the realization that there is no hope. Otherwise, they will not be able to live with their child in love and peace for the remaining time.

* The founder of the concept of psychological assistance to dying patients and those who are close to them during this period. How to help people pass away without fear and suffering has become her life's work. She is the author of the bestselling book On Death and Dying.

Kübler-Ross described 5 emotional states that a person goes through when he or she learns of his or her own or a loved one's terminal diagnosis:

1. Objection: "No, it can't be true"
2. Anger: "Why me? Why? It's not fair!"
3. Bargaining: "There must be a way to save myself or at least improve my condition! I'll think of something, I'll behave properly and do whatever it takes!"
4. Depression: "There is no way out, it doesn't matter"
5. Acceptance: "Well, we have to live with it somehow and prepare for the last journey."

Despite the terrible verdict, the child lives on, and the parents need to take care of him or her

For parents, it is impossible to accept the fact that their child is dying. Their grief is endless. That is why they need someone who will listen to everything that is pouring out of their souls: pain, despair, anger at doctors, at their own powerlessness and fear. Sometimes loved ones are not able to support them in such a period - they are in despair. Therefore, it is better to have professional psychological help. After all, despite the terrible verdict, the child lives on and parents need to take care of him or her.

What and how to tell parents about death. 5 stages you should know

• First. Find out what the child knows about their treatment, as well as who they are most emotionally attached to, who they feel most at ease with, and who they would like to stay with (not necessarily their parents). In the end, a decision is made whether to leave the child in the hospital or take him or her home.
• At the same time, you should talk to everyone who will be involved in this process.
• Second. Before you talk to children, you should find out what they would like to know. Only then can you determine what to say to a child and whether to say anything at all, because it may turn out that they do not want to know anything.
• Third. Observe the child's emotional reactions, which may be acute if he or she learns that he or she is dying. Whatever these reactions may be, they should not be suppressed. On the contrary, encourage such a surge of emotions - let them come out.
• Fourth. Finding out what forms of support the child needs and how to provide them to improve their quality of life. It is not only about daily needs and professional care, but also about wishes that can be realized.
• Fifth. To be there for the child. To support a child whose life is coming to an end to the last second. And it is equally important to accept help from others.

What to tell children about death and when depends on their age

Up to 10 years old

Children under 10 have magical thinking. This means that they perceive death through the death of others, such as a pet. Children do not yet have a fear of death, although they know that it can be caused by illness or an accident. And yet, when children talk about death, they imagine it as in the fairy tales they read. "It's like just falling asleep and never seeing mom again," is how they think. It's the pain that makes them much more afraid.

During this period, it is not just important for them to be close to their families, it is a need, regardless of their condition. Even when a child is very weak, he or she may be anxious from time to time, screaming without waking up. But when the mother touches him, hugs him, whispers something, the child calms down.

When a child is still active, he or she has a desire to watch cartoons, draw, play, communicate with peers - all this should be allowed, creating a familiar home atmosphere around him or her. The more routine it is, the calmer the child will feel.

Seriously ill children should be given time and opportunity to feel themselves, to hear their own desires and thoughts

The seriously ill child is under the close attention of the family. The mother does not let him go for a second. But you need to understand that children also need time and the opportunity to feel themselves, to hear their own desires and thoughts. And this can only happen when they are alone with themselves.

In such families, healthy children - the siblings of a sick child - are often neglected. And this should not be allowed, because they are also worried and need communication. It is important for parents not only to talk to their children about what is happening, but also to add them to the close circle of support for the sick child so that they feel needed and important.

Children should not be separated from others, depriving the sick child of contact with the people they want to share their lives with.

11 -18 years old

This is already a fairly adult age. Children's logical thinking works well - they realize the severity of their illness, they understand that they can die from it. And even if they do not know that they are dying, they definitely feel it. This means that they can experience all 5 stages of grief mentioned above, with mood swings and depression. And it is worth giving them the opportunity to go through them, sharing these moments with them if possible.

Sometimes teenagers ask directly: "Am I going to die?". A straightforward answer is not appropriate here. Before discussing death with your child, you should find out why they are asking and what they would like to know about it. Surely he or she will have his or her own idea of death and what happens to it. By communicating with the child through questions, you can gradually talk him or her through the answer to the main question to the extent that it is appropriate for him or her. To understand him, you may need to clarify whether you have answered the question.

The child chooses who to stay with during this period.

A conversation during which a child opens up can also happen with a person who is not as close as mom and dad. It is difficult for parents to restrain themselves in such a situation. This means that the child's feelings, including fear, cause him additional pain. In the end, he or she withdraws into himself or herself, refusing to communicate at all.

The child chooses who he or she wants to stay with during this period. It is up to them. Parents have to accept this, no matter how painful or bitter it is. And if a son or daughter chooses a psychologist, doctor, distant relative, or a colleague of the father instead, it should be so.

The only condition is that guardianship is a team effort, and therefore all actions must be coordinated. Each person in the support group must remember in advance how and what to say.

What actions are unacceptable:

• > Avoiding eye contact is a signal that you are pushing your child away;
• > Forbid him to show his emotions, even if it is just a desire to cheer him up: "Don't worry!", "Don't cry, don't be upset". This way the child realizes that you are disturbed by his or her feelings;
• > Use phrases such as "We will all die", "We will all be there";
• > Artificially smiling, pretending that everything is fine. Smiling and joking is allowed if it is sincere;
• > Asking questions "just to keep the conversation going." For example, "Are you hungry?" Impatience with silence should not be a problem. Instead, you can ask: "Can we talk about something?"
• > When a child feels almost nothing anymore, you should not talk about feelings, but you can share them with him or her: "It's hard for me now, I don't know how to support you. Tell me how I can do it."

How to behave when children talk about death

Being sincere, frank, and natural is the only way to inspire trust.

It happens that a child, realizing that he or she is dying, begins to suffer because of the thought that his or her life is wasted. Having noticed this mood in time, parents should often recall happy moments that are important to the child in conversation. At the same time, emphasize that it was his or her participation that made these events so vivid and valuable. By listening to the child's opinion, he or she realizes that he or she is important to his or her family and that it will always be so.

Sometimes a touch or a look is enough to say, "I'm with you."

Sometimes a child does not have the energy to talk. Then you can just be silent together.

To understand what she really wants, you need to be in contact with her. It's not so much about talking and caring as it is about listening, hearing, and observing. Sometimes one touch or look is enough to say, "I am with you."

Anastasia Leukhina has a wonderful book called "Not a Scary Book at All. About life, death and everything in between". It describes 10 main theses that are important for those who are dying and those who are close to them to know. Here they are:

1. 1. 1. You are not alone;
2. 2. Time is a resource. How and what you spend it on is up to you;
3. 3. The final decision on what to do and what not to do is up to the patient;
4. 4. Fear and silence are our greatest enemies;
5. 5. Honesty and openness, even in the most difficult conversations, are our friends;
6. 6. The house and walls help. It's familiar, not so scary, and not as difficult to arrange as it seems at first;
7. 7. Pain is torment. There are painkillers. It makes life easier, and you have the right to it;
8. 8. You can only care about someone if you care about yourself;
9. 9. Children and adults have the right to know what is happening to their loved ones. They have the right to support and understanding;
10. 10. Where there is love, it's not so scary.Psychological support hotline fromPledges» the number 0 800 4000 23 is available:
    • free
    • throughout the territory of Ukraine
    • from all mobile operators
    • for calls from abroad +38 050 493 03 07
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