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Bad things sometimes happen to good children.

Over the years I have been asked, sadly too many times, how to deal with the impending death of a parent. An example: “My daughter-in-law has cancer and is very ill. There are three children 13, 9, and 8 who know their mother is sick and in the hospital a lot. But their parents have not talked about her death. Should they?”

This is a subject I wish nobody ever had to deal with but the reality of life is that death follows, sometimes much too early.

How do you tell three young children that their mother will soon die? Three guiding principles: Tell children the TRUTH. Pay careful attention to TIMING. And TALK a lot, not only about what is going to happen but how you feel so the children will learn it’s OK to express their feelings.

The age/developmental status of the child and the condition of the parent are all pertinent insofar as truth and timing are concerned.

Children under 2 have no cognitive understanding of death although they perceive and respond to a parent’s absence, illness, or negative emotional state. Preschool children can fool you; they may talk about death but they think of it as temporary and reversible. They also are egocentric and likely to think they caused the illness or death and worry about death’s “contagion” (Will I catch it and die too?)

School-age children 6 to 10 view death as permanent and real but are unable to comprehend their own mortality. Preadolescents, 11 to 13, begin to view death as real, final, and universal and are fascinated by details of the illness and funeral. Adolescents, 14 to 18, begin to grope abstractly with the existential meaning of death yet they may deny their own mortality through risk-taking.

To tell children about the impending death of a parent you need developmentally-appropriate words of truth. It’s important that the parents demonstrate sadness and encourage the children to express their sadness. It’s also important to tell the children what will happen (hospital, hair loss, funeral) and to remind the children over and over again that someone will always take care of them.

Cancer is particularly difficult because it means hospitalizations and prolonged therapies that make the cancer patient too sick to function at all, let alone as a parent.

In order to adapt to cancer in a parent children need three things. 1) Someone to meet the child’s ongoing physical and emotional needs. 2) Help to understand on their own level what is happening at every step of the way. 3) Continual reassurance that they will be cared for no matter what happens to the parent.

Most children when told their parent has cancer will ask, “Is Mommy going to die?” The mother might answer, “Mommy has to go to the hospital for medicine. I will be very sick but the doctors think they can make me better.” If they ask will the cancer come back, again truth is the guiding principle. “Right now it looks as though the cancer is gone. If it comes back I hope it won’t be for a very long time but if it comes back sooner I will be treated again.”

Don’t wait for the parent to become too sick to say goodbye. Talk to the children at a time when death is or could rapidly become imminent. I suggest the children be told that their mother is not doing well, the medicine is not working, and it’s time to say goodbye.

Painful as it is to face the death of a loved one, facing the loss together gives a family precious time to deal with what is to come and to say goodbye. Be realistic about what to expect from children depending on their age. The dying parent should repeatedly tell the children he or she is not abandoning them, would stay with them if possible, and someone will always take care of them.

Grandparents can play an important role not only providing surrogate, loving parenting but encouraging the children to talk about their feelings by expressing their own. Help children write stories of how they feel or draw pictures of what is happening to them. All forms of expression are helpful, anger as well as tears. Do not be surprised if a child seems to play normally and ignore what is happening. This is a defense mechanism that allows children to process the information in order to begin to deal with it.

Some parents who know they are dying write letters or prepare videotapes for their young children to see at a later date when they are better able to understand.

Carefully timed truth and lots of talk about feelings are not enough. Children will need grief counseling–the death of a parent is too big a loss to deal with alone. Many communities have organizations that provide individual and group counseling to children who have lost a parent. If not a family therapist can help.