Preparing a young person for the news that someone they’re close to isn’t going to get better can be very difficult. Get advice on the support available.
Preparing children for the loss of a relative or someone close to them is an incredibly hard thing to do. You will know the best way to do this for your own family. But talking over the different ways of approaching this can be helpful.
You do not have to do it alone. You may need a lot of support from family and close friends. Professionals such as social workers, palliative care nurses, doctors, counsellors, and psychologists can also help you.
Sometimes, your closest relatives are so distressed themselves that they may not be able to understand the best way to help you or the children. And family members may have different views about when and how to talk to the children. It might help you to involve them in your discussions with professionals, but only when you are ready to do this and are clear about what you want.
Be honest and open
Being honest and including children in what is happening is usually the best approach. It is natural to want to protect children from painful experiences. But we know that adults who had someone close to them die when they were young often wish they had been told what was happening. They knew something was wrong, but everyone told them the opposite or would not talk to them at all.
When talking about dying, talk openly with your children and use clear, age-appropriate language. This allows you to find ways of helping your children to cope in the future. It may also give you the chance to show how much you care for each other. It is often easier for children to hear information in small chunks, rather than all at once. You may need to repeat simple messages several times. It is important to explain things in language that children can understand.
Tell them that everyone, including the doctors, nurses, and yourself, have done everything possible to keep you living, but there is no medicine that can make you better. Explain that it will soon be your time to die.
Be prepared for the possibility of children asking what happens to people once they have died. How you approach this will depend on your own beliefs. It may be helpful to think in advance about your answer to this kind of question.
Use clear language
Use simple words such as ‘dying’ or ‘died’ when you tell young children about death. Try not to use phrases that may confuse them. For example, saying that you will be ‘going away’ or ‘going to a better place’ may make a child feel that you are abandoning them. Try not to use ‘going to sleep’ to describe dying, because young children may then be afraid of going to sleep.
Also encourage the people who will talk to children after you die to use clear language. Saying a relative or friend is ‘lost’ or has ‘passed away’ can be confusing. They may wonder why no one is looking for the person who has died.
Talking honestly and clearly about what is happening helps children to feel more secure at an upsetting time. Young children can often find reasons to blame themselves in ways that you would not expect. Being honest with them helps to reassure them that they are not responsible for someone’s death. You will also be giving them the chance to talk about how they are feeling and ask questions that are important to them.
Check their understanding
Be aware of what children may hear when you are talking to other adults. It can be frightening for children to understand some but not all of the facts that they overhear.
Children are imaginative, and in stressful situations using that imagination can sometimes scare them. They may imagine far worse than what is actually happening. This is particularly true if they are trying to make sense of what is happening without talking to you directly.
It is a good idea to check their understanding every now and then. This is especially important if you think they may have accidentally overheard a conversation not meant for them.
The way children understand and react to death can depend on their age and their level of understanding. It may be helpful to know how the children might react before you talk to them.
Emotional reactions in children and teenagers can also appear as physical symptoms, such as headaches or stomach aches. There may also be changes in their behaviour.
You may find yourself becoming upset or tearful when having difficult conversations with children. But that is okay. It can help children to see that sometimes adults cry too when they feel upset.
The organisation Child Bereavement UK has information about these age groups. They also worked with bereaved young people to develop an app for teenagers.
Very young children (aged under 3)
Children under 3 can pick up that something very serious is happening, even if they cannot understand what death means. Children as young as 3 can grieve. Some children in this age group may slip backwards in some of their developing behaviours, for example toileting or feeding.
Children aged 3 to 5 may have heard about dying, but they may not understand what it means. For example, they may imagine that a dead person will come back or is living somewhere else.
How you can help:
- Keep reminding children that you do not want to die and leave them. But, explain that when it does happen, you will not be able to come back.
- Keep to everyday routines when you can.
- Let them know that the cancer is not their fault.
- Reassure them that they cannot catch the cancer from you.
- Ask someone that you and the children know and trust to keep a special eye on how they are coping and feeling. Tell the children who you are asking to do this.
- Tell someone you trust at playgroup or school what is happening, so that extra support can be arranged.
Children aged 6 to 12 know about death, but they may not always understand the emotions they feel. By about 8 or 9, children begin to understand death more like adults do. But, they may still believe that if they are very good, the person who has died may come back. Their worry is more likely to be that death is frightening or painful.
How you can help:
- The suggestions for children aged 3 to 5 will still be helpful to many children in this age group.
- Use books to talk about the end of life.
- Encourage them to keep up with school work, activities they enjoy and friendships.
- Let them know it is okay to enjoy themselves. It is also okay to be sad.
- Give them small tasks to do to help out. For example, they could put flowers in a vase or bring you a glass of water.
- Explain the situation to their teacher. You may also want to explain what is happening to a few parents of their close friends, who you know they trust. They can also offer support.
Teenagers may find it harder than younger children to cope with the news that someone is dying. They are old enough to know that this means a major change and loss in their life. They may cope in ways that are difficult for you to understand or deal with.
Some teenagers may refuse to talk about the illness. Others may try to become closer to their parents. Some may get angry with you or your partner in ways that seem thoughtless. They may then feel guilty about how they have acted. Or they may feel bad about spending time with their friends.
Teenagers need to know that there is no right or wrong way to feel at this time and that it is okay if their feelings change a lot.
How you can help:
- Ask them what they think and, if they want to be, include them in the same way as you would include an adult.
- Help them see that talking about feelings is a positive and mature way of coping. Encourage them to talk to someone they are close to, such as their friends, a relative, a family friend, or a trusted teacher.
- Give them time and space to themselves when they want it.
- Tell them about useful sources of information and support.
- Encourage them to keep up with their friendships, activities, and normal life as much as possible.
- Keep to usual rules and boundaries. These can be even more important now than before, as they can help teenagers feel safe.
- It might help to gently remind them that their behaviour may affect any younger children in the family.
It may help to think in advance about the kind of questions your children may ask, and about how you want to respond. There is no right or wrong way to answer.
We have some suggestions here, but you will have your own ways of explaining things to your family. What matters is that your children feel able to ask questions and talk about how they feel.
Answering children's questions
- What will happen to me?
‘Daddy/Mummy/Granny/Grandad will still be here for you and will look after you. It is very important to me to make sure you will be safe and looked after. We have talked about it and made plans for what will happen.’
- Will I get cancer?
‘Cancer is not like a cold and you cannot catch it. It is okay to sit close to Mummy/Daddy/Granny/Grandad and hug or kiss them.’
- Am I going to die too?
‘You cannot catch cancer. Most people die when they are old and their bodies get worn out. It is very unusual and sad for someone young to be so ill that the doctors cannot make them better.’
- Is it my fault?
‘Nothing you did, said or thought made me ill. It is no one’s fault.’
- Who will look after me if Daddy/Mummy/Granny/Grandad dies too?
‘If something happens to Daddy/Mummy/Granny/Grandad, we can arrange for someone you know well to become your guardian and they will look after you.’
- Our booklet End of life: a guide has more information, which you may find helpful.
- Childhood Bereavement UK produces information about supporting children when a parent is not expected to live.
- Plan If is a campaign launched by the Childhood Bereavement Network (CBN). It encourages all parents to put plans in place in case they die before their children grow up. It has instructions on how to appoint guardians in different situations and helps you to make these difficult decisions.
If you do talk about appointing a guardian for your children, it is worth talking to them about who they would prefer.
Preparing a child or young person for loss can be an incredibly difficult thing to do, but you do not have to do it alone. You can ask for help from the health professionals looking after you, such as your GP or your specialist nurse.
Friends and family may also be able to support you, but sometimes it is easier to talk to someone who is not directly involved.
Organisations such as Winston’s Wish or Marie Curie provide information about supporting children and teenagers when an adult is dying. You can also look for local bereavement services near you at the Childhood Bereavement Network. Your local hospice may also be able to support you and your children.
Schools and clubs
When a child has a parent with terminal cancer, they are likely to have complicated emotions. It is important for the school, nursery, or club staff to be aware of the cancer diagnosis and any extra support the children may need. If your child is facing exams or coursework, keeping the staff updated on how your child is coping means they can offer the right support.
Online support and useful websites
Teenagers in particular may look for information about cancer on the internet. You or your doctor could help them understand whether the information they find is accurate and relevant to your diagnosis. Some teenagers may feel more comfortable joining an online support group rather than speaking to a counsellor.
- The Hope Support and Rip Rap might also be helpful. They are for teenagers who have a parent with cancer. You can also use them to search for other useful organisations that can help you.
- Cruse Bereavement Care has information for bereaved children and young people, as well as a free helpline: 0808 808 1677.
- Child Bereavement UK has information and support for bereaved children, young people, and families. They also have an app called Grief Support for Young People and a free helpline: 0800 02 888 40.
Support from Macmillan
You can visit Macmillan’s Online Community, where you can chat with others in a similar situation. Or you can call our cancer support specialists for free on 0808 808 00 00. Our team can tell you more about counselling and can let you know about services in your area.
We have some easy read booklets that use simple language and pictures. They can be useful for anyone who finds it hard to read. The booklets are about care at the end of life and after someone dies.
Books for children whose parent is seriously ill
- The Secret C – Winston’s Wish
- Flamingo Dream – Jo Napoli
- No Matter What – Debi Gliori
- When Someone Has a Very Serious Illness – Marge Heegaard
- When Dinosaurs Die – Laurie Krasny-Brown
- Always and Forever – Debi Gliori
- The Sad Book – Michael Rosen
- The Memory Tree – Britta Teckentrup
- The Copper Tree – Hilary Robinson and Mandy Stanley
- Is Daddy Coming Back in a Minute? – Elke Barber & Alex Barber
Books for adults with life-limiting illness
- As Big as it Gets – Winston’s Wish
- Late Fragments – Kate Gross
- Stepping Stone Postcards – Childhood Bereavement Network
- Muddles, Puddles and Sunshine – Winston’s Wish
- Making a Memory Box: Activity sheet – Winston’s Wish
- Memory boxes – Macmillan Cancer Support
- Grief Encounter Work Book – Dr Shelley Gilbert
- Beyond the Rainbow: A Workbook for Children in the Advanced Stages of a Very Serious Illness – Marge Heegard
- Standing on His Own Two Feet: A Diary of Dying – Sue Grant