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Communicating with children when a parent is dying
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Discussing with a child that a parent will die is heartbreaking. It is fundamental to consider the child’s age when discussing this issue.
Children in the pre-logical age group (3-5 years), children of this age group may not understand what death means, but they notice when there is a change in a parent’s behavior and daily routine. In the concrete-logical age group (5-8 years), the children know that death is final. In this age group, death should be framed in concrete terms; for example: “Death is when the heart stops and the body does not work anymore.” Children of formal-logical age (>9 years) understand that death is irreversible and happens to everyone.
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To help with a healthy adaptation to the loss of a parent, clinicians should focus on sharing information. The timing is very critical. Disclosing the information too soon can prolong anxiety, whereas waiting for a long time prevents the children from being able to interact with the parent and say goodbye in their own way.
Communication allows children to express emotions, such as guilt, and helps us teach them how to cope with their feelings. The research literature has shown that in some families, the lack of — or inadequate — communication about death results in unresolved or pathological grieving. Children also develop behaviors leading to emotional complications later in life.
Asking the child questions about how they feel can resolve the child’s concerns or correct misconceptions. Every child has a different personality. Some children feel comfortable talking to the parent in the presence of visitors, whereas others prefer to be alone or with close family members.
When children are visiting the hospital, it is necessary to describe how the ill parent will look and behave. Children should be encouraged but not forced to visit a dying parent.
I recently had the good fortune to be part of an interdisciplinary team that was treating a young woman with breast cancer and providing support to her family. The team consisted of an oncologist, a social worker, a chaplain and a psychiatrist. Each member of the team had different skills, and by working together, the team was able to provide medical, psychological, social and spiritual care. The team worked with the patient’s husband, her 10-year-old daughter and her extended family during the course of her disease. The team invited the child to participate in choosing caregivers, planning rides to school activities, selecting who will provide updates on the parent’s condition, and when and how.
Phone calls, emails and instant messaging helped the team and caregivers to keep in touch with each other. The team attended the patient’s wake and had the opportunity to interact with the entire family. It is beneficial for the children to see and hear different ways people express their emotions during death-related rituals.
Maria Rueda-Lara, MD, is assistant professor of psychiatry at The Cancer Institute of New Jersey, Robert Wood Johnson Medical School.
For more information:
- Forrest G. BMJ. 2006; 332:998-1003.
- Muriel AC. J Support Oncol. 2003;1:143-145.