How to talk to a child about a serious illness or death

Finding out that someone close to a child is seriously ill or dying is hard on everyone. You might feel unsure what to say, or worry that talking about it will make things worse. This factsheet is for anyone- a parent, sibling, or friend who needs to start that conversation.

Why it helps to talk

Children pick up on more than we sometimes realise. They sense when something is wrong, even if no one has told them directly. If they’re left out of the conversation, their imagination can fill the gaps with something often more frightening or self-blaming than the truth.

Being honest, in an age-appropriate way, helps children feel more secure. It gives them time to process what’s happening, including having the chance to say goodbye. Children who are told what’s going on are also more likely to ask questions or express how they’re feeling. Younger children in particular may need reassurance that they can’t catch the illness, and that they didn’t cause it.

Helping a child express emotion

Younger children often have big feelings without the words to explain them. You might say something like: “It’s okay to feel sad, or even not know what you feel. Whatever it is, I’m here to listen.” It can also help to gently offer possible explanations, like asking whether they might be feeling scared or angry about what’s happening.

Letting a child see your own emotions is okay too. It shows them that feeling and expressing emotion is normal. If a child is finding it hard to talk, try other ways like texting or writing, drawing or doing art together, reading books about illness, or simply offering a hug when words aren’t there.

Watch for changes in behaviour

Some children express big feelings through behaviour rather than words like unexplained stomach aches, acting younger than their age, or other physical symptoms. This is normal, though persistent changes can be a sign that a child needs more support.

Try to keep routines going

Routine gives children a sense of predictability, even as things change around them. It can be harder to maintain as more time is needed caring for the person who is sick. This is often a good moment to let friends or family help out.

Starting the conversation early

It’s best to start talking as soon as it becomes clear that someone is seriously ill. This gives a child time to process things gradually and ask questions. You don’t need to share everything all at once.

Parents are often best placed to have this conversation, but if they are finding it too hard to accept the situation themselves, it’s okay to ask someone familiar to the child like an extended family member, friend, sibling or a hospice social worker to help.

It can help to start by finding out what the child already understands, and build from there. You might begin with something like, “Granny is ill, and the doctors are doing everything they can,” and later gently explain that the medicine can’t make them better but it can make them more comfortable for a period of time. Sometimes situations change quickly, and you may need to share more information in a shorter space of time.

Preparing them for changes

It isn’t always possible for doctors to say exactly how long someone has left, and things can shift week to week. But if you are in a position where medical staff have told you that death is likely soon, it’s important to share this with the child. How much detail you give can depend on age. Younger children have a limited sense of time so telling them death is expected “in a few weeks” might mean they anticipate it daily, whereas an older child or teenager may cope better knowing further in advance.

At the end of any conversation, give the child a chance to ask questions, and check what they’ve understood. It’s okay not to have every answer. Children might respond by wanting to go back to a game or the TV. That doesn’t mean they haven’t taken it in. It often just means they need time to process. Keep checking in with open questions like “How are you feeling about everything today?”

It can help to let teachers or other caregivers know what’s happening. Bedtime can be a difficult time for anyone, but particularly younger children, to process feelings, so encouraging them to talk during the day can ease things at night.

Contact with the person who is dying

Helping a child spend time with the person who is dying gives them a chance to say goodbye, and preparing them for what they might see or hear can reduce fear:

• Describe physical changes gently, like hair or weight loss, changes in voice or breathing
• Describe the room, including any equipment, and consider showing a photo beforehand
• It’s okay if a younger child wants to stay outside the room at first
• Let the child know they can talk to the person even if they are sleeping, and that they can touch their hand or hug them
• Keep early visits short and let the child bring something comforting like a teddy
• Give them a small task like filling a water glass or drawing a picture so they feel included
• Introduce them to the care team and let them know that it’s okay to ask questions
• Consider ways to help them say goodbye: writing a letter, drawing, or recording a message

Looking after yourself too

Supporting a child through grief while caring for someone you love is exhausting. Make time for your own wellbeing like talking to a friend, resting, eating, exercising, or speaking to a professional all help. You don’t need to get everything right. Being present, honest, and loving matters more than being perfect.

This factsheet was developed for the book Something Has Changed: Helping a Child Cope With Illness and Dying, published by St. Francis Hospice Dublin.