The death of a young adult is always difficult, even more so when there are young children survivors. A frequent question asked by dying adults or their family is, “What do I tell the children?” Physicians and other health care providers can provide counsel to young families through this crisis.
Screening and understanding the situation
• If the ill person has children at home, what is their age, personality, and coping style?
• What has the ill person told the children about the illness?
• Does the ill person have specific worries about the child?
• Has the child had recent problems in school, at home, or with relationships?
• Who would the children like to talk to them if they have concerns?
Often a parent’s biggest worry is what to say if the child asks if they are dying. Giving examples of words they might use and asking if they would feel comfortable saying them can begin a dialogue between patient and clinician to arrive at an adequate language.
Give adults concrete actions to guide their interactions
• Express interest in the child’s day.
• Work to maintain normal family routines.
• Welcome questions without forcing discussions. It is essential to understand the real question — and to take time — before answering.
• Overhearing bad news is the worst way to hear it. Talk with children from diagnosis onward, being sure to give updates when there are changes in prognosis or treatment.
• Ask children to share what they are thinking, or hearing from others.
• Prepare children for visits with the ill person by describing what they are likely to see. Bring along another adult who is comfortable to stay only as long as the child wants. Bring along coloring materials and paper, so children can leave the parent with a picture or message.
• Talk to the child's teacher, or guidance counsellor to alert their teachers.
Know the resources for parents and children in your community
Considering referral to a mental health professional when any of the following occurs:
• Symptoms of depression or anxiety that interfere with school, home life, or with peer relationships.
• Risk-taking behavior.
• Significant disagreement between the child and the surviving parent.
• Significant disagreement between the parents.
• The child says that they want to talk to someone outside of the family.
See reference for more information. Adapted from Rauch P, Arnold R. What do I tell the children? Palliative Care Network of Wisconsin. Fast facts and concepts #47. Internet. Accessed on January 27, 2019.