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
• ¿The ill person has children at home? ¿What is their age, personality, and coping style?
• ¿What the ill person has told the children about the illness?
• ¿Do they have specific worries about the child?
• ¿Has the child had recent problems in school, at home or with relationships?
• ¿Who would like to talk to them if they have concerns?
Often a parent’s biggest worry is what to say if the child asks if he or she is 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.
Giving adults information about their behavior to optimize interactions
• Expressing interest in the child’s day
• Working to maintain normal family routines
• Welcoming 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.
• Asking children to share what they are thinking, or hear from others.
• Preparing children for visits with the sick person describe what they are likely to see. Bring along another adult who is comfortable to stay only as long as the child wants. Bring along markers and paper, so children can leave the parent with a picture or message.
• Talking to the child's teacher or guidance counselor to alert the teachers.
Knowing the resources for parents and children
Considering referral to mental health professional when any of the following occur
• Symptoms of depression or anxiety that interfere with school, home or with peers
• Risk taking behavior
• Significant disagreement between the child and the surviving parent
• Significant disagreement between the parents
• The child says he or she wants 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