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Breaking Hard News: Helping Children Understand the Loss of a Loved One in Hospice Care 

Grieving the loss of a loved one in hospice care is a tremendously painful experience, especially when you are trying to help a child understand it. In this article, I hope to provide a steady, sympathetic resource to help you navigate those difficult conversations. With a combination of personal experience and research, I’m here to give an insight to help lighten the load for both you and the child. We’ll focus on being honest yet kind in our communication and ensuring that we are aware of a child’s capacity to comprehend such an immense loss. 

On the day my father died, I was in bed with severe vertigo. The sound of my sisters crying infiltrated my room like an unwanted guest, perplexing me. On that day, nobody had informed me that my father had passed away. However, I clearly remember getting a sensation and recognizing what it meant. I also recall being terrified and struggling to comprehend my sisters’ pain and grief. I think their age allowed them to grasp the finer nuances of death in a way that I, as a seven-year-old, could not. 

I vaguely recall a family member whose identity has since faded, telling me that my father had died and gone to heaven. This possibly sincere but abstract explanation for death perplexed me. As a result, my interpretation was based on the heavens above us—the night sky. I took solace in the stars above our small town, imagining the Milky Way as a celestial passage for those who had died—the brightest of them all being my dad. 

If someone had explained my father’s death in a manner I could understand, it would no longer be an incident that overwhelms me. It’s possible that the overwhelming grief drowned out any potential for clear or comforting words directed at me. I only remember mirroring my mother’s grief, acutely aware of her loss but not thinking of my own. 

Reflecting on my own experience, I am convinced that we can and should do better when discussing death with children. We must approach these discussions with the utmost care and do our best in these situations. 

I believe that a parent or a trusted adult should be the one to share such deeply personal and sad news rather than leaving it up to a provider. This is because they understand the child better and can provide more comfort and reassurance during this difficult time. 

Here is a guide based on several reliable sources to help you with this task. This is intended to be a broad guideline, and there is no one-size-fits-all solution, so you should adjust your conversation to account for any nuances that may improve it. 

  1. Be emotionally prepared before discussing the death of a loved one with your child. Be ready to offer comfort, answer questions, and guide the discussion with compassion, care, and sensitivity. 
  1. Choose the most suitable time and place. Find a quiet, comfortable location to sit with the child without disruptions. If possible, choose a time to speak with them when they are relaxed but also receptive to discussion.  
  1. Use simple, clear language that the child can understand. Use comparisons that younger children can understand and relate to, such as the life cycle of plants. Avoid using euphemisms like “passed on” or “sleeping.” This will only confuse and can be particularly scary to children.  
  1. Provide them with basic information: Explain what it means to be in a hospice; for example, “It is a place where people go when they are very sick, and doctors are unable to cure them.” You can add that the providers at hospice make every effort to make the person as comfortable as possible. This information can help the child understand the situation. 
  1. Inform the child of the death: Deliver the news carefully but directly. You could say, “I have some sad news. Remember I told you that Grandpa was very sick, and even though the doctors tried their best, they were unable to make him better. He died today at the hospice.”  
  1. Allow the child to ask any questions they may have and answer them as honestly as you can. It’s fine to say “I don’t know” if you don’t know the answer to a question. 
  1. Validate their feelings and thoughts: Reassure the child that it is normal to feel a variety of emotions, such as sadness, anger, or even relief, and that it is acceptable to cry if necessary to express their feelings. If the child does not want to speak to you right away, inform them that they can in their own time. 
  1. Try to maintain routines as much as possible after sharing the news. Routines can provide a sense of safety and normalcy. 
  1. Provide comfort and assure the child that they are loved and will be cared for. It can be reassuring to know that there are still people in their lives who care about them and will support them. 
  1. Seek Professional Help If Necessary: If the child is having difficulty processing the news or if their grief is interfering significantly with their daily life, consider seeking help from a professional, such as a pediatric psychologist or a grief counselor. 

I believe direct explanations, rooted in age-appropriate facts, can make these sensitive conversations less daunting and more accessible to young minds. Nonetheless, I acknowledge that some families may lean towards more symbolic or spiritual views of death. In such instances, discussions about the afterlife that are age appropriate and thoughtful are perfectly acceptable. I encourage parents, however, not to forget our biological reality in these spiritual conversations—while we may be spiritual beings, we are also biological ones, and death is a part of life. 

Balancing these two viewpoints is possible, and presenting a holistic perspective on death is critical. While it is crucial to provide a biological, factual explanation, it shouldn’t necessitate sidelining spiritual beliefs or other worldviews. Families with deep religious or spiritual roots can offer an explanation that harmoniously merges both perspectives. For example, after explaining the physical reality of death, they can express their beliefs about what happens to the soul or spirit afterward. It’s crucial to remember that it’s entirely possible, and indeed vital, to respect and uphold cultural, spiritual, and religious views while ensuring a child comprehends the biological aspect of death. 

As these conversations unfold, it’s crucial to be prepared for several questions, especially the inevitable “how” and “why.” Try to answer these questions as honestly and directly as possible while considering the child’s age. For example, if they ask how Granny died, you can explain that she had cancer, which caused her death. If they ask why Granny died, you can explain that her cancer was incurable despite treatment and medication. It is not always helpful to explain the “why” because that is when we start trying to explain metaphysical or existential questions, which can be quite challenging for a young child to understand. 

For a child, abstract ideas like the purpose of life, why people die, or why some diseases cannot be cured can be perplexing and even upsetting. Furthermore, a person’s religious, philosophical, or personal beliefs, which are not always as obvious or as significant to a child, may greatly influence the explanations given. Therefore, when discussing the death of a loved one with a child, it may be more helpful to concentrate on concrete and understandable facts. 

Another important factor to consider is the child’s emotional needs. A child’s emotions can be highly variable in the aftermath of the death of a loved one. They may alternate between tears and playfulness in quick succession. This abrupt change in mood does not imply that they are not grieving or that their mourning process has ended. Rather, children’s coping mechanisms differ significantly from those of adults, and their engagement in, for example, play may serve as a protective strategy, preventing them from feeling overwhelmed.  

Furthermore, it is common for children to experience feelings of sadness, guilt, anxiety, or even anger toward the deceased or others entirely. For very young children, such a loss can lead to a regression in behavior. They may revert to earlier stages of development, which could manifest as bedwetting or resorting to baby talk. 

According to clinical expert Gail Saltz, supporting a child in sharing their feelings during grief is critical. Encouraging children to adequately express their emotions, therefore, is key. Children’s books discussing death can help open difficult conversations with them. As some children might not be able to articulate their feelings, it is possible to encourage them to express themselves through drawings, creating a scrapbook, looking at photos, and narrating stories – all of which could be beneficial. 

To wrap things up, discussing the death of a loved one in hospice care with a child can be difficult; however, it is a necessary conversation. Grieving is highly individual, whether an adult or a child. But trust me on this- with time, assistance, and your loving support, they will come to terms with their loss, even within the challenging context of hospice care. 

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