Talking about death and dying with children

Before talking about death and dying with a child, establish:

  • consent for the interaction
  • an understanding of the child’s developmental stage, communication capability, level of comprehension of death and intellectual functioning
  • family, cultural and spiritual considerations and preferences
  • the nature of the relationship with the person dying.

Children generally benefit from open and natural communication about illness, death and dying. However, their perception and understanding is influenced by their developmental phase; present concepts in an age-appropriate manner, recognising that children’s understanding of what death means develops mostly between ages 6 and 8 years.

Table 1. Children’s understanding of the concepts of death

Concept and average age at which it is understood

Consequences of incomplete understanding of the concept

separation—the deceased are located separately to the living (age 5)

–

causality—death is caused by illness, age, trauma (age 6)

child may believe they have caused death through bad behaviour or thoughts, and feel excessive guilt

irreversibility—the dead do not physically return (age 6)

child expects deceased to return as if from a trip; they may not detach personal ties to deceased

cessation of bodily functions—the dead cannot move, breathe (age 6)

child may be preoccupied with physical suffering of deceased, eg worries about buried person being cold, hungry or in pain

universality—all living things ultimately die (age 7)

child may see self and significant others as immortal; death may be viewed as punishment or the result of bad behaviour or thoughts

insensitivity—the dead cannot feel pain, fear (age 8)

child may be preoccupied with psychological experience of the deceased, eg worries that they may be suffering or feeling sad

Create a comfortable environment that facilitates open and nonthreatening interaction. Gently explore what a child already knows and provide ample opportunity for them to ask questions. Start by giving a small amount of information, provided as clearly as possible as appropriate for that child. For children with a developmental disability, adapt the information if needed.

Encourage the family to use simple language to explain what is happening. Suggest they consider including children in visits to the dying person and attendance at the funeral and anniversary rituals—this can help normalise death and promotes the family as the continuing supportive environment. Parents can prepare children for these occasions by explaining the nature of these rituals in advance. For advice for families about children’s involvement in visiting a dying person, see Advice for families about children visiting a person who is dying.

For features of grief in children, see Children’s responses to death. For management of grief and its complications, see Responding to grief.