Articles and Updates from Phoenix Children's
Death is a difficult topic to discuss amongst other adults, let alone with children. For most, the idea of having a sit-down conversation with our children about death and dying is pretty horrifying. However, just because it may make us uncomfortable, it doesn’t mean our children don’t have questions or surrounding thoughts.
And right now, with the COVID-19 pandemic feeling nearly inescapable; growing death statistics circulating, discussions of overflowing hospital capacity and full intensive care units, children are being bombarded by headlines about death, critical illness and hospitalization. So, how do we start conversations about death with our children?
First, it’s imperative to recognize the relationship between your child’s age and their developmental understanding of death. For example, toddlers and preschoolers have very little insight into the concept of death. They may feel more anxiety and fear, because your body posture and demeanor is tense when discussing this subject (and kids are experts at modeling the attitudes and behaviors of those they trust). Kids do not intrinsically understand the finality of death. To this end, most do not understand that death is a permanent condition: Using language like “passed away” or “went to sleep” will only solidify that a particular individual will be returning at some point in the future and/or make your child fearful of falling asleep.
In turn, children at this age will often ask questions about why or how death happened (with the goal of seeing whether their actions, in some way, contributed to this individual’s disappearance). It is thus important to use concrete language when discussing death and highlight for young children that they had no influence on causing someone’s illness or death to alleviate potential future feelings of guilt.
Once children reach school-age, they begin to possess more nuanced cognitive processes that allow them to better-comprehend the finality of death. Youth at this age will often use personifications of death like ghosts, angels, skeletons or the grim reaper as a way to help them make sense of the transition from conscious life to death. So, doesn’t be alarmed if your child asks questions about the physical process of death, what happens after death or why some people die and not others. Should you encounter these types of questions from your kids, positively reinforce your child’s behavior for coming to you with their questions (rather than turning to a media outlet) and answer as honestly as you can without judgement. Also, do not be afraid to let them know that you don’t have all the answers and validate that uncertainties associated with death are scary for adults, too.
Finally, as youth become teenagers and young adults, they become increasingly aware of death’s permanence and the fact that all humans will endure the dying experience at some point. For some, this realization can prompt a more defiant attitude that fosters behaviors that attempt to highlight their desired immortality (i.e., they start acting riskier). Others may experience feelings of fear and helplessness. The most important gift we can offer our kids in this age bracket is validation of their thoughts and feelings and reassurance that they can always come to us with their questions.
Adolescents and young adults may also wish to have a voice in decisions about their treatment and goals of care should they ever be medically compromised and/or in a position that they cannot effectively advocate for themselves. In fact, research has found that many adolescents want to have advance care planning discussions with family before they are ill. So, don’t be afraid to use common death experiences as a way to empower your child to explore their death and illness-related preferences. For example, if a family member dies and makes the decision to be an organ donor as well as cremated, this presents an opportunity to share information with your adolescent about organ donation as well as the difference between cremation and burial within the context of exploring what they might want for themselves. Similarly, if your teenager sees a news story about a shortage of ventilators and asks associated questions, this is a wonderful opportunity to give information about various life support interventions.
And if you aren’t sure whether your child is ready to have these conversations, let them be the guide and do not push them. Age is less important than your child’s level of cognitive and emotional maturity, so don’t worry if your school-aged child isn’t asking questions about death or your adolescent has no interest in discussing any component of advance care planning. As a parent, you are not supposed to know everything about everything (despite what your child may think). This is especially true when it comes to talking about death. So give yourself permission to be unsure of their answers and uneasy in approaching these conversations. What’s important is that you remain a safe person for your child to turn to when they have questions.