How to talk to children about death

Talking about death and dying can be confronting for adults, so knowing how to have that conversation with a child can be challenging. One common question is “what on earth do I say?”.

From a very young age children are introduced to the themes of loss in picture books, video games, and popular children’s movies. This can prompt children to come forward with questions about death, particularly their own mortality, from an early age.

As children grow and death touches their lives, be it a parent, grandparent, sibling (including those who die before birth, or family pet the questions can be complex.

Clinical Psychologist Dr Allana Canty from not-for-profit children’s psychology practice Child’s Play Qld, has focused her work on helping children and families grieve and adjust to life transitions.

She says that if adults can acknowledge themes of death and dying as a normal part of life, this can reduce emotional distress when an unexpected loss occurs.

“This may take the form of discussing the death of a character in a movie or book, acknowledging the aging process, or even exploring the garden for dead insects, chrysalises, or describing the natural lifecycles observed in plant life.

“Discussions about death are appropriate at all ages, and the level of detail that is appropriate can often be guided by the types of questions that a child asks.

Dr Canty recommends adults use language that welcomes questions about death and dying such as ‘what else would you like to know?, ‘I like it when you ask me questions. If more questions come to mind, I will make sure that we talk them through’.

“It is a common misbelief that we shouldn’t talk about death or dying, that such conversations change a child’s innocence, and that children will not be able to cope with this information.

“Research suggests that children benefit from honest and open communication, and that such communication facilitates healthy grieving and acceptance of loss.

“When there is a known prognosis of death in the foreseeable future, it is recommended that families explain to the child what is occurring as soon as possible and keep them informed of changes in the loved one’s health.

“Children benefit from the opportunity to cherish the time that is available with the loved one, and benefit from activities that allow them to express their thoughts and feelings during the end of life phase of a loved one.

“It is helpful to prepare a child for what they will see. I recommend families describe factual information ahead of time, and help the child identify new ways they can express their love or engage with the loved one.

“If a loved one has experienced change in their consciousness, mobility or ability to communicate, a parent may say, ‘Poppy’s legs are not strong enough for him to walk. Poppy will be in a special chair that helps him move around. Poppy won’t be able to colour with you on the floor, but would you like to take him a special picture that he can put beside his bed?’.”

Dr Canty says children’s reaction to death can vary greatly. Dr Canty describes seven characteristic responses:

1. Difficulty distinguishing between animate and inanimate objects
2. Fear – will I be the next to die?
3. Curiosity – why? What will happen to the body?
4. Association – hospital means death and going to hospital means the person will die
5. Magical thinking – loss can be reversed if I am good. 
6. Self-centred responses – who will take me to swimming now?
7. Anger - I hate my dad for dying.

Dr Canty says parents should be ready to accommodate all types of emotional responses.

“Anger is often a manifestation of a more vulnerable fear or hurt. We encourage adults to be mindful of not being reactive to temper outbursts, and help the child connect to their primary feelings by normalising the child’s experience. For example, an adult may say, ‘It is okay to have big feelings and for your heart to hurt. You loved Nana very much’.”

Families will face questions about whether children should attend funerals and how involved children should be in the proceedings.

Dr Canty says attending funerals and allowing a final goodbye can be very meaningful for children, and it is reasonable that they attend.

She also suggests ensuring having another carer ready to support your child during the funeral if you think you may need assistance during the ceremony or afterwards.

“Helping children understand what is to be expected can be important. Key points include explaining the agenda for the day, that they will likely see people sad or crying and that such reactions are normal, it is also okay for them to feel sad, cry or to feel that they may like a break.

“Having a bag of activities that the child can do when they need a break or if the adult needs to attend to other matters is a helpful preparation.

“Open caskets can be confronting, particularly as the person’s appearance has likely changed compared to what the child would be familiar with. Often children are encouraged to approach the casket once the lid is sealed to share their thoughts, feelings, or place a token of remembrance.”

Dr Canty says losing a pet can also be significant source of grief for a child and they can benefit from participating in a funeral to process their thoughts and feelings.

“It is normal for children to return to burial places of their loved animals and talk to their pet, share memories, and place gifts/cards for their deceased pet.

“Carers may like to ask their children if they would like to plan some special words, place a special gift, or create a picture for their loved pet.”

Parents may also face the question of ‘if’ or ‘when’ to introduce a new pet to the family.

“The swift arrival of a new pet facilitates avoidance of strong feelings, and suggests to the child that strong negative feelings are to be avoided.

“Whilst grief is painful, it is healthy and normal, and allowing space for grieving creates a good template for how to manage other strong emotions throughout their life such as a relationship breakup, losing a special item or a friend moving away.

“Many special, cherished and loved aspects of our lives cannot simply be replaced, therefore having healthy examples of moving through and accepting loss is valuable for a child’s emotional development.”

Dr Canty discussed common signs that a child might be struggling to adjust to the loss of a loved one. These include:

• Increased irritability, moodiness and more intense emotion dysregulation
• Withdrawal from previously enjoyed activities, or spending time with their friends or family
• Changes in eating (more or less), toileting (regression) or sleeping (difficulty getting to sleep, chronic day-time fatigue, frequent waking during the night, emotionally distressing dreams).
• Refusal to discuss the loved one or avoidance of stimuli that remind him/her of the loved one.
• The child describes intrusive thoughts and images about death or worries about their own or others death, and the frequency of these impacts on their social or emotional functioning.
• Asks the same questions multiple times per day.

Dr Canty says that children will often demonstrate the above signs in the weeks following a loss. If such signs persist however, it may be helpful to consult a child and family psychologist. This can take the form of parenting support in knowing how to respond to your child’s presentation, individual support for your child or family counselling.

If a child is struggling with the death of a loved one, Dr Canty says parents can provide opportunities for the child to express their thoughts and feelings. This can include creative solutions such as finding songs that capture feelings, drawing a picture of the loved one, writing a card for the loved one, creating a memory box, or decorating a time-line of their loved one’s life.

Dr Canty explains that grief does not ‘resolve’. Rather, a child will integrate the loss into their life story, and the pain of that chapter may surface at different stages in their life.  

5 common questions children ask about death and Dr Canty’s suggested answers:

Q: What does death/dying/dead mean?

A: Use factual information to explain that death is final, irreversible, inevitable and universal. For example, “death is when the organs in our body stop working. When our organs stop working, we are no longer able to see, smell, hear, move, or feel pain” and/or “death means that the body of the person/creature cannot come back to life and talk, breath, or play”.    

It is not advised that families refer to the deceased as ‘asleep’, ‘on holiday’ or ‘gone to live on a farm’. This can create many confusing follow up questions such as “when is dad going to wake up? When will Rex come home? Can we go and visit Uncle Tim?”). Confusion can extend a child’s grief, and may position the adult in a tricky situation where they feel obliged to continue with convoluted stories.

Q: What happens after someone/something dies?

A: As there is considerable variation in religious and spiritual beliefs between, and even within, families, it is recommended that adults agree on what language they intend to use when explaining what happens after death. Families are encouraged to consider whether they would like to make references to Heaven, spirits, the soul, death as a final phase of existence, or an afterlife.

Children will often have follow up questions such as “What is Heaven like?” “Will I go there?”. Having made proactive decisions about what terminology and belief systems the parents would like to use, encourages consistency in language and can reduce confusion for children who are trying to navigate this tricky topic. Further, children’s beliefs about what occurs after death will undoubtedly be challenged. T

o increase the likelihood of a socially appropriate responses from your children, families may like to normalise differences in beliefs (e.g., ‘people can have different opinions about what occurs after death. There is no right or wrong belief and it is important to respect that your friends may not believe in heaven. You can have a different belief to your friends and that is okay’).

Q: What happens to the body after death?

A: Burial: “Lilly’s body will be put in a special box. This special box is put in the ground and covered with garden. A special stone will be put on top of the garden. This stone has writing on it which tells people who is buried there”.

Cremation: “Nathan’s body will be put in a special box. A machine heats up the box and turns it into dust which we will keep in a beautiful container/spread at Nathan’s favourite spot”. It may be important to remind the child that the body no longer feels temperature or pain. 

Q: Will I die? Will I die next?

A: All living things on earth will die. Different animals and plants have different life spans. Some trees can live for 500 years but a butterfly can sometimes only live for 2-3 weeks. Most people live very long lives, and get to live for around 100 years. Your body is healthy and we hope that you will live for 100 years.

Children often worry if death is contagious. Explaining the cause of the person’s/pet’s death helps the child separate their own mortality from that of the deceased.

Q: What will happen to me if you die? 

A:  Children will ask egocentric questions such as “who will make my lunch” or “who will take me to school”. This is a normal way of children wanting to make their worlds predictable and stable. Creating a picture of all the adults that would be available to support the child can be very comforting and reduce anticipatory distress about the death of their primary carer. If death is not imminent, parents/carers may like to emphasise that they plan to have a long, healthy life ahead.