What To Tell Kids When Their Parent Is Sick

When my best friend's cancer returned near the end of 2020, her first instinct was not to tell her children, who were 11 and 9. The last thing she wanted was to add more stress to their already emotionally-charged lives. They'd faced remote school and a three-month stint living away from home while she and her husband, a doctor on the front lines of the pandemic, figured out how to protect the family from getting ill. And it was almost Christmas.

I understood her hesitation. Shielding our children from worry is our most natural instinct as a parent, and I wasn't sure what to tell my kids, who spent countless hours playing together at her house. Her illness made me acutely aware of the untold number of parents in the same situation, whether from COVID, cancer, or another life-threatening condition.

What should you tell a child when a parent, caregiver, or loved one is sick? At what point do you talk about death or the possibility of dying? Here's what experts who work with families facing significant health challenges have to say.

Talking to Children About a Parent's Illness

"Should I tell my children about my sickness is the most critical question I always get in the beginning," says Amanda Thompson, Ph.D., chief of pediatric psychology and director of pediatric programs at Life with Cancer, part of the Inova Schar Cancer Institute in Annandale, Virginia. "Hands down, honesty really is the best policy."

No matter their age, she explains, kids pick up on all sorts of cues parents and caregivers think they are hiding, like whispered conversations, telehealth appointments behind closed doors, red eyes, and more visitors to the house. And when they don't know what's going on, they make up stories in their minds, which can be more frightening than the truth. "Anxiety decreases when kids are told accurate and developmentally-appropriate information about what's going with their loved ones," explains Dr. Thompson.

Of course, what you say to a 6-year-old will differ from what you say to a 16-year-old. Young children may not always be able to grasp the details of an illness, but they are capable of understanding that a loved one isn't well and that it's affecting their family. "Toddlers and young school-aged kids are concrete thinkers, so we have to give them simple and direct explanations. Always use the name of the illness, like cancer, and tell them what it means and where the illness is located," says Dr. Thompson. "Kids this age want to know how their loved one's illness will affect them. Try not to be hurt if their first question is 'what's for dinner?' or 'can I still see my friends?'"

She also says you should tell them about how the treatment will affect the caregiver—like mom will take more naps or dad will feel sick to his stomach. Plus, tell them the illness isn't contagious (if that's the case), and encourage them to give lots of hugs and kisses.

Older kids will have a more sophisticated understanding of illness and may ask bigger, more existential questions. Dr. Thompson says not to shy away from less familiar words like cardiologist, oncologist, or chemotherapy. Also, give them space to ask what they want and realize it's also OK if they don't have any questions or don't want the details. Teens are at an age where they're more likely to talk to peers than their parents.

"If you're too upset emotionally or struggling to get the words out, it's OK to have someone else do the communicating, like a partner, someone you trust, or a mental health professional who specializes in these conversations," says Dr. Thompson.

Handling Hospital Visits

Hospitals can be scary places for children and adults alike. Parents often wonder if visiting a loved one (if COVID restrictions aren't an issue) will do more harm to the child's psyche than good.

"If there's an option to visit a parent at the hospital, I think it can be very helpful," says Dr. Thompson. "Kids often feel better when they see the environment and are given a chance to meet the people taking care of their loved one."

To prepare your children for what they'll see, hospitals have staff, like child life specialists, who work specifically with children of adult patients to provide them with the psychological preparation and coping skills to manage a loved one's critical illness, from trauma and ICU wards to long-term stays. If you're unsure who you can speak with, ask the front desk or a nurse to connect you with the right person.

It helps for children to know what to expect. Cami Frickman, child life specialist and certified grief support specialist at Inova L.J. Murphy Children's Hospital, says, "I show children pictures of everything they will see before entering the room. I explain what certain machines are doing and the sounds they make. This preparation makes a world of difference in their comfort level."

If your child can't go to the hospital, there are other ways to foster connection. Frickman encourages parents to use phone calls, video calls, and texts. Younger kids can draw pictures to send with a parent, and the patient can record messages or the child's favorite book to read at bedtime. Kids can also paint messages on a hospital sheet that the nurse then places over their loved one like a virtual hug.

Frickman also says that if a patient is sedated or unable to communicate, hospitals often have goodie bags to take home and give to children from the patient.

Managing End-of-Life Discussions

Unfortunately, a parent's illness or trauma may get to the point where it's time to discuss death or communicate that a loved one has died. Experts agree that these conversations are tough, and it's OK if you struggle. Seeing you get emotional will help a child understand it's all right for them to be emotional, too.

"Just like with understanding of illness, understanding of death and dying gets more sophisticated with age," says Dr. Thompson. "You're going to match the language you use with a child's maturity level. But try to stay away from euphemisms like passed away, gone to sleep, or 'we lost your grandma.'"

Dr. Thompson explains that young children likely aren't going to understand what you're saying and can get very confused. Saying someone has gone to sleep can lead them to fear the same thing could happen to them in their sleep. Also, correct any misconceptions right away. Kids engage in magical thinking, and they may believe something they said or did caused the illness or death.

Parents also question if it's appropriate for children to attend the funeral. Experts say the decision is up to the caregiver, but funerals or other rituals around death give children the opportunity to participate with the family and community in traditions of mourning. They can say goodbye, experience the love of their family and friends, and they may learn things about their loved one that they'll cherish in the future.

Supporting Children During This Difficult Time

"There's no portrait of a grieving child, and a wide range of behavioral and emotional responses are completely normal," says Dr. Thompson. "There's also no timeline for processing grief. It will ebb and flow."

Although grief looks different for everyone, certain red flags indicate your child may need additional help from a mental health professional. Dr. Thompson says to be particularly aware of children who have pre-existing risk factors, like anxiety and depression or limited social support.

"Also, keep an eye on lasting behavior changes, like when a child has lost interest in activities they used to love. Or they're no longer hanging out with friends, refusing to go to school, or sleeping poorly at night. Of course, talk of harming themselves should be addressed immediately," adds Dr. Thompson.

Because children won't always open up to their parents or their parents may be mired in their grief, Frickman explains that it's helpful to have other sets of eyes on your child who know the situation and are part of their extended support network. That can be aunts and uncles, a teacher, coach, school psychologist, or any other adult involved in that child's life.

Children are remarkably resilient, and with loving support, they'll make it through this difficult time.

Resources that can help grieving families:

• Coalition to Support Grieving Students
• Eluna
• National Alliance for Children's Grief
• The Dougy Center
• The National Child Traumatic Stress Network
• New York Life Foundation
• Option B