On Talking to Children About Death and grief

Recently, some of my online groups have been talking about how to talk to children about death and grief. I realized that I am in a unique position with my work at the intersection of life and death to share what I have learned, since I visit with many children and their families about death and grief.

I have found that the resource, "What Will I Tell the Children?" published by the University of Nebraska Medical Center has been one of the most useful pieces of literature for me.

Here are some of the things that I have learned in my work as a hospital chaplain about how best to support children with regards to the death of a loved one.

1. The importance of security and secure attachments cannot be stated enough. If the child is experiencing the death of a parent, they need security that they will be cared for.  They need to know that adults will meet their needs. It is best to explicitly say this. It can be as simple as, "I know your mom has cared for you up until now, but now we, your aunt and uncle, will be taking care of you. You will live with us."  If the child is experiencing the death of a grandparent or other relative, they might feel like their parents could die too.  Listen to these fears because they are real. Share that while everyone will die someday, that time will likely not be for a very long time.

2. Help your child to say goodbye  This can take place at the bedside or at the funeral service. Encourage the child to say goodbye in their own way.  The Four Gifts of Dying ("I love you", "Thank You", "I'm Sorry" and "Goodbye") are as appropriate for children as they are for adults. If the death was sudden, encourage the child to write or dictate a letter to the person that died. It can be buried or cremated.

3. Give accurate, age-appropriate information about the dying process Use simple concrete language. Do not use euphemisms such as "lost" or "passed." Do not be afraid to say "Dead" or "Death." Talk about how once someone has died, they do not hurt anymore. Be prepared for questions like "What happens after death?" and "Where does the body go?" It is okay to let your child know that you do not have all the answers.

4. Keep the lines of communication open  Let your child know that they are always welcome to talk. Talking about the loss of their loved one is important and won't cause additional pain. You can say, "I miss Grandpa too. Do you remember some fun times we had together?" 

5. Enlist the help of outside resources  Involve your child's school (principal, social worker and school psychologist), church (if relevant), and therapists (such as play therapists or family therapists).  Let your child know that they are many people who care about their well-being.

6. Normalize Grief  Let your child know that it is okay to feel sad, angry, or happy. Sometimes it is possible to feel all those feelings at the same time. Say that the intensity of these feelings will come and go and whatever they are feeling is okay.

7. Understand the long-ranging concerns Children and teenagers who are losing loved ones might be concerned about the future. They might ask, "Where will we spend Christmas now that Grandma is dead?" or "Who will walk me down the aisle at my wedding if Dad is dead?" Provide love and reassurance. Recognize that birthdays, holidays and other special days such as graduations, proms and weddings will come with grief.

How to talk to children about serious and terminal illnesses

Recently in my work at the hospital I have accompanied a number of children who are learning that their parents or grandparents have serious illnesses or are dying. I have provided support and end of life education to many parents and relatives. Additionally, some clergy in professional groups of which I am a part have been discussing this same topic. So I am sharing what I have learned in the hope that it might be helpful for others.

Here are some helpful tips:

1. Be honest
Children are incredibly intuitive beings. They can sense their emotional environment and they know when something is different.  You are not sparing children's feelings by hiding a serious diagnosis. By honestly saying, "you father is sick" or "your grandmother is dying", you are validating what children already probably know.

2. Use simple, concrete language
This is not the time for euphemisms.  Children tend to be very literal in their understandings of the world.  If you say, "We are losing grandpa" they might not understand what that means. Saying, "Grandpa's heart and lungs are sick, and they are having a hard time doing their job to keep him alive, so he is dying" is preferable. Do not be afraid to use the words "Cancer" or "Dying" or "Death."  Odds are, your child is probably already thinking it, so saying it out loud gives them permission to ask questions.

3. Be open to questions
This is not necessarily comfortable. But giving your child space to ask the questions that they have is an important way of caring for them. It is a way of assuring that they are seen and heard. Also be willing to admit, "I don't know the answer to that" and enlist the help of nurses, doctors, social workers, chaplains, and education professionals.

4. Provide reassurance
Children often have questions related to security, such as, "Who will take care of me?" and "Can we afford this?"  It is crucial to remind children that they are loved and cared for, and they will continue to be cared for. If parents are unable to be provide the necessary care and support while hospitalized, enlist the help of other relatives or caring neighbors to provide support and attention. Also, reassure children that financial matters and other "adult" worries are being taken care of. A child's most important job is to continue to be a child.

5. Encourage children to be as involved (or not involved) as they wish
Provide children with the opportunity to visit their parent/grandparent/other family member in the hospital. Because of developmental needs, children often need to see someone who is sick and/or dying to understand what is happening. There is often an impulse to give children happy memories or not see their relative in a sick or weakened state. But also give your child an opportunity to refuse. Do not pressure them to touch the sick person or talk to them, as this is an extremely difficult situation. If you child chooses to visit someone who is seriously ill or dying, designate a specific support person for them during that time. Make sure that person is attentive to the needs of the child.

6. Prepare children for what they will see upon visiting
Provide careful and developmentally appropriate information. For a younger child you could say, "Your mom has a tube down her throat. It is breathing for her."  For a teenager you could say, "Your mom is on a sort of life support called a ventilator, it is doing the work of breathing for her." You could describe the room and talk about who might be present in the room ("Your dad has a nurse and a doctor in his room with him who are taking care of him") and encourage children to talk to their parent/loved one or touch them if they like. If someone has extremely traumatic injuries, be sure to emphasize that their pain is being managed by the medical team.


Here are some resources that I have used in my work:

When Someone Has a Very Serious Illness by Marge Heegaard

Resources from the American Cancer Society

The Elephant in the Room by Amanda Edwards

I hope to continue to curate a list of other resources. Stay tuned for my next blog post about how to talk to children about death and grief.

What Not to Say: < awkward silence >

A.Hanson, Boulder, 2010

Today's phrase in the "What Not to Say" series is not saying anything at all.  I think we have all had the experience of not wanting to say the wrong thing.  So perhaps we think that the best thing is not to say anything at all.

One of the most hurtful things that compounds bereavement is when one's friends drop off the face of the earth.  Sometimes we don't want to exacerbate someone's pain unintentionally, by saying something wrong.  Or perhaps we are afraid of unintentionally unleashing a tsunami of grief by asking the wrong question. Or perhaps we just can't deal with other people's tears or pain.

I know from my own personal experience and from the people that I accompany through their own grief, saying nothing at all is painful.  There is a fear that if you should ask about someone's recently deceased loved one, you will cause them increased pain.  The pain exists whether or not you mention their loved one and one of the few things that can be balm to a grieving soul is talking about the person they love and miss and have lost. Telling stories of your wife or father or sister or son is a way of preserving their memory for just a bit. Talking about the loved one that has been lost is a way to make sure that they are not forgotten, which is one of the greatest pains for those who are left behind.

It is not likely that a kind and compassionate conversation will unleash a torrent of grief that cannot be stopped.  People who are in grief are already living in a place that is overwhelming.  Your reaching out might be a life raft.

I have almost nonexistent patience for people who cannot stand to witness others' grief. This is one place where it is really difficult for me to summon compassion.  You do not have to say anything profound, because honestly, there are sometimes just not words.  But showing up and showing that you care goes a long way, so try to get over your discomfort about tears and runny noses and pain, and meet your friend in your humanity. Because one day you are going to need the support of your friends too.

Here are a few things to say instead of saying nothing…

"I just don't know what to say, but I am here for you."
"I cannot imagine what you are feeling, how much pain you are in, but I love you."
"I wish I knew what to say. Would it be helpful if I walked your dog/babysat your kids/brought you dinner?"

What not to say: "You can have other children"

A. Hanson Denver, 2014. Blue Christmas. 

Today's post in the series, What Not to Say is particularly heartbreaking.  I have encountered well-meaning people saying "You can have other children" to those who have recently experienced a miscarriage or to those parents who lost a child or children just before birth, during birth, or in infancy.

It is so heartbreaking because in saying this to grieving parents, you have completely ignored the reality of an already-loved and cherished child who is very real and a part of this world.

One of the most heartbreaking spaces where I find myself as a chaplain is the birthing room with parents whose child died in the womb, during birth, or shortly thereafter.  It is a liminal space in which life and death are so intricately intertwined, that it is impossible to distinguish one from other. The crushing reality of not leaving the hospital with a newborn is suspended for a short time. Parents will hold and kiss and snuggle their baby and say the things they need to say.  As hospital staff, we do our best to create memories with footprints and handprints and locks of hair. This space of honoring all the lost possibilities and potential of this child, THIS child, is so very necessary.

Saying, "You can have other children" ignores the child who has died. But it is also cruel because there is no guarantee that there will be other children.  Conception may have been difficult, there may have been complications that make future pregnancies difficult or impossible, or perhaps the grieving parents just cannot bear the pain of infant loss again.

The most painful thing is to pretend as if the child never existed, that a miscarriage or other infant loss is merely something to get over.  To be so scared and uncomfortable with someone else's pain that we cannot even bear to talk with them.  Please never say, "You can have other children" because those potential future children are not what we are talking about now.  We are talking about the beloved one who has been lost.

Try saying this instead…

I am here for you in whatever way is helpful.
I would like to hear your baby's story, if you want to tell me more, I am willing to listen.
I love you.

Or the ever helpful,
Here is a casserole.  Please bake at 350 degrees for 30 minutes.

What not to say: "Everything happens for a reason"

A.Hanson, Denver, 2011

I stumbled across this really excellent article the other day, ""Everything Doesn't Happen For a Reason" by Tim Lawrence. It articulates the philosophy behind my care in chaplaincy.  I spend nearly all of my work hours walking alongside people who are living the very worst days of their lives. There really are not words for these moments, so most of the time I just stand or sit quietly. My ministry is one of presence.

But there are things that well-meaning people say that cause more harm than good.  I should preface that my patients guide their own care.  If someone expresses the belief that their illness or suffering, or that of their loved ones, fits into a plan that is meaningful or provides hope, I would explore that system with them.  I would never dismantle structures of meaning for someone.  This series of posts, "what not to say" is directed towards those who wish to support those who are suffering.

Platitudes like "everything happens for a reason" are misguided attempts at support that are much more like self-soothing on the part of those who seek to assuage their own discomfort.

Placing suffering into some greater plan is an attempt to push back the deep paralyzing fear that a crisis could happen entirely randomly. If we admit that someone experienced an entirely undeserved and random event, the unspoken corollary is, "It could happen to me too."

The task of placing meaning onto a random event, to find some greater purpose in suffering, is ONLY for the person for whom the suffering belongs.

Let me repeat that, ONLY the person who is experiencing the rupture of the fibers of their world can place meaning for good onto their suffering. 

No clergy-person or well-meaning friend or family member can assign a greater purpose to suffering.  Suffering is never part of God's plan.  It is not about drawing someone closer to the divine or reminding them to trust in God or turn their lives over to a higher power.

Meaning can be found on the other side of suffering.  I know many families who have found purpose in advocating for organ donation or financial support for disease research or have indeed found that their experience of suffering encourages them to draw closer to the divine.

But I also know people and their families whose lives have been destroyed. Who never recover.  Who never find meaning in their suffering.

Not everything happens for a reason.  Sometimes shit just happens.   By saying, "Everything happens for a reason" we refuse to see the person who is suffering. We do not see the pain right in front of us, instead, we jump forward to some greater meaning at the expense of the very real person who is living that pain.

Instead of saying, "Everything happens for a reason," say, "I can't imagine what you must be feeling. Can I sit with you?" or "I see you."

Or better yet, don't say anything.  Just be.  That's what I do a lot of the time.

Stories in chaplaincy: Miscarriage

Miscarriage. It drops into conversation like a bomb and silences everyone. It is a source of silent shame and deep pain. It is the death of hope and potential. It is a "personal problem" and a "woman's problem." It is tremendously common and yet deliberately hidden.

I was called into one of the small Emergency Department rooms early in the morning. My patient was lying in bed, covered in warm blankets. She was pale and tired. She had been there all night. She asked if I would hold her hand. She was alone.

We sat in silence for what seemed like hours. She said, "I didn't even really want it, you know. I was still trying to decide what to do with it."  I waited in silence.  "But its even more confusing, now that it's gone. I feel like I should be happy or sad. But I don't know what to feel."

I continued to hold her hand. I said, "What are you feeling?"

"Like I am missing part of me."

I decide to take a risk, saying, "Do you want to say goodbye?"

She started to cry and nodded. I stepped out of the room. A small specimen jar at the nurse's station contained the products of conception. I wrapped the jar in a towel. I cradled it gently in my arms as I walked back into the room and handed it to her.

She cradled the bundle and wept over it. She whispered for a few moments and then handed it back to me. Still holding the bundle gently, I left the room and returned it to the RN. I returned to the patient who was sleeping now. I stroked her hair off her forehead gently and turned to leave the room.

I said very little words in this interaction, but I made deliberate choices as pastoral interventions. I carried her fetal remains as an infant, wrapped in a towel, and handed them to her as such. I recognized the need for a small memorial service of sorts. This moment of ritual and of saying goodbye was just a few moments in the timeline of her hospital stay, but I hope that it made a difference. I hope that she had the time to say what she needed to say to her potential child and that moment, while filled with pain, was filled with humanity.  A fetal demise is not just a biological process, it is a death and requires ritual and attention.