Cancer Health Center

No Regrets: Discuss Death With Dying Child

No Regrets continued...

But for parents who couldn't face "the talk," there was true regret later, Kreicbergs reports.

"Even though they knew that death was coming -- and they felt that their child was aware of imminent death -- they could not talk about it," she tells WebMD. "It's a situation where the child is trying to protect the parents, and parents are trying to protect the child. It's such a hard situation to witness. I think we could help those parents and children. I think it's easier for parents who have had this discussion."

In fact, it is conceivable that children are aware of their impending death -- even if parents or health care workers do not always notice this awareness, she says.

How can parents bring up this sensitive subject? Watching a special movie like The Lion King -- where death occurs -- is one way, Kreicbergs suggests. "Just ask a very simple question about death, let them express how they feel about it. How they feel will be based on the child's age, religion, culture. But just letting the child talk will help."

Many parents said their child "adopted" the movie as a sort of symbol of their struggle, she adds. "They often didn't bring anything else to the hospital except a copy of that movie. So many children are aware of the situation, are aware they are going to die, and are trying to prepare themselves for it. They want to see these stories where death occurs, to really identify what death is."

Child's Age Makes a Difference

Eugenio Rothe, MD, professor of child psychiatry at the University of Miami School of Medicine, was not involved in the study. But he offered his insights on preparing for the death of a child.

"The most important thing to keep in mind: Children don't begin to understand the finality of death until about 9 years old," Rothe tells WebMD. "Before that age, it's important to be with the child, so the child feels supported, does not feel abandoned."

But many very young children ask about death, he says. "Try to answer them at a level the child can understand. Encourage them to talk about it -- what they think about death, about angels, about heaven. You can hear from the child what they are ready to understand."

By age 9, children have a more realistic idea of death. "Pets die, grandparents die. That's when it becomes real to them," Rothe tells WebMD. "Most of the time, children can sense when their end is near. It's a very, very delicate point how to deal with that. Some children and adults do better using massive denial; others do better knowing what's going on. Be aware where the child is at, and probe lightly to see what they can process.

Most of all, it's critical that parents stay close to the dying child. "Years ago, parents were not allowed in the hospital when children were sick," says Rothe. "Now we know that's very detrimental, it can cause double traumatization. It's universally encouraged that parents must be there for their child" when death of a child is imminent.