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Talking to Children about Death

What Can My Child Understand? continued...

3- to 5-year-olds have response that are shaped by the way they see the world:

  • They are magical thinkers and don't understand the difference between fantasy and reality. They may believe death is temporary or reversible.
  • They are ego-centric and may believe the death of a sibling is punishment for something they did.

Tips for helping 3- to 5-year-old siblings cope with their feelings about a sick or dying child:

  • Use concrete language, such as "die," not euphemisms such as "sleep."
  • At this age a child can understand "Your brother's body stopped working"; "Your sister stopped breathing."
  • Make it clear to siblings that the death is not a consequence of something they did.

6- to 9-year-olds have a more evolved sense of dying:

  • They ssociate death with old age. They may not understand that they or a sibling could die.
  • They know more about how the body works, so they may have specific questions about how someone dies. A sibling may think that a bruise on his own body indicates the same illness a brother or sister had.
  • They may associate death with frightening images from cartoons, such as ghosts and spirits.

Tips for helping 6- to 9-year-old siblings understand their feelings about a sick or dying child:

  • Use visual aids they can understand. Child life specialists have used marshmallows to explain tumor growth or described leukemia as a thickening of the blood.
  • Make specific references to organs like heart and lungs.
  • Make clear that death is not like the images in cartoons.
  • Make clear to siblings that what happened to a brother or sister doesn't happen to everyone.

10- to 12-year-olds understand the permanence of death:

  • They know that death is final and will happen to everyone including themselves.
  • They understand that their own death or the death of a sibling will cause sadness in others. A sick child at this age may say he has to hold on for his parents' sake.
  • They will respond more like adults with anger, sadness, and fear.
  • They will have increasingly more specific questions about the illness and about death.
  • They can find information on their own.

Tips for helping 10- to 12-year-old siblings of a sick or dying child:

  • Find opportunities for constructive venting of feelings, such as sibling groups at hospitals and art or play therapies.
  • Provide as much specific, factual information as possible.
  • Keep siblings in regular routines as much as possible. It may not seem like long, but professionals advise that children under 12 not miss more than a week of school after a sibling has died. But they acknowledge that each child has unique needs.
  • After a death, make sure siblings still have a clear role in the family, but don't let them take on a parent's role.

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