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Palliative Care Center

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Talking to Children about Death

What Can My Child Understand?

Each year of a child's life brings enhanced ability to understand the reality and permanence of death.

Infant and toddler siblings of a sick or dying child can feel loss through:

  • Absence of a parent or of a sibling due to the treatment or death of the sibling
  • Interruption to routine caused by the treatment or death of a sibling
  • Grief and stress of their parents or other family members

These tips may help manage the feelings infant or toddler siblings of a sick or dying child may have:

  • Make time each day to hold, rock, and cuddle the sibling.
  • Keep the child on a schedule as much as possible.
  • Play a recording of parents reading a story or talking to the sibling in the parent's absence.

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 associate 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.

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