Today Dr. B (our resident early childhood development specialist) returns with the very serious topic of talking to your child about dying and death. It's a heavy subject matter for Mommy Shorts but my heart went out to two readers who recently sent questions to Dr. B asking for guidance.

One letter was from a woman whose father is quickly deteriorating and she wants to help her four-year-old daughter cope with the inevitable loss and the other letter was from a mom who doesn't know how to explain the death of their family dog to her three-year-old.

Dr. B says the following suggestions can be applied to either situation. It is not intuitively how I would have handled it, so I feel it is very helpful and much-needed advice.

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When a loved one becomes terminally ill or dies, it is difficult for everyone in the family. Although we want to protect our children from sad feelings and events such as death, it is usually not the best approach.

Children are usually able to sense that something is wrong, especially when a family is grieving. It is important to provide them with developmentally appropriate information so that they don’t misinterpret their family’s grieving as something else which may create unnecessary fear and anxiety.

The way you explain the illness or death depends on your child’s age. The challenge is providing your child with the appropriate amount of information so that they understand what is happening, how it will impact them, and why people are sad or acting differently, without confusing them. 

Suggestions On How To Address Death And Dying With Young Children:

Explain what is happening in developmentally appropriate terms. Infants and toddlers are very concrete and literal in their thinking and their understanding is limited to their own experiences. They don’t understand the finality of death and have difficulty understanding that the person or pet that has passed will not come back. Preschoolers are very curious about death, especially the physical aspects of death (e.g., where the person is, the food they will eat, or clothes they will wear), and they may ask several questions to try to grasp the concept. Therefore, your explanations should be clear, simple and factual. For example, you might say, “Grandpa is in the hospital because he is sick and his body isn’t working right. There are a lot of machines in his room that are helping him get better.” Or if the person or pet dies say, “His body stopped working.” Children are scared of the unknown so the best way to reduce their fear is explaining novel things in language they can understand.

Be careful about using language that may cause confusion or fear. Children have a tendency to oversimplify what they learn and think in terms of cause and effect relationships (e.g., if X happens, Y will follow). Be aware of how your child may interpret the language or information you give them. Do not use vague explanations such as “grandpa went away” or “is sleeping” because your child may begin to fear these events whenever they occur and associate them with death. Similarly, words such as “sick” or “boo-boo” should be clarified so that a child does not mistakenly think that any time a person gets sick or gets a boo-boo, there is a possibility that they will die.

Respond to your child's questions in concrete, literal terms with only as much information as your child is asking for. It is important not to read too much into children’s questions and to answer questions one at a time. Responses to questions should be short, truthful, and to the point. For example, when a child asks a question such as, “Where is grandpa now?” a religious or spiritual response is not necessary and your child will probably be satisfied with something like, “He’s at the cemetery.”  Similarly, infants and toddlers think death is reversible and it is typical for them to ask multiple questions about when the person or pet is coming back. Keep reiterating in a calm and matter of fact way that the person died and is not coming back. Then direct them to a tangible reminder of the person (e.g., toy or picture).

Try to understand the loss from your child’s perspective. Adults tend to interpret a child’s feelings about death from their own perspective and forget that children do not have the same understanding, fears, and perceptions of death. For instance, an adult may think that a child is upset about the loss of a loved one when they are really upset about something specific about the loss that impacts them. For example, a child may start to cry when they hear “you won’t be able to play at grandma’s house anymore,” because they love swimming in grandma’s pool. It is also common for a child to think that something they did or said could have caused the death. Make sure your child understands that the death was not their fault. Attempt to acknowledge your child’s feelings, understand what is truly upsetting to them, and ask questions about why they are upset so that you can correct any misconceptions they may have.

Acknowledge your child’s feelings. Make sure to validate your child’s feelings about the event by labeling their emotions. If your child becomes upset or angry as a result of the loss, do your best to describe what you think they might be feeling. You might say, “You are sad because I said grandpa can’t play with you anymore.” If they are scared about seeing the person in the hospital, say “You are scared because grandpa looks different,” Or “You are scared because there are a lot of machines attached to grandpa’s body.” Reassure your child that it is okay to have sad or scared feelings, ask questions about what is making them feel that way, and encourage them to talk to you about their feelings.

It is okay to grieve in front of your children. Sometimes adults think it is important to be strong in front of children. But displaying appropriate degrees of emotion in front of children models for them that it is okay to cry when you experience emotional pain. Showing appropriate emotions in response to sad events such as the loss of someone special, helps children learn that it is okay to cry and be open about their feelings when they experience sadness.

Create special ways for your child to remember the person who has passed and to cope with the feeling of loss. When a child becomes upset or asks to see the person who is dying or who passed away, give them something tangible to do when that person comes to mind. For instance, if your child asks to see grandpa, say, “Let’s go look at [our special picture, video, or photo album] of the two of you together.” You might also give your child a special stuffed animal from the person to hug whenever they are thinking of them or suggest that they draw a picture of something that reminds them of the person.

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Dr. B recommends the following book to read with your child: