A child’s age and maturity will affect how he or she reacts to the news that someone they love has a serious illness.  The guidelines below are broken down by age and offer ideas on how to support children at different levels.

Before age 3
Babies and toddlers live in the moment.  They feel the emotion of what is happening around them even though they don’t understand illness.

Behaviors you may see:

• May be more fussy
• May be harder to soothe
• May “regress” or begin to act like a younger baby. This can include their sleeping, eating and toilet habits. For example, a toilet-trained child may return to needing a diaper again.

How to help:
Provide security and as much routine as possible
A caring presence and a regular routine help babies feel safe and secure. Try to keep a regular schedule for meals, naps, story time and bedtime as much as possible. You may want to use simple words, like “grandma is sick” to explain changes they are seeing in the family.  Lots of physical contact at this time is helpful and comforting to young ones.

Guidelines for children 3 – 5 years old

Children ages 3 to 5 are sensitive to major changes, strong emotions and other behaviors in their parent or caregiver.   We should expect them to react to changes in their normal routines and to frequent, unplanned separations from their mother or main caregiver.
Expected behaviors:

• Brief outbursts of emotion followed by play
• Waking up very scared (“night terrors”), nightmares, and trouble sleeping
• Not wanting to be separated from parents or caregivers
• More temper tantrums and stubbornness
• May “regress,” or begin to act like a younger child. This can include sleeping, eating and toilet habits.

How to help:

Talk to the child about the illness
Use words your child understands.  Children at this age take things very literally.    Pick words that talk about the real illness instead of using words that avoid what is happening.  Brief, concrete explanations are best.  This may be something like:

“You know that Grandma is very very sick.  That is because she has a sickness called heart disease. “

“Heart disease is not like a regular sickness because you can’t get it from germs, and no one can catch it from anyone else.  Grandma did not get sick because of anything you did.”

“I am really mad and sad about Grandma’s illness.  How do you feel about it?”

Inviting children to draw a picture or make a card for the person can be a good way to end the conversation.

Explain what they are seeing and hearing
As the ill person becomes more sick, use very simple terms to explain the changes the child may see. Explain things gradually as changes happen. For example:

“Daddy is very, very sick.  That is why he’s so tired and sleepy lately.  The doctors are trying to help him with his sickness, but he won’t be strong enough to play ball with you for now.”

It is important to not give the child false hope. This can cause them to lose trust and be confused.  If asked, “Is Daddy going to die?” you might say something like:

“People have died from the disease that Daddy has, but the doctors are doing everything they can to keep him comfortable.”

Even as the possibility of death comes closer, it’s important to talk to the child about what is happening.  Reassure them that they will be cared for and talk with them about how family life will continue.

Help children understand that what they are feeling is normal
It is helpful to set aside a regular time each day when children can ask questions and share their feelings. Evening can be a good time to do this. If other demands make it hard for you to find this time, you may want to ask a trusted family member or friend if they can be with the children at a regular time each day.

Children this age usually don’t ask many questions about the illness because they don’t know what to ask.  Parents may think that the child isn’t affected by what is happening when the child doesn’t ask questions. The child may also use play as a way to express feelings.  Realize that these are both normal ways of coping at this age and don’t mean the child is not upset.  

Let children know that they are loved and will be cared for 
Keeping regular routines and schedules helps reassure children. Let them know ahead of time when there will be changes to their routine. They may find it harder to separate from you during this time. Try to limit the number of different people who care for them. If possible, have the same relative or babysitter care for them when you are away.   Express your love and affection often.

Allow time for play
Children work through stress and emotions by playing.  Play allows them to take a break in the midst of everything that is going on around them.  Play also helps children make sense of all that is happening in the family.  Giving children a play doctor kit, colors, markers or paint and paper gives them way to work through their feelings. Encourage kids to be kids and play!