Part 4 of our 6 part blog series sharing coping tips to help support children when someone they love has a serious illness.

Children ages 9-11 are able to understand more about the illness than younger children and may ask about the details.  Their desire to know these details may make it seem like they don’t have a lot of feelings about what is happening.  Yet getting facts to help them understand what’s going on is one of the ways that they cope with scary and strong feelings.

Children this age understand that death is final and can feel sad about a future loss.  They wonder how they will be impacted by illness and death and who will do the “daddy” or “grandma” things.  When one parent is terminally ill, the child often fears the death of the other parent and worries about what will happen to them if both parents died.  They tend to hide emotions and it’s easy to think the situation is affecting them less than it is.  They may silently wonder, “Can I catch this?” “Did I do or say something to cause this?” Or they may create their own explanations when they are not given facts about what is happening on a regular basis.  Children this age welcome distractions of school, activities and friends.

Behaviors to expect:

• A lot of interest in understanding the disease, treatment and progress
• Wanting to avoid strong or scary emotions
• Not wanting to talk about or show feelings
• Anger (used to cover fear, anxiety and grief)
• Angry and mistrustful reactions when not given the facts about what is happening
• Strong reactions to stress and normal frustrations in every day life 
• Wanting to stay active with schoolwork, sports and outside activities
• Wanting to help care for the ill loved one

How to help:

Talk openly with the child about the disease
Watch for opportunities to talk about the illness and explain what children are seeing and hearing. Include them in discussions and updates. If children are not given enough information they will listen in doorways or strain to hear whispered phone conversations and may jump to false conclusions.

Talk about the name of the disease, how it affects the sick person, causes, and side effects of treatments.  Children also like learning things from doctors and nurses when possible.  You can try to be optimistic about what to expect but not give false hope that the person will heal from the illness.  So, instead of saying, “Grandma is a fighter, and she will be cured,” it would be better to say, “The doctors and nurses are working hard to help Grandma feel as comfortable as possible.  She may be well enough to come to your birthday party this weekend.”

Encourage children’s natural interest in the illness by reading together and providing time to write or draw.

These are some common questions:
How did she get it?
Can I get it?
How do you know I won’t get it?
What if the medicine doesn’t work?
What will happen to me when she dies?

Reassure children the illness is not their fault. Gently let them know when the person may be close to death.  This will help them to make final visits and say goodbye.

Let children know that what they are feeling is normal
Let them know that the situation is hard for everyone and that the family will deal with it together. Remind them often that your moods are not their fault.  Encourage them to express their thoughts and feelings about all the changes that they are seeing in themselves, in you and in the patient.  When it is time, acknowledge sadness about the possibility of death.

Prepare ahead of time for changes in routine 
Children need time to prepare for changes.  Talk with them ahead of time about upcoming changes in their routine as much as is possible.

Offer children ways to be helpful
Some children this age want to help take care of the sick person as a way to show their love and caring.  Let them help by doing simple things but limit their responsibilities so they don’t feel burdened.  Children can help the patient feel loved by drawing pictures, telling the patient they love him or her, talking quietly, sharing favorite memories, etc.

Be an advocate for children
Help the child stay active with after-school activities and by spending time with their friends.  Let teachers and other supportive school staff know about the illness so they can provide support as needed.  It is not uncommon to see a temporary drop in grades due to changes and stress at home. You may want to ask teachers for homework packets if you know children will be absent from school.