Marilyn Heins: Hospice, funerals and children

‘Our grandchildren are 5 and 7. My father is 91 and terminally ill with cancer and heart failure. The children saw him frequently before he went to hospice. Should we take them to visit?”

“My 3-year-old keeps asking to see my father who is going home on hospice care. Can a visit to a person this sick harm my son?”

“What are the rules on taking children to funerals?”

All children will one day be confronted with the painful realities of life. The most painful reality is death. All living creatures die. Death is sad. However, parents are the buffer between a bewildered child and the sadness. This means that while parents are themselves grieving they have to find the strength to help the children deal with their sadness.

A child’s understanding of death is developmentally determined. Before the age of 6 or so children may think of death as reversible. But young children do experience grief and loss. They may even feel responsible for the death if they once felt angry at the person and think their negative thoughts killed the person.

There are no “rules” about taking a child to a funeral. Children over 7 who are beginning to grasp the permanence of death should be involved in the family grieving process. A funeral makes the death seem real and gives the child a chance to both honor the dead person and feel a sense of community because others are sharing the grief.

A younger child may not experience the important sense of closure that the funeral can impart. But if the young child is not likely to be disruptive and the child’s parents will not themselves be so overcome by grief as to disturb the child, there is nothing wrong with taking the child to the funeral.

Prepare children ahead of time as to what will happen at the funeral including lowering the coffin and covering it with earth. Someone familiar to the child but not involved in the ceremony should be with the child at all times to help the child with the grief, to answer any questions (“No, Grandpa doesn’t feel anything any more”) or to remove the child if the child gets too upset.

Even if the child may forget attending the funeral, talk about the child’s presence there (“Remember the rainbow we saw the day we said goodbye to Grandma at her funeral?”). This can help the child remember the dead person and deal with any lingering concerns.

Children grieve differently than we do. Some may seem quite callous when told of a death and neither cry nor seem concerned. But children who lose a loved one have the same strong emotions to deal with the loss that we do: guilt and anger. The child may exhibit a drop in school performance, behavior problems, lack of appetite, sleeplessness. These symptoms could occur weeks after the death, so parents should realize the possible association with the death and seek counseling help if indicated.

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When should you tell a child that a loved one is dying? I believe in telling the child the truth and, depending upon the child’s age and the circumstances, giving the child a chance to say goodbye.

Lead up to the bad news. Start by telling the child Grandpa is very sick. If the child asks, “Is he going to die?” be honest. If the child does not ask, give the child a chance to get used to Grandpa’s illness before mentioning death. Always prepare the child for what to expect when he or she visits especially if the person’s appearance is changing or medical paraphernalia is in use.

Do not try to conceal your own grief when you tell the child. Better you cry together and talk about how sad it is that Grandpa is dying than give the impression that grown-ups hide their feelings. Hidden feelings, not honest answers, are what can harm a child who thinks: What is wrong? Why is everybody so upset? Did I do something wrong?

Sharing grief with your child does three important things for the child: it gives the child permission to grieve, it gives the message that you consider the child mature enough to deal with such issues, and it gives the child a sense of closeness and community with the most important persons in the child’s life, the parents.

If a child is properly prepared, seeing a person in hospice care is not harmful though it may be a painful reality.

The toughest task can be dealing with the untimely death of a child. Explain to your child that sometimes children get so sick they cannot be made better again and they die. Go on to explain, “Dying at this age is very rare, what Jimmy has isn’t catching, you are not sick and you are not dying.”

Be sure to add this makes you feel very sad. Cry, if you can, and hug your child. Give the child plenty of time to express his or her own sadness. Ask your child if he or she can think of anything the sick child might like to have.

Help the child memorialize the friend. Plant a tree, make a contribution in the child’s memory, have the children draw a picture of their friend, or make a card for his parents.

Your child can learn a valuable lesson from you by hearing what you say to the sick child’s mother. “My heart goes out to you and I don’t have the words to express how badly I feel.” To reach out we have to do only four things: look the person in the eye, hug the person, say how sorry you are, and ask how you can help.