Talking to Children About Serious Illness and Grief

Adults need to begin serious illness conversations with children but follow their lead in terms of how much information they want and how they wish to receive it. Adults can model emotions and show that it is ok to have questions and express emotions. The 6C’s and 3W’s are two frameworks to guide conversations with children about serious illness. They can help enhance opportunities to talk with children about their thoughts and feelings, while providing space to listen and validate⁴.

Serious Illness

The 6 C’s

Common questions children have about serious illnesses⁴

1. What is it Called?
2. Can I Catch it? Reassure they cannot get sick just by being close to someone they love
3. Did I Cause it? Children believe in magical thinking, and we can gently reassure this is not their fault
4. Can I Cure it? Children often want to fix things.
5. Who will take Care or me? Children may worry about their own future and who will care for them which may cause anxiety or fear underlying.
6. How can I Connect to people I care about? Sharing memories, spending time together or using linking objects to help maintain that bond over time.

The 3 W’s

Talking about children’s Wonders, Worries, and Wishes will help them to feel supported and less alone with their feelings, thoughts and potential fears about serious illness.⁴

1. Clarify the child’s understanding of the illness, or anything they are Wondering about. This is an opportunity to explore their level of understanding and meaning they have attached to words and concepts.
2. Allow the child to express their Worries about the illness. This may include worries about various aspects of their life such as friends, family, school, etc. Avoid judgement or minimizing difficult topics or concern.  Note: It is common to offer reassurance by saying “don’t worry”, but telling children not to worry can unintentionally make them believe that they cannot openly talk about their worries.
3. Encourage the child to express their Wishes. For instance, you could ask the child “Is there something you wish you could do or have happen?” You don’t need to have all the answers. It is appropriate to wonder about things together, to worry about difficult things, and to wish for things that may or may not be possible.

Grief

Children express grief in different ways than adults. While children may not understand death to the same extent as adults, it is important to remember that children aren’t too young to understand, or be included in, related activities.
How parents and others grieve affects the way children grieve. Adults who acknowledge their feelings are better able to help their children to accept and understand their grief. ^1,2,3

• Include the child in what is happening¹
• Be honest and give answers in words they understand while giving lots of support³
• If the death is a result of illness, reassure children that illness does not always lead to death³
• Tell children that their thoughts and feelings are normal and it is okay to cry²
• Encourage them to express feelings with talking painting, poetry, puppets and music³
• Try to keep the children’s same routine as much as possible²
• Use specific concrete words- not euphemisms; Avoid “Grandpa has gone to sleep”²

Developmental Milestones and Strategies

Birth-2 yrs	Nurture and comfort by anticipating and addressing emotional needs. Maintain close physical and emotional connection to significant others. Try to keep schedule of routine activities.
2-5 yrs	Magical thinking: believes their thoughts, actions words caused the death; or can bring deceased back; death is punishment for bad behaviour. Regressive behaviours may occur, not wanting to sleep alone, separation anxiety. May think death is their fault. Give age-appropriate realistic information honestly. Keep stable structure environment. Create opportunities for play.
5-9 yrs	Begins to understand the finality of death. May fear that death is contagious. Very curious about what the body looks like. Include the child in funeral ceremonies if they choose. Encourage the child to talk of feelings through words play or drawings. Give clear honest information. Ensure child does not feel responsible in any way.   Notify school for additional support
9-12 yrs	Self conscious about their fears (own death, remaining parent dying). Talk to teacher at school maintain routines. Provide appropriate ways to work out anger and aggression. Provide opportunities to express self and feelings. Encourage outside relationship with trustworthy mentors. May see disrupted relationships with peers.
Teen	Approaching adult understanding. Many prefer to express their grief privately or with their friends. Provide outlet for strong feelings (sports, recreation), open communication, peer support, honesty. Set clear limits and expectations and seek out support groups for the teen/family.

Resources

• Southwestern Ontario Hospice Palliative Care Education Program. (2017). The Fundamentals of Hospice Palliative Care, Second edition. London, ON: Southwestern Ontario Hospice Palliative Care Education Program, St. Joseph’s Health Care London.
• Davies B, Limbo R, Jin J. Grief and Bereavement in Pediatric Palliative Care. In: Ferrell BR, Coyle N, editors. Textbook of palliative nursing 3rd ed. New York: Oxford University Press; 2010
• HPC Consultation Services, Waterloo Wellington & WW Integrated Hospice Palliative Care. (updated 2025) Advanced Palliative Practice Skills for PSW’s
• Sick Kids PACT (Paediatric Advanced Care Team) 2021. Parts of this document were adapted from Kidsgrief.ca

Additional Resources

• Family Education Centre, Brampton, ON.  Parenting Grieving Children e-Learning Courses
• Kids Grief, ages 0-18   www.kidsgrief.ca
• Youth Grief https://youthgrief.ca/  Overview of grief experience and expression by developmental stage and provides discussion on supports and resources

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