When Grandma is Going to Die: What to Tell the Children

In recent weeks two mothers asked for advice on assisting their children through the impending deaths of a grandparent. The children ranged in age from 3 to 9. This is one of the most difficult issues for parents to deal with because of the combination of our culture's discomfort with death, the fact that the parent is simultaneously dealing with their own grief process, and parental instincts usually lead us to try to protect our children from anything painful.

The first question was when to tell the children that grandmother is dying. The general rules involve a mixture of the age of the child (the younger the child, the longer you wait) and the amount of contact between child and grandparent (the more they see each other the sooner you need to tell them but this is influenced by when it is clear that something is wrong with grandma). One common error here is to assume the children are not aware that something is wrong. Parents typically underestimate children's awareness of a problem (this includes a range of issues such as marital problems or a job loss).

As soon as the grandparent's health is a serious issue in your home, something should be said to the children. Don't assume that the children aren't aware or concerned unless they are asking questions. Typically, children don't say anything if they don't get permission to discuss the issue by your introducing it. You may simply note that grandma isn't able to play as much with the children, she's making many visits to the hospital or doctor, or they can't visit her as often. This might prompt a child to ask if grandma is going to die. Honesty is the overriding priority because it is the basis for the child's long term ability to trust you as well as being a cornerstone of your expectations of them. So if death is a certainty, tell them so and give a brief, factual explanation of why. Yes, use the word "cancer"! If it is not certain, say it might happen but right now the doctors are working hard to fix the problem. This may lead to questions about your possible death, or the child's, because children are primarily concerned with how events impact their lives. You can't promise children a long life for anyone; you can only reassure them that reaching eighties is the norm and point out the people they know that are old and healthy.

It is important for parents to allow their own grief to be expressed. Crying as you talk to the children is healthy and important. It models how to express sadness and states it is a strength to cry when sad. The stiff-upper-lip model is not the message to give children or the way to deal with your own grief.

Sometimes the grandparent will have asked you not to tell the children. This may result from her/his generation's notion that children were to be shielded from dealing with death or even that it didn't have a serious impact on them. It may also be their anticipated discomfort in dealing with the children's questions or reactions. It is important to firmly reassure your parent that it is best for the children to know and that they are unlikely to ask grandma a lot of questions about her health. You can help to assure this by telling the children to ask you their questions because it is hard for grandma to talk about it. Children will understand this although sometimes a three or four year old will blurt out a comment you wish they hadn't said. Surprisingly, grandma will handle it better than expected.

Children will often be helped by being encouraged to draw a picture or make a card for grandma to express their love for her. Bringing her some hand-picked flowers or something the child wants to make is also helpful. This leads to a common question about visiting the grandparent. The only time I discourage visiting is if there has been some physical change in the grandparent that might be scary for the child to see, e.g., marked discoloration of skin, a proliferation of tubes, or mental confusion. But, usually children can handle most anything if you are calm and reassuring and they are told to ask to leave the room if they feel uncomfortable. The key is telling them ahead of time what to expect. If you have prepared them, children will usually end up telling you it wasn't as upsetting as you thought it might be.

The key theme in all of this is that children are nearly always more resilient than we expect them to be and if we are dealing honestly with our own emotions and with theirs, then they will be okay. This is a normal part of life and we need to convey a sense that while it is sad, it is something that we can deal with and life will continue with many more good things to happen.