Understanding bereaved children and young people

The way in which children are communicated with and involved at the time of the death of a parent or a sibling will affect how they are able to grieve at the time and how they manage loss in the future.

When talking to bereaved children it is important to remember that each child is an individual and may well react differently. What they need is information and the chance to ask questions, to be answered honestly and to be given the opportunity to express how they feel.

Children's responses to bereavement

How children respond to the death of a family member depends on a number of factors including:

• Their age and consequent understanding of death
• The nature of their relationship with the person who has died
• The circumstances of the death
• The reaction of other family members to the death
• The overall effect on the family unit
• Their culture and religion

Breaking sad news to children

Ideally parents are the best people to talk about sad news with their children, but if they are unable to do this then a close relative known to the child or a caring adult would be most helpful, although sometimes this difficult task falls to the health professional caring for the person who is dying or has died. It needs to be sensitively explained as soon as possible so that the children don't find out inadvertently from someone else or are left for hours anxiously wondering what has happened. It is important to try and find out what the children already know or have been told. Ideally a place that is free from disturbance needs to be found with sufficient time set aside to explain what has happened, to answer questions and to offer comfort and reassurance.

When talking to young children it is important to remember that touch is a valuable way of communicating and to recognise the comfort that physical closeness can bring. Try to find the right moment with children when they feel open and able to listen or to concentrate on what you are saying, pick up on their cues or wait until they ask a leading question. What is said will depend on the age of the child, but particularly with younger children what has happened needs to be made very clear so there is no chance for misunderstanding. Euphemisms such as "gone to sleep" or "Daddy has passed away" are not helpful.

The rate at which information is given should be varied according to the children's level of understanding and open-ended questions can be used to encourage them to respond and ask questions. Picking up on particular things the child has said and asking them more about what that means to them, helps to ensure the child has understood what had been said. The information given must be truthful and consistent. Children do not need long detailed information, but easy to understand explanations.

Children, like adults, will experience shock and disbelief and may not take in everything at once. They will assimilate as little or as much as they can bear at any one time. They are likely to need repeated explanations with pauses to enable them to digest the information and they may want to have time alone. They need to be told what is likely to happen next, who is available to help them. Clear information needs to be given about the opportunity of returning at a later date to ask questions from the professional staff they have met.

Children's reactions can vary from deep despair to denial or active protest. Whatever their reaction, it is important that they are allowed to express their feelings without being stopped or urged "to be brave" or "to be the big boy now who can look after the family".

When deciding whether children should see the dead person, parents may be concerned that frightening memories will be powerful and children will be very upset - this is unlikely to be the case, especially if the children have been prepared for what to expect. Factual explanations of death are helpful. 'When people die it means their body doesn't work any more and although they will look like they are asleep, they are dead, because when you are just asleep your body works very well.' It is useful to explain that the person may feel cold to touch and their skin colour may be different.