Palliative care professionals are no strangers to difficult conversations — including those involving children. While most of us are not afraid to talk to children about death and dying it is important to consider each situation as unique, particularly if family dynamics are complex or time is limited. Whether the child has a life-limiting illness themselves, is a sibling or the child of an adult with a life-limiting illness, effective communication with children about death and dying will require specific communication skills and an in-depth understanding of family-centred care in the palliative care setting.
A Whole-Family Perspective
Every family is different. Some parents and carers have open, ongoing conversations with their children about death and dying, while others struggle with how to start discussions. As health professionals, we play a vital role in helping families navigate this time.
Even if we’re not directly responsible for providing support to the child, we can:
- Prompt conversations with parents and carers about what their children understand.
- Offer resources to help explain illness and dying in age-appropriate ways.
- Work alongside social workers and pastoral care workers to ensure the child’s needs are considered as part of the care plan.
Here are some ways professionals can refine their approach and build on their existing confidence:
Start Early and Normalise the Conversation
Rather than waiting for a crisis point, aim to bring the topic of the child’s wellbeing into conversations early on. Phrasing like “How are the kids managing?” or “Have you been able to talk with them about your illness?” can open up space for honest discussion.
Support Parents and Carers to Lead
Most parents and carers want to protect their children, and many worry about saying the wrong thing. Palliative care staff can support them by:
- Reassuring them that children often cope better when they’re informed.
- Offering simple scripts or language suggestions.
- Being available to answer children’s questions directly, when appropriate.
Tailor Communication to the Child’s Developmental Stage
Children process illness and loss differently depending on their age, maturity and past experiences. Brief, honest explanations are usually best. Avoid euphemisms that can confuse or worry children (e.g., “gone to sleep”). When in doubt, consult colleagues with paediatric or psychosocial expertise.
Work as a Team
No one person needs to carry the whole load. A collaborative, multidisciplinary approach – involving clinical staff, allied health, pastoral care and volunteers – makes it easier to ensure that families receive consistent and thoughtful support. Flag concerns at team meetings, share resources, and refer to external services when needed.
Support for children does not need to only be provided by those in the palliative care team. Wherever possible engage a network around the family. Schools, sports clubs, counsellors and friends all play a role.
Suggestions for Practice:
- Include questions about children in initial and ongoing assessments.
- Offer parents and carers language and guidance for age-appropriate conversations.
- Partner with palliative care team members to create a shared plan for supporting children within a family.
- Build relationships with community organisations who can help families long-term.
Resources:
- PalliLEARN courses: Palliative Care NSW offers a free online easy-to-understand introductory course about this topic. Click HERE for more information.
- The new edition of Palliare includes several chapters that can support volunteers to better understand how to communicate with children about death and dying in various palliative care settings.
- For families that may need resources and support CareSearch has printable information.
- An Overview to Family Meetings and Difficult Conversations. Click HERE to access it.
- Paediatric End-of-Life Care Communication offers a specialised course for healthcare professionals working in paediatric end-of-life care. Gain essential skills to communicate effectively with children, young people and families.
- The Green Book aims to empower clinicians to care for infants, children and young people with life limiting conditions and their families. This edition includes practical supports, psychosocial issues, bereavement support, communication resources. Click HERE to access it.