My five-year-old son has had leukemia since he was about one and it keeps recurring despite aggressive treatment. How can I begin talking to him about dying?
A. A child’s understanding of what dying means will be different from what we might think as an adult. The monumental existential issues of loss and finality most often have little power for children. Instead your child may be most concerned about separation from you, in an immediate, physical sense. In whatever you say, therefore, be certain to include reassurance that you will always be there to comfort and care for him. Children deserve to be treated honestly. It is only fair to tell them when the treatments have stopped working. But it is certainly acceptable to balance the bad news with some good. When a decision has been made to halt further chemotherapy, for instance, it is OK to emphasize that he won’t have to go to the hospital nearly as often, that there won’t be so many needle-sticks anymore, and that your family will be spending a lot more time together at home and having some fun. Your pediatrician, the cancer program or the local hospice will be able to help and will have
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