How and When Do I Tell My Kids Their Grandma is Dying?

Ask Lisa Podcast, Ep. 76: How And When Do I Tell My Kids Their Grandma Is Dying?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional

mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being,

consult a physician or mental health professional.

REENA: Well, there seems like some hope with spring around the corner.

LISA: There does. Oh, Reena, to have the windows open is making my days so much better.  I just, I love fresh air so much.

REENA: I’m just thrilled that they’re hopefully getting rid of daylight savings time, so.

LISA: You know? That would be a wonderful thing. It is ridiculous and it makes my family so miserable.

REENA: You were saying this went on Instagram Live that you can tell, kids are just a total mess when they lose that one hour of sleep.

LISA: Well, and mostly I  just feel so bad for their teachers, you know, sending them to school like that when they’re kind of a wreck.

REENA: So true, so true. Speaking of time and how valuable it is and how much we’ve realized that this pandemic, we got a letter asking about grief and when do you let someone know that their grandparents are dying. I’m going to read you this letter, Lisa: ‘Dear Dr. Lisa, my kids, 10 and 12, are lucky to have a close relationship with their nana, my husband’s mother. We live locally and Nana’s been a big part of their lives, including regular visits. The past few years have been a roller coaster of cancer diagnosis, surgery, chemo that is working, and chemo that is not working. Treatment options are now exhausted. Nana’s recently entered home hospice care. Right now, she’s generally feeling, looking, acting herself, but we don’t know that time grows short and at some point in the coming weeks or months, we will all have to say goodbye. Dr. Lisa, would you please offer guidance for breaking this news to my children? Should we wait until there are unmistakable physical signs of progressing illness? Or start talking about Nana’s prognosis right away. Additionally, my husband and I will be on the front lines of end of life care giving, and it may be difficult or impossible to shield our children from the realities of Nana’s final illness. Should we even try? We would so benefit from your steady calm perspective on grief and grieving alongside precocious middle grade kids. Likewise, suggestions of books to read together or separately are very welcome. Thank you.’ Do you know what got to me about this is I think it’s something all of us will have to deal with.

LISA: Yep. Yep. This is the normal course of events and something we all need to be prepared to help our kids through.

REENA: So, where does she begin?

LISA: Well, my inclination is to be honest and to really be up front about it because at 10 and 12 especially, kids are picking up a lot of information, and if this woman has already been moved into home hospice care, you know she may in many ways look and feel like the Nana they remember, but if they know her as well as this letter writer says they do, they have to be aware that something is different at minimum and what happens when kids become aware that something is changing a different and yet the adults aren’t saying anything about it, they start to think, wow like why can’t we talk about this? What am I not aware of that makes this something that even my parents can’t bring up with me? And so there’s no downside besides their sadness to telling them the truth that grandma is sick and there’s nothing anymore the doctors can do to help her. The doctors have done everything they can and she will die from what has made her sick. I think that may be the place to start.

REENA: I mean I’m curious about, why you don’t shield them, because you say they’re going to pick up on this, they’re going to know it’s almost worse that you don’t talk about it.

LISA: Yeah, because it is part of life and, you know, maybe one of the things that’s so strange about coming out of this pandemic is that we’ve had this very bizarre, completely unusual landscape around illness and death and disease and fear, and what we have to remember is that people coming to a point in their life where either they get sick or they’re dying from old age or some combination of the both, this is how it’s always been and this is very much part of what it means to be human and what we want always in caring for our kids is to lead the way in showing them that hard things are part of life, there are ways we can make them more bearable, part of how we make those things more bearable is that we talk about them. We are forthright about them, we are mindful of how much anybody can tolerate at any given time, but that sort of turning and facing it quality that I think the parents may want to use now makes it all less frightening to children. When we are hiding from things that are expectable parts of life and we are so cautious and anxious about them and our kids can tell, it actually all becomes more frightening, but what this family is up against is the kids are going to be really, really sad, and I think none of us want to say anything to our children that we know are going to make them really, really sad.

REENA: Yeah and I think sometimes that’s why the instinct to sort of, shield them for as long as you can and don’t say anything, but you’re saying that’s actually worse.

LISA: It is, but it’s interesting to hear the way you put it. It makes me think about where is that instinct coming from? Because I think you’re right. I think our instinct is like, don’t tell the kids, like they don’t need to know,  they’re happy, why would I ruin their day? But whether we mean for it to be the case or not, I think sometimes it’s the parent protecting themselves in that, not protecting the child because Reena, you know, as a parent, like when your kid’s upset, it’s awful, right? Like it’s painful for you.

REENA: Yeah.

LISA: And so, I really feel for this letter writer because they actually are getting it coming and going, they’re losing a parent who they love, and they have a lot of sadness about that, for sure, and they’re also going to need to help their kids navigate their sadness. So, you know, we use the term sandwich generation for lots of things but we can definitely say this parent’s in an emotional sandwich, right? Of having to deal with their own feelings about loss and grief and then also doing as good a job as possible in helping the kids to deal with loss and grief, and I have all the empathy in the world for the parent being like, you know what? I don’t want to eat this whole sandwich all at once. Like I’m dealing with my own side of this, I don’t know that I want to rush into my kids’ grief if I can hold it at bay or delay it. I certainly understand the instinct.

REENA: I want to get into the care taking aspect and everything, but I want to ask you, when you see kids going through grief, and I’m sure it’s different based on age, what do you think parents don’t think about and where they miss the mark on helping them cope with grief?

LISA: Well, it’s interesting because, you know, we have very different guidance age by age because sometimes the questions that are very high in a parent’s mind are very different from the questions that are high on a child’s mind. So, these kids are 10 and 12, so they in all likelihood understand the permanence of death, understand that a dead  person can’t feel things, their body won’t be working anymore, that when you’re gone you’re gone, but younger kids don’t always have that understanding, and so especially when we’re telling children under the age of 5 about death, we often have to be very, very explicit around things like, you know that plant we had that died and it stopped working and there was nothing we could do to bring it back? Well, the human body works that way too. Or, you know that pet we had that died and we said goodbye and we never saw that pet again, we just held that pet in our hearts? Well that happens with people too. So, with the little kids, we have to be mindful that they just don’t get it. They just don’t really understand. Even with 10- and 12-year-olds, and honestly even with 30- and 40-year-olds, the permanence of death is actually pretty hard for people to wrap their heads around. You know there’s such beautiful poetry about this idea of like, maybe the person’s just in the other room, they’re going to come back soon. You know, it’s so human to ward off the fullness of the reality, and we have to make room for kids to do that as well. You know at 10 and 12, they may really need time to take in the permanence, which is an argument for telling them sooner rather than later.

REENA: Lisa, in this letter these, her children are middle schoolers, obviously capable of processing things far differently than maybe a toddler. How do you deal with grief and explaining death based on age?

LISA: So, if we think then about the middle school group or kids who are well over age 5, they know what it is. I think we want to be straightforward and I think we really want to follow their lead in terms of how much they can tolerate at a time. So, I do think it’s important to be forthright with these kids, to give them time to really be able to say goodbye to their grandmother. You know one of the things I’ve sometimes heard is that people are really clear with kids or think kids understand things. They don’t think kids understand that there’s a looming death and then the child doesn’t realize it and then it all happens really fast and then the person’s gone and they haven’t really had a chance to take in what’s happening. So, I do think it’s important to say, you know, look, your grandma’s been sick. The doctors have done everything they can. There’s nothing left to do. This illness will be what brings her to the end of her life. You know, just to be very straightforward and then to say, what questions do you have for me? And to make space in time for kids to take that in. The other thing I would do is before any conversation like this, is give kids a chance to brace themselves, to say to kids, I have really, really sad news about Nana that we need to share with you, and that sentence is a huge gift to kids. It is a huge basically, kiddo, brace yourself, and they will almost always know what’s coming, but even just that five-second interval took kind of Marshall their forces and brace themselves a little bit is a really kind thing to make possible.

REENA: Knowing that she’s dying, how often should kids be expected to visit because it must be painful for them as it is for the parent?

LISA: That’s a great question. So, one is I would follow the kid’s lead. Absolutely follow the kid’s lead, and they may say great, we want to see her every day, and you say, okay great, she wants to see you every day. I mean, I think that there’s real, real value in letting kids lead the way. If a kid is like, let’s say this isn’t happening, like I don’t want any part of this, I don’t want to see her sick, I think it gets a little more complicated because there’s two things you’re trying to balance. You know one is, what would the grandma want to have happen? You know, and how would she want to be able to say goodbye or be close with her grandchildren, you know, touch them and hug them and have that time. The other is what will the kids be able to feel comfortable with in retrospect, right? So if the child’s like, I don’t want to do this or it feels too uncomfortable, I think there’s room for the parent to say, I understand completely and I want you to be able to look back on this time and feel comfortable with how it was handled, and I have a feeling that if you don’t see her of say goodbye in a way that feels right, you’re not going to feel okay about it later, and so let’s see if we can come up with a solution that lets you do this.

REENA: Isn’t that a lot to put on a kid’s plate? To be like how are you going to process this best? What do you want to do, and especially if grandma might not be the grandma that they remember and love who could be fading? That’s also dramatic, isn’t it? To see that?

LISA: Yup, yup. No, Reena, you are 100 percent right. I mean this is a real tension the parent’s sitting in, but it gets to something else and this guidance, to me, feels really important, whether the kid’s like, yep, I want to see her everyday or no, I’m feeling uncomfortable about it, we have to prepare kids for what they’re gonna see. And what the letter writer is saying is that right now she looks and seems pretty familiar, like the grandmother they remember, but even if they’re small adjustments, it’s almost like giving that kid a chance to brace themselves when you’re saying, I’ve got some really sad news. It is critically important that we say, okay, when you see grandma, you’ll notice that she has lost weight, or when we’re taking kids to hospital visits , whether or not it’s end of life visits, I have to tell you, Reena, hospitals, kids see a lot, and one thing I have learned clinically is when I have, really actually a client of any age who has been to the hospital to see a loved one or who was in the hospital, I have learned to say, did you see things that were upsetting to you? And, Reena, I cannot tell you how often the thing they saw in the hallway on the way into the room where they were headed, or to walk into a room and to see a post surgical parent who may have come through the surgery just fine but is swollen in a way that’s unexpected or has tubes in places that are unexpected.

REENA: Yeah.

LISA: That  piece, I just, I can’t overstate clinically how much I’ve come to appreciate that the visuals that sometimes go along with major medical procedures or end of life experiences are jarring to people in a way that we, I think, tend to kind of breeze right past.

REENA: Right.

LISA: And you know how, Reena, it’s one thing to see the movie, it’s another thing to read the book?

REENA: Yes.

LISA: You kind of can’t unsee things?

REENA: Right, right.

LISA: So, I would really put a lot of energy into preparing kids for what they’re going to see at every step of the way and then giving them maybe some options like, okay, I’m not ready for that or I don’t want to see that or something in that way but the visual piece, Reena, I cannot overstate also how hidden it becomes. It’s amazing to me clinically where someone will come in, they’ll talk about it, a grief experience or visiting someone in the hospital, worrying about their health, and then when I say did you see anything that was upsetting? And they’re like, I did. It was so clear it was never going to come up any other way but that that was carrying as much weight to them as anything else that was going on.

REENA: I hadn’t thought of that. Even just something like tubes, being intubated. Obviously that’s significant, but even just having an IV in an arm can be traumatizing probably for kids who haven’t seen that when we’re used to it.

LISA: Yeah and especially if they know the person, you know them really well, they’re used to that person and their body and then to suddenly see their body in such a different way. It’s a big deal.

REENA: I want to ask you also about this mom because helping a parent through the end is also a lot to take on emotionally and you’ve got kids at home. What advice do you have for this mom who’s probably going to be, the parents are going to be away helping care for Grandma?

LISA: Yeah, you know it reminds me that when stressors go up, supports need to go up too.

REENA: That’s a good one.

LISA: Yeah because sometimes the stressors can’t be brought down. You know if we can bring them down, we should bring them down, but sometimes you can’t and this is one of those moments. So, I think I would really want any family in this position to up all the supports they can. So, it may be that sometimes it’s social support, reaching out to friends who are not in the full face of the grief but love this family, love the people in it and saying, you know, we need your help. And, you know, Reena, you’ve got friends like this, I’ve got friends like this, like when it comes to the end of my parent’s life, I know who I’m calling because they love us but they don’t have the same kind of skin in the game and so they can be helpful. So, that is huge, but also, Reena, one of the things I’ve become much more aware of is sometimes the supports are things like getting more takeout.

REENA: Amen to that. What a great point. So true. I mean just the basic survival of every day getting through those. Yeah, you’re absolutely right.

LISA: Absolutely. So those kinds of things can make a difference, and then the other thing I would say is asking for what you need, right? So, if you’re like, I don’t like take out but we really could use some decent food, then tell the people who love you are not in the middle of this, here’s what we could really use. If you could coordinate to have some folks bring some stuff by and make sure we don’t have too much or too little, that would make all difference in the world, and what we have to remember in these moments is people want to help and people don’t always know what to do and I watch individuals who are in the center of these very painful situations feel like, oh, well I don’t want to impose on anybody, and I’m like, no, it’s the opposite. They’re desperate to be useful, you giving them explicit instruction about what will be useful to you is a gift to them. Give them that gift. So, I would just say, as much support as a family can call on, they absolutely should.

REENA: You know, we’re taught to say please and thank you, but we don’t know what to do when somebody is grieving or dealing with a significant death. What do you think really helps?

LISA: One of the key things as we think about helping kids through grief is to keep the people they’ve lost alive through remembering them and doing things like when it’s middle school graduation say like, oh, here’s what Nana would be thinking right now, or Nana is so proud of you, wherever she is she is so proud of you, and to keep on going presence is, for kids, a way that we don’t forget what they’ve lost and we make the ongoing conversation about the person who we’ve loved who we’ve lost. Very normal, very natural to their days and I think that’s how, as parents or adults, we keep it from feeling strange or frightening are alarming and just acknowledge like you missed her when she died and you’re going to miss her at your wedding and you’re going to miss her when your first child is born, and just to normalize that makes a huge difference in the sort of the long tail of grief.

REENA: Before we go I want to ask you about the funeral because I think so often parents don’t know what you should tell your child about the funeral and how kids process.

LISA: Oh boy, that is the truth. Okay, so when it comes to funerals, whoever’s funeral it is, back to this point we’ve made a couple times today, preparation, preparation, preparation. Kids should know what they’re walking into, and especially if it’s one where there’s options, kids should be given the option of whether or not they want to walk into it, and so when it comes to the question of whether children should go to funerals or getting kids ready for funerals, what we want to do, as adults, is to give them the total play by play, a complete account of what to expect, and especially if there’s going to be of a body on view, and because that is its own very I mean frankly, strange experience that kids will want to be prepared for, and this is also true for wakes, this is also true for other things, and so giving kids an entire account of what to expect makes it easier for them to bear everything that comes their way, and then there may be times when you want choice, right? You may say, we’re not going to the wake because the casket will be closed after the wake and I’m making the call that my child does not need to see the body. You also may give older kids an option, and then they may get to change their mind when they get there, so I think again, prepare, prepare, prepare, let them know what to expect. Kids can handle an enormous amount if they know what’s coming, but funerals are tricky. And the other thing we should prepare them for is there may be very upset people at the funeral, you know, so we’re often so focused on the body and the whatever service or kind of ceremony there will be and our own experience, but we need to say, oh you’re Nana’s best friend will be there and you should expect that she may really be very, very upset and I want you to be prepared for that.

REENA: So, to wrap it up, Lisa, on death and dying, what do you think your advice is to parents that they should keep in their mind as they’re coping with this and trying to help their children through?

LISA: It’s okay to be sad in front of your kids, and I think that’s often what parents are most frightened of is if I get upset, will that upset them? And I think if you get upset in a way that feels out of control, it probably will, but I think if you are weeping and talking about missing the person and feeling very sad and they can see that and they can see that you just take this in stride as part of how we process emotion, that will be a great gift to your child and so don’t be afraid of your own sadness or your child’s sadness, and know that you can dip in and out of it and that you don’t have to do it all at once.

REENA: You know, a friend of mine once said grief is the price you pay for love.

LISA: Absolutely, absolutely. You can’t have life without death.

REENA: So true. So absolutely true. Lisa, do you have any books that you can recommend for parents on dealing with grief?

LISA: Yeah. I think we kind of want to break it down by age. So, for younger kids, there’s some wonderful books. One’s called “The Fall of Freddie the Leaf.” Another one’s called “The Tenth Good Thing About Barney” about a dog, and Maria Shriver wrote a wonderful book called “What Is Heaven.” And then there’s not a huge adolescent literature, but there’s some stuff that’s for adults that may be useful to teens and younger kids. So, there’s a wonderful book called “Grief Day By Day,” which justs let people kind of deal with grief in bite sized pieces, as we say I think that’s an excellent resource, and then there’s another book called the “After Grief” about the long arc of bereavement, and I like the way in which it really appreciates that it takes a long, long time to get used to the idea of losing someone we love.

REENA: I think so often we think it gets better after six months to a year and that it can live with you for your lifetime is something that I don’t think we think about.

LISA: Yeah, no and I think often it’s almost sitting in it six months to a year, and I think if we can change our thinking, we’re better prepared for losses and were better prepared to support people when they face them

REENA: It’s great advice. Thanks, Lisa. So, Lisa, what do you have for us for parenting to go?

LISA: I think I want to underscore something that’s come up several times today, which is preparing kids for hard things. I think sometimes we know something’s going to be challenging whether it’s a funeral or any variety of things that we expect our kids to do or want our kids to do, and we can get anxious knowing that it may be strange for them, whatever it is. Whether it’s a hospital visit or anything along those lines, even going to the doctor themselves for something that’s different from what they’ve usually done, and let’s never forget the power of preparation to make challenging new things a lot easier for kids to manage.

REENA: It’s great advice and so much to unpack here with grief. I want to thank you so much, Lisa. There’s so much that is helpful, and I want to tell everyone what we’re going to be talking about on our episode next week. We’re going to talk about how do you help your teen deal with college rejections? I’ll see you next week, Lisa?

LISA: I’ll see you next week.