Honesty, reassurance help children cope when a grandparent is ill

With grandparents living longer, many grandchildren will be adults before they have to face the loss of Grandma or Grandpa.

But while the issue of death may be postponed, there's a good chance a grandparent — and especially a great-grandparent — will face a serious illness while children are still young.

Many grandparents have grandchildren and great-grandchildren spanning a wide range of ages. Half of grandparents age 75 and up reported having a grandchild or great-grandchild age 3 or under, according to an AARP survey. It's often a close relationship: In another AARP survey, more than half of grandparents age 70 and up said they see grandchildren at least once a week.

Here are some common questions parents ask about how to talk to their children when a grandparent or great-grandparent becomes ill, and experts' tips on how to deal with everything from breaking the news to visiting the hospital.

(Caveat: This advice is not tailored to children being raised by a grandparent. In that case, an ill grandparent should check resources targeted at parents with serious or chronic diseases.)

Should I tell my children their grandpa is seriously ill?

"If parents don't tell their children what's going on, they're going to make up their own story, which will probably be scarier than what the parent would have said," said Kris Nilsson, a pediatric social worker at Swedish Medical Center. "You can't protect your child by just not talking about it."

However, "you can be honest without telling them everything," said Anna Bakke, a pediatric social worker with the Seattle Cancer Care Alliance. "Parents often give way more information than children want."

Though the situation might be hectic, parents need to carefully formulate how they will break the news to a child, advises Frances M. Lewis, a University of Washington professor of health promotion and nursing who has conducted 22 years of research on this topic. "When anxiety is high, parents say things they wish they hadn't."

For example, don't drop a bunch of bad news on a child and then end with a few reassurances. Lewis recommends parents picture the initial talk as if they were packing a suitcase. "Those are the words children will carry forward and will be there to help them," she said.

Parents might start off: "Grandma is in the hospital, and we're going to see her. She's got the best doctor who is giving her the best medicines. We'll give her a hug."

"That's hopeful, and it's still giving facts," Lewis said. "Notice I didn't say, 'Grandma had a stroke and she can't talk and when you see her she'll be drooling. But look past that, and she's still the same Grandma.'

"Even a 15-year-old couldn't handle that with equanimity. It's too much, too soon and too fast."

Parents will want to prepare children for physical and emotional changes in their grandparents but should wait until the child has processed the initial news first.

Parents are in a difficult spot of trying to reassure their child while facing their own fears as an adult child of an ill parent. "This is a life-altering experience," Nilsson said.

"Parents often say, 'I can't talk to my child because I know I'm going to cry,' " she said. "Children expect some emotion from you if you're telling them their grandparent is seriously ill. If you're too factual and calm, it doesn't seem natural."

On the other hand, "if you're so upset you can't even talk, then you're not ready." Seek support from a partner or friend before addressing children, Nilsson said.

How do I explain a grandparent's illness?

Don't say anything until you find out how your child views the situation, Lewis said. Ask open-ended questions ("What do you know about cancer?" or "How do you feel about Grandpa being in the hospital?"), and don't jump in with explanations until the child is finished.

Hearing a child out lets parents figure out a child's fears and concerns, which may be completely different from what the adult expects. "Premature reassurances don't let the child unburden his heart," Lewis said. "Don't respond until you have the full picture."

In research on children whose mothers had breast cancer, Lewis found some imagined cancer as a spaceship coming to Earth to take away their mom, or like Swiss cheese, causing holes in her body. Flooding children with medical information may overwhelm, rather than enlighten them.

Young children are so egocentric they often blame themselves for causing the illness.

When children do have questions, keep it simple. "Even a lot of teens don't understand what's in their bodies," said Dr. Jeffrey Wright, medical director of the Pediatric Care Center at the University of Washington Medical Center and a UW professor of pediatrics. "Parents are better off describing the symptoms, rather than the disease itself."

For example: If Grandpa has Alzheimer's, describe it as "Grandpa has a problem remembering things," Wright advised.

Try to avoid generic terms like "Grandpa's sick." This might worry a child any time he or another family member gets sick, even with a simple cold, Wright said.

Reassure children that the disease is not contagious and neither you nor they will "catch" a grandparent's illness. This is not the time to bring up the concept of hereditary diseases and how children may be at future risk, Wright said.

How old should my child be before visiting the hospital?

The child's age, personality and temperament, as well as the grandparent's condition, should determine whether a child visits. Children who are sensitive, prone to nightmares or have vivid imaginations might find all the machines, tubes, sounds and smells too frightening, experts say.

Nilsson said all three of her children, then ages 3, 5 and 7, came to the hospital to see their grandfather when he could sit up, talk and play cars with them. But when his condition deteriorated and he had a tube down his throat, she kept her 5-year-old with a family friend in the hospital waiting room.

"I knew he wouldn't like it at all," she said. "It would be too overwhelming."

Seeing a loved one in pain or suffering may make a child feel helpless, said Martha Wakenshaw, a Seattle child therapist and author of "Caring for Your Grieving Child: Engaging Activities for Dealing with Loss and Transition."

Give older children the option of going along, making sure there is a backup who can drive them home early if they find they're uncomfortable and you need to stay at the hospital, Bakke said. Explain the function of some equipment ("the machines give medicine," "the tubes help him breathe") before children go in.

How do I help them adjust to changes in their grandparent?

If children are accustomed to active grandparents, they may not want to accept that Grandma can't do as much. "Children will need to grieve that loss," Bakke said. "It's different than a death, but it's real grief."

It's important to focus on what kids can do with grandparents instead. For example, Grandpa might not be able to go hiking in the woods, but he can come watch grandchildren play at the park where there are benches to rest, Nilsson suggests.

"Try to make it as practical and real — how it relates to the child's life," Nilsson said.

Faced with a grandparent who has had a stroke, for example, reassure children that it's OK to feel shy around a person who suddenly doesn't feel familiar anymore. Parents should brief a child on what to expect — Grandma can't talk or Grandpa has to stay in bed — before a visit.

How can I help my child cope?

Suggest concrete things a child can do: make a card, draw a picture, write a poem, make a grandparent's favorite cookies to bring to the hospital or nursing home.

While an ill grandparent can weigh constantly on a parent's mind, don't be surprised if children are easily distracted. "Younger kids will listen to their mom explain that Grandma is really sick and react to her face," Bakke said. "They'll feel sad for a while. But the minute there's some diversion, then off they go."

Maintain young children's daily routines as much as possible. If a grandparent was a regular baby-sitter, reassure the child that you will find someone to take care of him.

Children often express grief or anxiety different from adults. They may act out, throw a tantrum about a completely unrelated issue or regress in behavior, such as sucking their thumb at night or wanting to be held more often.

How do I talk to my teenager?

While parents might expect teens to better handle a grandparent's illness or death, in some cases it might be harder. If teens are rebelling against their parents, grandparents sometimes serve as safe confidants. "It can be extra hard on a teen if Grandma or Grandpa is someone he feels closest to," Wakenshaw said.

Parents may find teens are very open about talking about their feelings or completely shut off. Either is normal.

"This is a time in their life when they're separating from family," Bakke said. "It's a mixed bag on how they'll react. They may want to see their grandparent, or they may be embarrassed."

Encourage uncommunicative teenagers to turn to their friends, but update them on what's going on. "It's fine if you just talk and they don't answer you back," Nilsson said.

Teens understand death on a mostly adult level but still have the fantasy of invincibility, Wakenshaw said. "So a grandparent's death or illness can be a shock, a reality check that reminds them that they too are mortal."

Do I tell my child there's a chance Grandpa might die?

"The great thing about kids is they're so honest," Nilsson said. "They may just ask, 'Is Grandpa going to die?' "

A parent's typical response is "Don't worry about that now," Lewis said. Parents may indeed want to say that, but it's best to wait until a child has shared what they're thinking.

"A child might say, 'I don't want Grandma to die; she's my best friend,' " Lewis said. "That's right from the child's heart. The child's feelings and grief need to be honored."

Unless death is clearly imminent, experts advise parents to focus on the positives — such as how doctors are trying to help Grandma get better — without making any promises that she won't die.

"Focus on what's going on in the moment," suggests Lory Britain, the Eugene, Ore.-based author of "My Grandma Died: A Child's Story about Grief and Loss." "Parents often don't know what trajectory an illness will take — it might be a week or a year."

It's important to emphasize that being in the hospital doesn't always lead to death. Wright remembers being convinced his brother was going to die when he went to the hospital for a broken arm.

How do I talk to my children if their grandparent does die?

"A grandparent dying is most likely children's first loss experience," Wakenshaw said.

Developmentally, young children don't grasp death's finality.

They may keep asking "When is Grandma coming back?" despite being told she never will. Children age 3 to 4 commonly stage death then immediately enact a resurrection (wave a magic wand, and the princess is alive again).

"The control over making something come alive again is comforting," Wakenshaw said. Parents can explain once that it's impossible to return from death but shouldn't feel compelled to always correct a child's play. Eventually they'll work through the issue and drop it, she said.

Parents should avoid euphemisms that confuse children, such as "Grandma went to sleep forever." Wakenshaw had a young client who was afraid to go to bed since she worried she, too, would never wake up. Another child, when told "We've lost Grandpa," replied, "Well, let's go find him."

Parents can discuss their religious beliefs but "kids are not going to get a heavy discussion about death," Wakenshaw said.

"They view the world more through their senses and what's tangible, rather than through abstract thinking."

Some common questions to expect: Did it hurt? What made her die? Will you die? Will I die?

"Be honest, but reassure them you're there to take care of them," Britain said.

Stephanie Dunnewind: sdunnewind@seattletimes.com