Most children under the age of five do not have a real concept of the true meaning of dying. This is partially because they have no sense of time or future. They truly live in the now, in the present time. The concept of “next week” or “next year” has little to no meaning to them. Seriously ill young children are usually not preoccupied with their own death.
They are generally more concerned whether or not their parent(s) is going to spend time with them. When they are seriously ill, their only concern is that they will be left alone. Thus, most dying young children think less of themselves than the frightening idea that their parent will not be available when needed most. That is why it is of extreme importance to make certain that the child never feels abandoned. When the child is in the last phase of the illness, a trusted and loving adult should always be present with the child, reassuring her, supporting her, loving her.
Between age six and ten they are generally aware dying means forever, but still lack a solidly based view of their own future. They are more concerned with the present than the toddler, but usually do not spend much time contemplating the future. Instead they probably will be more frustrated about the limitations imposed by the illness or the treatment, and will ask questions about this. Encouraging discussion, being honest and open about everything are very important, but also listening to the child and being thorough in hearing exactly what the child is asking and telling is as important as well. The child may repeat the same questions over and over again, and being patient and using simple wording is key.
Teenagers, on the other hand, will understand everything and they will resent their shortened life. They probably will realize their loss, they are aware of their personal potential and now they have no possibility to reach their goals or follow their dreams. This can be a tragic and bitter experience, for the young patient, the family members and other people who support him. It is this realization of lost potential and the accompanying bitterness that causes the teenager to express their emotions in rebellious actions, such as refusing to take medication or treatment, or ignoring medical advice. This is a common reaction to having to face death at this early age.
To connect with teenagers I would start out with describing my own experiences with grief and loss. I would not be afraid to show my emotions, and with this I’d hope the teenager would feel safe enough to confide with me and willing to share emotions.
Adults with serious illness not only need support and spiritual guidance with facing their own death, but often also need practical help; for example sharing concerns on who will look after their children after they passed, financial aspects, etc.
Depending on age, religion, faith, culture; as a Counsellor I would use music, art, sharing stories, reading from sacred texts, prayers, meditation, to help the patient, family and friends in this difficult time.