Talking About Illness and Death: Making Impossible Conversations Possible

Oxford University’s Dr Elizabeth Rapa and Dr Louise Dalton, share their eight step guide for families during the COVID-19 pandemic.


In these exceptional times, we are constantly bombarded with news and opinions about the immediate and far reaching consequences of the pandemic. This has created high levels of stress and anxiety for many families as we face coping not only with the immediate threat of illness, but also the potential impact of the global situation on our day to day life, including how we shop, travel, work and manage our childcare.

Sadly, many families have also had to cope with a loved-one being admitted to hospital during the pandemic. Understandably, visiting has been restricted to avoid the spread of COVID-19, and these separations can add to the already difficult circumstances. Importantly, this has also made it harder for hospital staff to get to know patients’ families and find out about the people who were important to the patient, especially children or grandchildren.

Parents often wonder how much to tell children when a friend or relative is seriously ill.

“Is it better not to worry them and wait until the situation becomes clearer?”

 “Perhaps even younger children won’t even know and so don’t need to be told?”

Understandably adults want to protect children from the devastating news of a loved one’s serious illness or death. However, a recent research paper published by a team from the University of Oxford Department of Psychiatry concludes that silence does not prevent children from being aware of what is happening within the family, but rather leaves them to cope with their feelings alone.

Even very young children are aware of changes within the family, and when they are not given an explanation for what they are observing, can reach their own conclusions. In some cases, these may be ‘more dire than the truth’. The researchers reported that although these conversations with children may feel daunting, communicating effectively about serious illness within the family had far reaching benefits for both the children and families’ psychological wellbeing.

How do I talk to children when someone they love dies?

In response to the COVID-19 pandemic, the Oxford team have developed a series of step by step guides and resources to support families when communicating with children about a loved-one's illness or death.

The team have produced a detailed eight step guide for families with advice about children’s understanding of illness and death at different ages, and suggested phrases to use. The full guide can be viewed here.

The eight steps are:

  1. Prepare yourself and the situation – do you need another adult present to help support you
  2. Prepare your information – consider what the child already knows and what they need to know
  3. Prepare your environment – where do you want to tell your child the news
  4. Consider how to start the conversation –make sure you have your child’s attention and you can talk without being disturbed
  5. Explain what has happened – slowly tell your child the truth using simple and concrete language;then pause before offering more age appropriate details (The guide provides suggested language and explanations)
  6. Prepare for a variety of reactions – from emotional to practical
  7. Prepare to answer children’s questions – the guide provides suggested answers to some commonly asked questions
  8. How to end the conversation so your child feels supported and knows what will happen next. It is also important to take care of yourself.

The team have also created an animation for adults who are preparing to tell a child that someone they love has died which can be viewed here.

Dr Elizabeth Rapa and Dr Lousie Dalton, Child and Adolescent Psychiatry group, University of Oxford

Where can I get more help?

All the resources produced by the team are freely available here.

They include multiple translations into Spanish, Urdu, Portuguese, Cebuano and Tagalog with French and Polish currently being finalised.