Speaking to Children About Life-Threatening Emergencies

What do I tell our children?

A family member or close friend’s life-threatening illness such as cardiac arrest is painful and complicated for adults, but for children, it can be as confusing as it is upsetting. And as a parent or guardian, telling them what happened can be difficult.

Parent insight while giving CPR to the father of her two children:

“I thought of our kids, ages eight and five, asleep in the next room. I knew I would have to face them in two short hours. The words I might have to say would shatter their childhood. I thought of them growing up without their dad, of holidays being grim reminders of loss and grief, and the void that would be left in their hearts.”

Here we suggest some ways you can support young children to help them understand and things you can expect as they grieve.

What is cardiac arrest?

Cardiac arrest is when someone’s heart stops working properly, and they stop breathing. It’s like when a car engine stops working, and the car won’t go anymore. Just like we call a mechanic to fix a car, when someone’s heart stops working, we must call 911 for help. Sometimes the mechanic can fix the car, and sometimes they cannot. Just like a car engine, sometimes the heart cannot be fixed, and the person dies.

Sometimes, the person can be helped by doing something called CPR, which is like giving the heart a little push so it can start working again. Also, there is something called an AED, which is a machine that can help the heart start working again.

It’s important to know what to do if someone’s heart stops working, like calling 911 and doing CPR, because it can save someone’s life.

What is death?

Death is when our body stops working, just like when a toy stops working, and we can’t play with it anymore. When someone dies, their body stops working, and they can’t breathe, move or feel anymore. It’s like when we go to sleep at night, and we wake up in the morning, but they don’t wake up.

Sometimes people die because they are very sick or very old, and their bodies can’t work anymore. Sometimes, people die because of accidents, like falling or getting hurt.

It’s important to understand that death is a natural part of life, and that everyone will die eventually. And it’s okay to feel sad or upset when someone we love dies; it’s normal to have feelings, and it’s okay to grieve.

We can remember the person we love by talking about them, looking at pictures, and sharing our happy memories with them.

What is anxiety?

Anxiety is a feeling of being worried or scared about something that might happen in the future. It’s like having a butterfly in your stomach that won’t go away, even when there’s nothing dangerous around you. It’s normal to feel anxious when you’re not sure if someone you love will be okay. Everyone feels anxious sometimes, but it’s important to know how to manage it so it doesn’t stop you from doing the things you want to do. Here are some things you can do to calm down and feel better:

• • Take deep breaths: When you start to feel anxious, take deep breaths in through your nose and out through your mouth. This can help you feel calmer and more relaxed.
  • Talk to someone: Share your worries with someone you trust, like a parent, teacher, or friend. Talking about your feelings can help you feel better and less alone.
  • Take a break: If you’re feeling overwhelmed, take a break from what you’re doing and do something you enjoy, like reading a book, listening to music, or drawing.
  • Practice mindfulness: Mindfulness is a way to focus your attention on the present moment. Try sitting quietly and noticing your breath or listening to the sounds around you. This can help you feel more calm and centered.
  • Exercise: Exercise is a great way to reduce anxiety. Try going for a walk or bike ride or playing a sport. Exercise can help you feel more relaxed and happy.

How do children respond to grief?

A child’s reaction to severe illness and the death of a loved one varies depending on their age and life experiences. Each child is different, and the below examples of age-related differences and responses can be applied to children of different ages and intellectual abilities.

Children under 5 years of age will not understand the significance of cardiac arrest. They will see the sadness and anxiety of the people around them. They may not understand the permanence of death either and may ask if or when the dead person is coming back. Talking to them about how you feel in a manner they can understand is appropriate. They may exhibit behaviors like clinging to their caregiver or regressive behaviors like bed wetting. These behaviors are normal and usually stop with time.

Children between the ages of 6 and 11 years start to understand that people can be sick or injured and that death is forever (though some 6-year-olds will still struggle with this concept). A common worry of children this age is that other family members and friends will have a cardiac arrest or will die. They may start to ask questions and want to understand what happened. They may show their grief through anger and experience aches, pains, nausea, or constipation.

Adolescents and young teenagers from around the age of 12 years understand that illnesses can be minor or life-threatening. They can usually understand what cardiac arrest is and its seriousness. They also often understand that death is irreversible and happens to everyone, including themselves. They are often interested in understanding why things happen. Their reactions will vary and can include apathy, frustration, anger, poor concentration, and sadness.

It is important to remember there is no “correct” way to experience grief and no exact stages all people must go through to “get over” their grief.  Children’s reactions vary depending on their age, their intellectual ability, their relationship with the cardiac arrest victim, and how other family members are responding, as well as the culture and community they live in.

How do children respond to anxiety? How can I help my child cope with their anxiety when we don’t know yet whether or not their loved one will be okay?

Children under 6 years old might not understand what anxiety is, but they can still feel worried or scared. They might cry or cling to a parent or caregiver when they feel anxious. They may also have trouble sleeping, have tantrums, or be more irritable than usual.

Parents can:

• • Help young children understand that their loved one had a problem with their heart, but doctors are working hard to help them get better. 
  • Provide comfort and reassurance, give hugs, and spend extra time together. 
  • Keep to their child’s normal routine to provide stability.
  • Connect their child with a counselor or therapist if needed. Most pediatricians can provide referrals.

Children between 6 and 11 years old are more likely to understand what anxiety is and be able to talk about their feelings. They might worry about their loved one or themselves or another person they care about having a cardiac arrest. They might also have physical symptoms, like stomach aches or headaches. Some children might avoid certain activities or situations because they feel anxious.

Parents can:

• • Talk to their child about what happened, answer any questions they might have, and provide honest information about their loved one’s condition. 
  • Help their child cope by encouraging them to express their feelings, letting them know it’s okay to feel worried or sad, and reassuring them that they are loved and safe.
  • Provide distractions and help their child stay busy with activities they enjoy.
  • Connect their child with a counselor or therapist if needed. Most pediatricians can provide referrals.

Children who are 12 years and older are more likely to be able to manage their anxiety with some independence. They might be able to recognize when they are feeling anxious and use coping skills to manage their feelings. However, some older children might still struggle with anxiety and need help from a parent, teacher, or counselor. They might worry about things like school, social situations, or their own health and future. They might also have physical symptoms, like sweating or a racing heartbeat. Some older children might avoid certain situations because they feel anxious.

Parents can:

• • Provide a supportive and understanding environment for older children. 
  • Encourage their child to talk about their feelings and offer to listen without judgment. 
  • Provide information about the loved one’s condition and what the doctors do to help. 
  • Help their child cope by suggesting healthy coping mechanisms, like exercise or mindfulness practices, and encouraging them to take breaks when needed. 
  • Offer to connect their child with a counselor or therapist if needed. Most pediatricians can provide referrals.

When is the right time and way to tell my child about cardiac arrest and death?

Based on our experiences, we recommend you do not hide the truth, and do not delay sharing what is known (“Mommy is sick”) and what is unknown (“Mommy will not come home tonight”). It is natural to protect your child, but in our experience, it is best to be honest. Telling your child what happened, what you know, and what you do not know yet, helps increase their trust in you and helps them cope with the uncertainty and loss of cardiac arrest.

Parent insight: “I opened the door to the bedroom my daughters share. I gathered all my maternal strength to use a normal facial expression and tone of voice while I gave them the news to the best of my ability. I didn’t know yet whether he would survive. Even if he did, I didn’t know if he would remember anything or be able to function. I tried not to lead the kids toward those questions.”

Find a safe and quiet place, free of distractions if possible, to speak to your child and think through what you will say. Ask the child to sit with you. If they are a young child and have a comforting object, like a toy or blanket they like to carry, let them have it. Be sure to speak slowly, pause often, give them time to process the information, and give yourself time to manage your own feelings. Your feelings and behavior will set the tone for the conversation and send a message to the child about how they should feel and behave.

We recommend an empathetic and honest approach with all ages of children. We also recommend using plain accurate language and not expressions they may not understand like “We lost Granny” or “Grandpa passed on,” because it can be confusing for a child who may not understand what this means. Instead, we recommend: “I have some very sad news. Granny has died because her heart has stopped working. We will not see her again alive, but we will say goodbye.” We know it can be hard to use honest and accurate language but being honest and transparent is easier in the long run. 

Children will need time to absorb this information. Young children may react by appearing not to listen. Wait with patience for their attention or repeat the information again later. Be prepared for younger children to repeat the same questions repeatedly, now and over the days to come.

Parent insight: 

It was late on a weeknight, well past my six-year-old’s bedtime. She had taken forever to brush her teeth and change into pajamas, intentionally cracking jokes to distract me from the task at hand. (She’s her father’s child, after all.) I was doing my best to keep my patience while my mind whirred with all the nightly chores that stood between me and my own bed. My phone lulled her with calming music while I rubbed her back, trying to entice sleep to come faster.

Out of the darkness, I heard her sweet little voice say, “Mama?”

“Yes, baby?” I responded.

“I know what controls the body parts.”

“You do?”

“Yeah. The brain.”

“That’s right, baby.”

“And the heart is the helper,” she stated, proud of herself.

“Yes, I suppose that’s true. Now it’s time to go to sleep.”

“Okay. But Mama?”

“I sighed. “What, baby?”

“I don’t know why Daddy’s heart stopped beating.”

Some children will worry they did or said something to cause cardiac arrest or death. Children may feel guilty, so check to see if they feel responsible and assure them they are not. You could ask them, “Are you worried that Daddy died because of anything you did?” Then in simple terms explain what happened and give reassurance that they did nothing wrong and they are not to blame. For example, you could respond with, “You have done nothing wrong. Daddy’s heart got sick, and he stopped breathing. There was nothing anyone could have done, and nobody was to blame.”

Can I show my emotions in front of my child?

It is natural and appropriate to express loss, grief, and anxiety in front of your family, including your child. You may want to prepare yourself so you don’t scare or startle your child with the intensity of your reaction, but be honest. If you feel sad and you are crying, tell them you are feeling sad, and that is why you are crying, and then reassure them there is nothing wrong with showing feelings to others. This will help your child identify the feeling and gain comfort in showing emotions.

How can I help my child cope with grief?

Mourning is what we do when faced with loss and grief. Mourning is how we come to terms with losing a loved one. It can occur after cardiac arrest when the survivor is significantly disabled, no longer who they once were, or when they do not survive. It is important for your child to be involved in mourning such as remembering happy times together, sharing stories, celebrating their life, and saying goodbye.

When a cardiac arrest survivor’s brain or body is greatly affected, they have trouble speaking, cannot speak or remember things, or are suddenly limited to a wheelchair. In cases like this, grief can be especially complex and confusing. You may be grateful for their survival but also mourn the person they once were to you and your child. You may also be experiencing the loss of your independence if you have become a co-survivor providing care to a cardiac arrest survivor with significant disabilities. It can be helpful to express how significant the survivor was and still is for you all, and deliberately mourn the loss. In some ways mourning a loved one’s death can allow for a more complete transition, where you can have a funeral and ceremony to celebrate how significant the person was. Talking to a professional like a psychologist, social worker, or chaplain can be especially helpful. 

Whether your loved one survived or died, you can find ways for your child to connect with memories of the person before the arrest and show their love and the importance of that person in their life. Children may like to paint a picture, read a poem or something they have written about that person, or sing a song.

Families will have different spiritual beliefs and cultural practices. When experiencing grief and loss, it can be helpful to contact your spiritual leader who may support you in mourning, understanding death, and providing comfort to you and your child.

How do I protect my child’s mental health?

• • Continue to provide the child with love and consistent care. 
  • Infants and young children will feel secure and loved when in close physical contact, like cuddling, rocking, and singing.
  • Try to maintain your regular life routines with time for usual activities such as play, meals, school, and exercise. 
  • If your child displays challenging behavior (tantrums, regression), you should try to view this as normal and temporary. They are showing what they feel but cannot say, and they shouldn’t be punished for it.
  • Inform teachers, close friends, and other parents what happened so they can support the child.
  • You need to take care of your own needs to be the best parent you can be for your child. Take time for yourself – get enough sleep, eat healthy, exercise, take time to relax, and also have someone to turn to for emotional support.
  • Have a plan for avoiding harmful practices such as increased alcohol or drug consumption. Identify alternative healthy activities to employ when tempted. Your children’s health is connected to your own.

Revisit conversations around the event and the child’s feelings as they get older. They will understand more as they grow. Take your cues from the child about when they are ready to discuss it again, and let them lead the conversation with their questions. Answer as honestly and age-appropriately as you can. Avoid speculation, and be honest about what you do and don’t know. Use the information and suggested coping strategies listed above, depending on the child’s age.

Sources

Meredith Edgar-Bailey & Victoria E. Kress (2010) Resolving Child and Adolescent Traumatic Grief: Creative Techniques and Interventions, Journal of Creativity in Mental Health, 5:2, 158-176, DOI: 10.1080/15401383.2010.485090

Kari E. Bugge, Philip Darbyshire, Eline Grelland Røkholt, Karen Therese Sulheim Haugstvedt & Solvi Helseth (2014) Young Children’s Grief: Parents’ Understanding and Coping, Death Studies, 38:1, 36-43, DOI: 10.1080/07481187.2012.718037

Flanary K. The Quiet Place. J Card Fail. 2021 Nov; 27 (11): 1300-1301. DOI: https://doi.org/10.1016/j.cardfail.2021.10.002 PMID: 34749929.

Thank you to our contributors

Matthew Douma & Kristin Flannery