These points are highly subjective and are listed here because they have proven helpful in conversations with children. It is recommended that they be used with caution and judgment, considering the child's age, developmental level and readiness. Parents need to be prepared to talk with children of any age about what they believe from a spiritual or religious perspective happens after death.

The content of communication with children is important; yet all sorts of things can be said and all sorts of "mistakes" can be made. Children often pay less attention to what is said, and more attention to the manner and concern with which it is said. Children tend to overlook "mistakes" in communicating. What matters to them is that the way they are spoken to matches their ability to understand and participate in the conversation. No matter how well-rehearsed and "correct" the content is, if you are not in tune with the child, the conversation often will become one-sided.

It is important to assess the readiness of the child. What is said early in the illness will be more in a context of hope for a lengthy survival. In the event it becomes necessary to shift the focus of care to preparing for a child's death, what is said is best presented in the context of providing comfort and support. Children tend to ask questions when they are ready to hear the answers. All of a child's questions need to be answered honestly and tactfully. Understanding should be provided to the degree it is requested by the child and contributes to her comfort and support.

(1) It is important to reassure children that they will not be alone in death and that the parents will remain with them even after death. All children need to know that parental presence and support are maintained even in death. This point is essential to children and needs to be phrased within the context of the parent's spiritual or religious beliefs.

(2) At the time of death, a person needs to know that he or she has done all he could do with his life. This is a universal human concern. Even children who die at an early age can have meaningful, happy lives and make lasting contributions to human relationships. Young children can touch the minds and hearts of those they deal with at school, in the hospital and at home. It is beneficial to point out that, to the dying child, (or to his or her siblings) the child's life and death can touch another person, he or she will have left a mark and will have led an effective life.

(3) When death finally comes, it will not hurt. There may be pain in the period leading up to death, but doctors will do what is necessary to reduce the pain to a minimum. Death itself will not hurt. After death the pain will never return. Children are very concerned with having the pain finally end. It is important to reassure them that it will.

(4) When a loved one dies, it is important for us to be able to say goodbye. It is okay for families to cry and grieve together with their loved one who is dying. Sometimes the person who is going to die may want to say goodbye to friends. There are many ways for people to say goodbye: in person, by telephone, by writing letters or having another person deliver a message on their behalf. After someone dies, people have a custom of saying their last goodbyes together. In Western cultures, these goodbyes are called funerals. People should not be afraid of funerals. They are very important and make the family feel better. Adults do this in the privacy of their homes or in church. After the funeral, the child's mother and father may want to have their child's friends over to talk about their child and how much they loved her.

(5) Adults sometimes do not know very much about death either. If parents talk with a doctor and cry afterwards, or if they talk about their child's illness and become teary-eyed, it is because they love the one who is going to die and will miss this person. However, if a child has to die, parents, family and friends still have the opportunity to remember the happy times, and memories about the child will live on. Talking to your own child about his or her own possible early death or the death of a brother or sister is very difficult. It is accompanied by enormous pain and great concern with a heavy price on your own emotions and feelings. The reward for your efforts will be a child who realizes that he or she is not alone in facing the most difficult task all of us ultimately must face: the fact of our own death. The failure to make the effort can only lead to isolation, loneliness and hurt. Making the effort has as its reward the fullest gifts that can be shared by anyone of us with our children: love, understanding and the continuation of life.

Physical Preparation. Taking care of necessary physical and legal matters is one of the most difficult tasks because it is a visible sign of imminent death. It is recommended to prepare ahead of time, days or even weeks before the death. While difficult and painful, early preparation allows the family members to do so more calmly and with presence of mind.

Talking about it and doing it are both very important. If preparations are done early and calmly for such necessary matters as funeral and burial, much of the later grief and frustration can be alleviated. Many parents who handled the death of their child or young adult exceptionally well told us that they had made plans for the funeral and burial weeks ahead of time. These plans included decisions regarding autopsy, method of burial and, as important to the dying child, methods of disposing of treasured possessions.

Children often want to know who will take care of their little dolls or trucks or favorite things. Some parents encourage their children to help decide what toy will be given to a certain friend or brother or sister. Other details of funeral and burial are best discussed privately, separate from the child who is dying.

Above all, early preparation assures that when death does occur, the family members will not be burdened with additional concerns, but will be free to support one another emotionally.

Dying in the Home. Parents and the medical team may wish to consider caring for a sick or dying child at home rather than in the hospital. This has become practical in recent years with the easy availability of many hospital techniques for use at home, such as oxygen set-ups, IV systems and the growing willingness of the hospital medical teams to provide the necessary physical and emotional support. The decision for a child to die at home is usually considered when the focus of care has changed from trying to arrest the disease to making the child comfortable.

It is encouraged that both the patient and the family agree on this plan of care with the availability of the medical team to provide backup to the family and the patient. Many patient families report that this arrangement is technically easy to set up and, most important, that it makes possible a close and caring environment.