Preparing a 3-year old for the death of a sibling

Question

We've got two daughters, aged 2 and 3. Our youngest has been battling with cancer for the past year and we've recently discovered that she has relapsed. At the moment we are still waiting for staging scans, but given the aggressiveness of her cancer (high-risk neuroblastoma) we are expecting that she doesn't have a lot of time left.

What can we do to help our 3-year old handle this situation?

She has been showing the strain a bit of late and we've engaged a couple of therapists, but are having a lot of trouble actually making appointments with the constraints on our time. I'm the only driver in our family and I'm also working full time, neither of which can be changed in time to make any difference. Grandparents are around, but working full time and not available to help out during the days.

She knows that her sister is sick and has had to spend a lot of time in the hospital where the doctors are trying to help her, but in a bit of a remote way. It's been a little tricky as we've had several lock-downs due to Covid-19, so she hasn't been able to spend much time in the hospital with her sister. We've also not wanted to expose her to the worse of the side effects, so she has usually been at home with the other parent while our youngest is in hospital with either myself or my wife.

I think this is going to be a fairly rapid decline and mostly at home as our treatment options are pretty much exhausted.

I'm looking especially for ideas/techniques we can use to help our 3-year old understand what is happening and come to terms with it, especially given she will be seeing a lot more of it than she has of the treatment thus far.

Thanks

Answer 1

I'm truly sorry for your situation, that's a horrific & traumatic experience to go through.

I wouldn't worry too much about the direct impact on your 3 year old. She is still very young and quite adaptable. A lot of what happens is hard for young kids to understand, so they are pre-wired to just accept it and get on with life. She may be sad or confused for a short while, but very likely get over it quickly.

The highest risk to your daughter is the traumatic experience that her parents are going through. The single best thing you can do for your daughter is take care of yourself and your spouse as much as you can. You will need help from friends, families and professionals to deal with this situation. Reach out and let other people help you. The more help you can get the better your daughter will be off. Let her help you too: it's perfectly ok for Mommy and Daddy to be sad, so let's do something fun together so we can be less sad. Then do something fun and try to enjoy it as much as you are capable. Do not feel guilty, it's best for your daughter, it's best for you.

Treat your daughter as normal as possible. Don't over-focus, don't under-focus. Do whatever you would be doing otherwise. Don't let it become a "special" or "defining" thing in her life that needs special accommodation unless there is a strong indicator that some special accommodation is actually required for her. The more normality you can bring into your daughter's life the more normality will eventually return to your own.

Answer 2

There are books (and even short films) for children of this age, to find words and images to explain what will happen. I would suggest you to find one or two, that fit into your point of view (religious/philisophy/ideology). Maybe you could ask the grandparents for help here, if searching this books triggers you. If your child visits a daycare you could ask there for recommendation. Some childcare-staff may had such books in their education.

I remember especially one book I read in German "Ente, Tod und Tulpe" (duck, death and tulip) where the death is a person and accompanies the duck on its way. They speak about philosophy aspects, like "Where will they go?" and "What comes after it?". It will be a base to find words and images to talk about this complex and difficult topic.

A second point that one should think about, are phrases adults use to discribe, that could cause fear in children. One often used is "the person is fall at sleep". We adults use it to not speak blunt about it, but for children, which most times understand this literally, it is frightening to "fall into sleep and be gone". They would not see the difference to themself simple falling asleep.

A third point would be to tolerate behavior, which is caused in not understanding the whole context by the child. There could be questions, maybe in front of others, that seem to blame you. But they will be honest questions, because the child do not understand adult's rituals around dying and burials. The child do not intend to blame someone. Maybe you could make an agreement, like a "special, magical, secret sign" that you could use, to show the child, that you heard the question, but can not answer it yet. (In another context my grandma did this with me. If I had to say her something, but she could not listen to me because she was in an important conversation, she pressed my hand and I know, she will listen to me as soon as she can.)

One last thing, I though about in your question, is the point of "not show her the side effects". I am not sure about this. Maybe you should follow your feelings, because you know the children best. You will be the first one seeing if your child is frightened by what it sees. Or if it want to come in contact more with the sibling. There are other ways to get in contact too, if you do not want to let them meet too much. Painting, handicraft, or care for the toys, that the sibling could not take into the hospital.

Like Hilmar wrote: ask for help of grandparents or other near persons, if there are points you can not talk about, or things you can not do. Care for yourself, to be able to care for your children.

Answer 3

Agree completely with Hilmar's answer. Most people rarely remember anything when they were 3 years old. While specific memories will lapse, emotional stress can linger. Be as happy and joyful as you can with the 3 year old. Try not to let her feel the emotional pain you are suffering. As hard as it will be, when your youngest passes, try to avoid making it a "heavy" event for the 3 year old. She will pick up on your emotional level and likely try to mimic it. Spare her that if at all possible.

Hilmar makes a point that I would like to echo... "Don't let it become a "special" or "defining" thing in her life..." I've seen parents make the loss of a child an ongoing family saga with annual reminders. Young children who won't remember their lost sibling anyway (in most cases) aren't served well with emotional reminders of someone they don't remember knowing.

That doesn't mean parents cant remember and carry the sorrow, but the young child should be shielded from it. It will be hard to avoid the "remember your sister" comments, but unless the 3 year old, on her own, unprompted, continues to bring her up, try not to yourself.

Do whatever it takes to stay together with your spouse. Letting this tragedy tear apart your family would do more harm to the 3 year old than anything else. Love each other as best as you can through this. Here's a book that I'd recommend: Holding on to Love After You've Lost a Baby

I'm so sorry you are facing this tragedy.