The first thing to bear in mind is that children will wonder what is happening. They are sensitive to their emotional environment and will pick up on feelings and changes in mood, despite any attempts to hide them. If we are not open and honest with them they may think they have done something wrong, or that they are not loved anymore, so it is important to tell them what is going on a supportive way while offering lots of reassurance. It is probably better to tell them yourself directly, but this might feel too difficult to manage. You might prefer to have someone who works with children in this area telling your child, with you in the room to comfort and reassure them.
Try to be honest with them at all times. A 'right time' may never present itself, so it's more important to get the information across so the child knows what is happening. This is better than leaving them to ask increasingly difficult questions, which become increasingly difficult to answer. Perhaps consider a regular conversation to see how they are feeling and ask if anything is not making sense to them.
Do not be concerned if your child seems unaffected or ambivalent about the information once you have given it to them. They tend to be more in tune with their emotions than adults, and they will not react or respond just because you expect them to. They often take the information away with them and think about it later on, sometimes at unexpected times such as when they are in the middle of playing. It is important to offer reassurance and be there to comfort them when they feel they need it. Try to let them decide when to bring the matter up for discussion, as they are usually very good at picking the times when they are best able to deal with it.
Another thing to remember is that children are good at switching on and off from the seriousness of the situation. Studies have shown that a healthy response in times of crisis and during prolonged stress is to switch on and off from confronting the difficulties. This is known as a Confrontational / Avoidant approach and it involves taking time out to switch onto more distracting and pleasant pursuits to give the mind and emotions time to recharge. Children will have a real need to do fun things as usual and you should continue to make sure they have plenty of opportunities to play and feel that things are normal, even though it is obvious things are not. With children, there is definitely a time for seriousness and a time for play, so try not to confuse the two.
When visiting a patient away from home with children, make sure they have something to occupy their minds. Their sensitivity to emotional undercurrents might cause them to misbehave or else become very quiet, so having something for them to distract them with is always a good idea. They also tend to have shorter attention spans so try not to stay too long during visits and it might be a good idea to take them somewhere fun directly after the visit. Changes in the appearance of the patient due to weight or hair loss can be explained before the visit so that the child can be prepared. You can explain tubes or changes in the environment, or ask the care team for help. This might prevent them from asking questions directly to the patient, who might be upset by it. The main thing to tell them in preparation is that although the person might look different, they are the same person they were before. Children have vivid imaginations and will complete the gaps in their understanding with their imagination. This may lead to distress and misunderstanding which could affect their bereavement.
You may not have all the answers to the questions the child might ask, so don't feel bad about it. It's fine to say you don't know the answer to something and it's more honest than telling them something that isn't true. Remember, being honest is what matters most. Stick to the facts and don't use flowery language. Obscuring the truth and the harsh reality by being evasive decreases the chances of the child understanding what you're saying to them. Young children understand the words death and dying but only start to understand the permanence of death around five years old.
If you would like to talk with someone who can advise on talking to children, your District Nurse or Social Worker can put you in touch with organisations which may be able to help.
Books that may help young children
A Dragon in your Heart - Sophie LeBlanc and Jessica Kingsley
Dr Dog - Babette Cole
The Huge Bag of Worries - Virginia Ironside
Laura's Star - Klaus Baumgart
Love you forever - Robert N. Munsch
Books that may help older children
The Secret C: Straight Talking about Cancer - Julie A Stokes
Two weeks with the Queen - Morris Gleitzman
The Soul Bird - Michal Snunit