A Child with a Seriously Ill Grandparent: Understanding a Grandmother or Grandfather Who Has Changed

What does a child with a seriously ill grandparent feel, and how do you explain it? Age-based wording, hospital visits, changed behaviour and saying goodbye.

The grandmother they visited every weekend, whose kitchen always smelled of biscuits, who hugged them every time saying "My little lamb", now hardly gets out of bed. Or the grandfather they planted tomatoes with in the garden has begun mixing up their name since he was taken to hospital last month. The adults whisper in the hallway, phone calls are cut short, and their mother is often close to tears. A child with a seriously ill grandparent feels this change at home deeply, even if they do not always ask about it in words. Many families choose to hide the situation from the child or to brush it aside so as not to upset them; yet children often fill in what is left unsaid with their own imagination, and in a more frightening way. In this article I look at how you can explain the situation to a child whose grandfather or grandmother is seriously ill in a way that suits their age, which reactions you can expect, how to prepare for hospital visits and what your child needs during this time.

What Does a Child with a Seriously Ill Grandparent Feel?

Grandmothers and grandfathers hold a special place in the lives of many children in Turkey. Some children have grown up for years at their grandmother's side while their parents worked; others have spent every religious holiday and every summer at their grandfather's village house. That is why a grandparent falling ill is, for a child, not just "a relative's illness" but the shaking of a secure bond.

Children may experience the following during this time:

• Confusion. "Why doesn't Grandma play with me any more? Why did Grandad forget my name?" When a child cannot understand the reason for a change, they come up with their own explanations.
• Fear. Illness, the hospital, the smell of medicine, medical equipment or a bedbound body can frighten a child. Some children worry, "Will I catch this illness too?" or "Will Mum become like this as well?"
• Guilt. Young children are prone to magical thinking. Thoughts such as "I didn't listen to Grandma the other day, I was cross with her, that's why she got ill" are common.
• Jealousy or anger. When the family's attention turns to the ill grandparent, the child may feel neglected, and then feel ashamed of that feeling.
• Longing and grief. Even while the grandparent is still alive, the child may feel they have lost "that grandma" they used to know.

All these feelings are natural. The first step to understanding what your child feels is to open up a safe space where they can tell you.

How Do You Explain the Situation to a Child with a Seriously Ill Grandparent?

General principles

• Be honest but age-appropriate. You do not need to tell the child every medical detail; but what you say should be true. Untrue explanations such as "Grandma has gone on holiday" lead to a loss of trust when the child learns the truth.
• Speak briefly and concretely. Start with a few sentences rather than long explanations; if the child wants to know more, they will ask.
• Name the illness. Names such as "cancer", "stroke" or "the forgetting illness" reduce uncertainty. A mysterious "something" is always more frightening.
• Say that it is not contagious (if it isn't). Answering in advance this question that children often have but cannot put into words is reassuring.
• Say clearly that it is not their fault. "Grandma's illness did not happen because of anything you did or said."
• Do not hide your feelings completely. You can be sad in front of your child. Saying "I'm sad too, I love Grandma very much" teaches the child that sadness is also part of love.

What to say and what to avoid

With fictional example sentences:

Sentences that help:

• "Something called a stroke happened in Grandad's brain. That's why he finds it hard to talk and walk. He still loves you very much."
• "Grandma's illness makes her forget some things. Even if she forgets your name, being with you does her good."
• "You can ask me anything you're wondering about. If there's something I don't know, we'll find out together."
• "Sometimes you might feel sad, sometimes cross. Both are OK."

Sentences to avoid:

• "You're too little, you wouldn't understand." This shuts the child out and leaves them to their imagination.
• "Don't cry next to Grandma, you'll upset her." This teaches the child to hide their feelings.
• "Don't tire Grandad out, don't make noise, don't go near him." This distances the child from their ill grandfather and fills the relationship with fear.
• "If you're good, Grandma will get better." This puts responsibility for the course of the illness on the child; if the grandmother does not recover, the child may blame themselves.

A Child with a Seriously Ill Grandparent: Differences by Age

Ages 3–6

Children of this age find it hard to grasp time, death and illness in the abstract. Short, concrete and repeated explanations work well. The child may ask the same question over and over; this is a sign they are trying to understand. Playing "doctors" with dolls, drawing pictures or simple picture books help the child express their feelings. At this age, regressive behaviours such as bedwetting again or not wanting to be separated from their mother may appear.

Ages 7–11

School-age children want more information and begin to make connections between cause and effect. They may ask questions such as "Why did they get ill? Will they get better? How long will it last?" Answer these questions honestly as far as you know; if you don't know, it is enough to say, "The doctors don't know yet either; I'll tell you as we find out." Giving children of this age a concrete role, such as drawing a picture for their grandmother, playing their grandfather's favourite folk song over the phone or reading a book during a hospital visit, reduces their sense of helplessness.

Teenagers

Teenagers understand what the illness means in a way close to adults; they may also think about the possibility of death. Some react by withdrawing, others by taking on responsibility. A young person may want to help with their grandmother's care; this can be supported, but they should not take on a load unsuited to their age. It is important to talk with a teenager as you would with an adult, to be open to their questions and to ask separately, "How are you doing?" Their schoolwork, exam periods and friendships should not be overlooked during this time.

Understanding a Grandparent Who Has Changed

Illness sometimes changes a grandmother's or grandfather's personality, behaviour and appearance. This change can be the hardest part for a child.

Forgetfulness and confusion

In conditions such as dementia, a grandmother may not recognise her grandchild, may mix them up with someone else or may ask the same question again and again. It can help to tell the child, "Grandma hasn't forgotten you; her illness is muddling her memory. But she's happy when she sees you, you can see it on her face." For families going through dementia as caregivers, the article on being the relative of someone with dementia can also offer guidance.

Anger or irritability

Some illnesses, or pain, can make a grandmother more irritable or angry. Explaining to the child, "Grandma isn't cross with you; she's in pain and that makes her grumpy," stops them from being hurt personally.

Changes in appearance

Weight loss, hair loss, changes in the face after a stroke or medical equipment can frighten a child. Describing these changes before a visit reduces the surprise.

From the grandma who cares to the grandma who is cared for

In the routine the child is used to, the grandmother is the one who cooks for them, combs their hair and waits at the door after school. With illness these roles may be reversed: now it is the child who takes water to their grandmother, straightens her pillow and reads her a story. In some children this change strengthens compassion and a sense of responsibility, while in others it creates sadness or a feeling of loss. It is important to appreciate the child's small acts of help, but not to expect them to take on care tasks that an adult should handle. Saying "Bringing Grandma some water really did her good" shows the child they can still connect with her. Making room for the grandmother to keep doing the small things she can, such as listening to her grandchild, looking at photos together or saying a short prayer, also keeps the relationship two-way.

Hospital Visits: Should You Take the Child?

There is no single answer to this question; it should be decided according to the child's age and wishes, the grandparent's condition and the hospital's rules.

Before the visit:

• Ask the child whether they want to go; do not force them.
• Describe in advance what they will see: "There's a thin tube in Grandad's arm that gives him medicine. Next to him there's a machine that goes beep beep; it keeps track of his heartbeat."
• Tell them the visit will be short.
• Decide on something concrete the child can do during the visit: give a drawing, sing a song, hold a hand.

During the visit:

• Make sure there is an adult with the child who can leave with them whenever the child wants.
• Respect the child's wish to touch, hug or simply look from a distance.

After the visit:

• Ask, "How did you feel when you saw Grandad?"
• If the child was frightened or cried during the visit, tell them this is understandable.

If the child does not want to visit, other ways of staying connected can be found: video calls, voice messages, sending a letter or a drawing.

Children can cope with hard truths; what wears them down most is the uncertainty they are left alone with.

The Final Stage and Saying Goodbye

If the grandparent is in the last stage of life, talking about this with the child is very hard for families. Even so, having a chance to say goodbye can make the child's later grief easier.

• An age-appropriate but clear explanation prepares the child, such as: "Grandma's illness has become very serious. The doctors have done everything, but her body can't get better any more. After a while she may die." Expressions such as "she's going to sleep" or "she's going on a long journey" can lead to a fear of sleep or of travel, especially in young children.
• If the child has something they want to say to their grandmother, help them pass it on face to face, through a drawing or in a letter.
• Give information about religious and cultural rituals in line with your family's values; decide together with the child whether they will take part in the funeral or the condolence gatherings.

You can read in detail about how children cope with grief after a loss in the article on grief in children.

When Should You Seek Professional Support?

A child with a seriously ill grandparent may show some restlessness, sadness or regression during this time. However, it may be helpful to see a child mental health professional in the following situations:

• Sleep problems, nightmares or intense separation anxiety lasting for weeks
• Not wanting to go to school, a marked drop in school performance
• Marked withdrawal, pulling away from play and friends
• Constant and intense fears about illness or death
• A marked increase in tantrums
• In teenagers, hopelessness, worthlessness or bleak statements about life

If you notice that a teenager has thoughts of harming themselves or ending their life, do not wait; in an emergency, call 112 (emergency services) or go to the nearest emergency department.

How Is a Grandparent's Illness Addressed in Therapy?

Young children often express their feelings not in words but through play. Child and play therapy gives the child room to express their fears about the hospital, illness or loss through toys, puppets and drawings in a safe setting. The therapist accompanies the child by following the themes in their play.

With older children and teenagers, talk-based sessions can work on naming feelings and developing coping skills. Thoughts of guilt, tolerating uncertainty and worry about the future can be addressed.

Sessions with parents are also an important part of this process. A mother or father is trying to cope at the same time with their own parent's illness and with their child's feelings. When a parent recognises their own emotional load and receives support on how to talk with their child, it helps the child adjust better too.

Frequently Asked Questions

My child never asks about their grandmother's illness. Should I bring it up?

Not asking questions may not mean they are not curious; some children stay silent so as not to upset their parents. You can make a short, natural opening: "Do you ever think about Grandma's illness?" If they do not want to talk, do not force it; knowing the door is open is enough.

My child is scared to go near their grandfather. Should I make them?

No. Try to understand their fear and ask what frightens them. Perhaps it is the medical equipment, perhaps their grandfather's changed appearance. You can start with small steps such as showing a photo first, a short phone call or waving from the doorway.

If the grandmother dies, should I take the child to the funeral?

This decision should be made according to the child's age, wishes and the family's values. It is important to tell the child in advance what they will see, to have an adult with them to accompany them, and to make sure they know they can leave whenever they want. If they do not want to attend, other ways of saying goodbye can be found.

As a parent I'm very sad too. Is it all right to cry in front of my child?

Yes, showing your sadness in front of your child is often healthy. Explaining, "I love Grandma very much and I'm sad because she's ill. Crying helps me," teaches them that feelings can be shared. However, if you are going through intense and constant low mood, it is important to get support for yourself as well.

• #grandmother
• #grandfather
• #explaining illness to children
• #patient psychology

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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