When a Classmate Is Seriously Ill: How to Explain It to Students

When a classmate is seriously ill, how do you tell students? Age-appropriate explanations, example phrases and classroom support for teachers and parents.

On Monday morning, one desk stays empty at registration. One day, two days, a week… The children start to ask: "Miss, why isn't she coming?" Whispers go round at break time; one says "She's going to die", another asks "Can we catch it too?" In the evening a parent rings the teacher: "My daughter is really frightened; what should I tell her?" When a classmate is seriously ill, teachers and parents face a difficult task: talking to children without frightening them, but without cutting them off from the truth either, while respecting their ill classmate's privacy. In this article I look at how you can explain a child's serious illness to the other students in the class, differences by age group, the questions children often ask, and how the bond with the ill student can be maintained.

When a Classmate Is Seriously Ill: Talk to the Family First

Before making any announcement to the class, the first step is to talk to the ill student's family. This step is very important both ethically and for the child's future experience of school.

Questions to clarify when talking to the family:

• How much information can be shared? Some families want the name of the illness to be mentioned, while others prefer the class simply to be told "They're having treatment".
• What does the child themselves want? Older children and teenagers in particular should have a say in what they want their friends to know.
• Is contact with the class wanted? Will contact such as cards, letters or video calls be good for the child, or do they need rest right now?
• Is a return to school expected? What changes might there be on their return (hair loss, a wheelchair, a mask and so on)?

If the family does not want information to be shared, this wish should be respected. Even then, the teacher can give an explanation such as: "Your friend won't be able to come to school for a while; the doctors are looking after them. Their family wants to keep this private, and we'll respect that." Teaching children to respect privacy is also a valuable part of this process.

You can find more detailed information on the role of a teacher working directly with an ill student in the article on how teachers can support a seriously ill student.

How Do Children Understand a Friend's Illness?

A classmate's serious illness leads to different reactions in children depending on their age. Understanding these reactions makes it easier to choose the right explanation.

Common reactions include:

• Fear of catching it. The question "Will I get ill like her?" is very common, especially among young children. With illnesses that are not contagious, such as cancer, saying this clearly removes unnecessary fear.
• Magical thinking. Young children may think they themselves caused their friend's illness: "I had a fight with him last week; is that why he got ill?"
• Worry about their own loved ones. A friend falling ill reminds a child that the people they love can fall ill too. Some children may start to worry about their parents' health.
• Curiosity. Children may ask many questions about illness, hospitals and treatment. This curiosity is not insensitivity; it is an effort to understand the world.
• Avoidance. Some children do not want to talk about it at all and behave as if nothing has happened. This, too, is a way of coping.

You can find general information on what anxiety looks like in children and how it can be supported at home in the article on anxiety in children.

Explaining by Age: Preschool, Primary, Middle and High School

The language used to share the news that a classmate is ill should suit the students' developmental level. The same information is explained very differently to a nursery pupil and to a high-school student.

Preschool and the early years of primary school

Children of this age need short, concrete and simple explanations. Long medical descriptions confuse them.

• Example: "Your friend has become ill and will stay in hospital for a while. The doctors are taking good care of her. This illness isn't catching, so you won't get ill because you played with her. Nobody made her ill by doing something."

At this age children may find it hard to put their feelings into words. Drawing, making a card for their friend or playing a hospital-themed game helps them express their feelings.

The later years of primary school

Children of this age may want more information and often ask "why" questions. The name of the illness can be given, with the family's permission, along with a simple explanation.

• Example: "Some of the cells in your friend's body have become ill. This illness is called leukaemia. The doctors are giving him medicine; this medicine can sometimes make him very tired, and his hair may fall out. When he comes back to school he might look a bit different, but he's still the same friend."

Middle school

Middle-school students can understand more complex information, but they are also more exposed to peer comments and information circulating on social media. At this age it is important to correct rumours.

• Example: "From what I've heard, some of you have been saying different things about your friend. I want to share with you as much as her family has allowed. Spreading information that isn't true can hurt both her and her family. If there's anything you're wondering about, you can come and ask me."

High school

High-school students may question abstract subjects such as death, uncertainty and fairness. At this age, giving students more of a say and planning together how they would like to offer support works well. Teenagers may want to be active in concrete roles such as messaging their ill friend, sharing lesson notes or planning a visit. At this age some young people may react with anger, a sense of injustice or thoughts such as "Life is meaningless"; others may be unable to concentrate on lessons for fear of losing a close friend. News of an illness that coincides with exam season can add an extra burden for final-year students preparing for the YKS (Turkey's national university entrance exam). It is important for the teacher to normalise these reactions and to remind students that those who wish can talk to the school counsellor.

Questions Children Often Ask and Possible Answers

Students sometimes confront their teachers and parents with difficult questions. The examples below are fictional answers intended as guidance; they can be adapted to the needs of each class and each family.

• "Is he going to die?" This question needs an answer that is honest but also keeps room for hope: "The doctors are working very hard to make him better. We don't know right now what will happen, but whatever happens, I'll tell you."
• "Can we catch it?" If the illness is not contagious: "No, this illness doesn't pass from friend to friend. You can play with her and hug her." If a contagious condition is involved, a calm explanation in line with school health policies and medical advice should be given.
• "Why did he get ill?" "Sometimes illnesses happen without it being anyone's fault. It didn't happen because he or anyone else did something."
• "When is she coming back?" "We don't know yet. Her treatment may take a while. When she comes back, we'll welcome her together."

When a question comes that you don't know the answer to, saying "I don't know, but I'll try to find out" teaches children honesty and how to live with uncertainty.

Sentences to avoid

• "Don't worry, he'll definitely get better." (This may be a promise that cannot be kept.)
• "Let's not talk about this; you'll get upset." (This leaves children alone with their feelings.)
• "Never mention her illness in front of her." (The ill friend may want to talk about it herself.)
• "You're lucky you're not ill." (This positions the ill student as "unlucky" and different.)

Children do not expect an answer to everything; what they really need is a safe adult to whom they can ask their questions.

When a Classmate Is Seriously Ill, How Can the Bond Be Kept? Preparing for the Return to School

A student being away from school for a long time does not mean the class has to lose touch with them. With the family's permission and according to the child's wishes, there are many ways to keep the bond going.

• Cards and letters. Each student drawing a picture or writing a short note to their friend does both the ill student and the children writing good.
• Video calls. When appropriate, a short call with the class helps the ill student feel part of the class.
• A class board. A corner or digital space where lesson notes and what is happening in class are shared helps the student not feel like a stranger when they come back.
• Keeping their desk. Keeping the ill student's desk, belongings and place in the classroom sends the message "We're waiting for you".

When the student is returning to school, it is important to prepare the class in advance. If there are changes in their appearance, these can be explained beforehand with the family's and the student's permission. Elaborate welcome ceremonies on the day they return can make some children uncomfortable; usually a warm but simple welcome such as "Welcome back, we missed you" is enough. Having one or two close friends keep them company so they are not alone at break time is also a good idea.

The teacher's own feelings

Teachers are affected by this process too. The serious illness of a student they have known for years can stir sadness and helplessness in a teacher, and sometimes misplaced guilt such as "I should have noticed sooner". Suppressing their own feelings while trying to stay strong in front of the class creates tiredness over time. Sharing feelings with the school management, the guidance service and colleagues helps teachers both protect themselves and give students calmer support. Becoming emotional for a moment in class is not a weakness either; it shows children that sadness can be shared.

What parents can do at home

Parents should keep the door open so that their children can talk at home about what they hear at school. Asking "Have you heard anything at school about your friend; is there anything you're wondering about?" makes it easier for the child to voice their worry. Parents avoiding spreading unconfirmed information about the ill child among themselves or in parent group chats is also an important form of respect towards the ill student's family.

When Should You Seek Professional Support?

Feeling sad, anxious and asking questions in the face of a friend's serious illness are expected reactions. However, in some children these reactions may last longer and be more intense:

• Sleep problems or nightmares lasting for weeks
• Not wanting to go to school, frequent complaints of tummy aches or headaches
• Constant, intense worry about their own health or their family's health
• Marked withdrawal or pulling away from play if the ill friend is a close friend
• A sudden drop in school performance
• In teenagers, hopelessness or remarks such as "There's no point in living"

In these situations, the school counsellor is the first person to turn to. If thoughts of self-harm or of ending their life are noticed in a student, 112 (emergency services) should be called in an emergency. If necessary, support can be sought from a child and adolescent mental health professional. Sadly, in some cases the illness may progress seriously and the class may face a loss. In such a situation, you can find information on how to support children's grief in the article on grief in children.

How Is This Experience Addressed with Children in Therapy?

Psychological support can help children make sense of the complicated feelings they experience in the face of a friend's illness. In work with young children, play-based approaches come to the fore; through a toy hospital, puppets or drawing, the child can express their fears, questions and feelings of guilt. Child-centred play therapy gives the child room to process this experience at their own pace and in their own language.

In sessions with older children and teenagers, the focus can be on noticing worrying thoughts, coping with uncertainty and thinking about how they can support their friend. In this process, working together with parents and, where necessary, with the school ensures the child receives consistent support in every setting. You can find information on this in the child and play therapy service.

Frequently Asked Questions

Is it better never to mention the ill friend's name in class?

No. Never mentioning the friend's name can give children the message that they have been forgotten or are something that must not be talked about. Speaking about them naturally, within the privacy limits the family wants, helps keep the bond alive.

My child wants to visit their ill friend; should I take them?

You first need to ask the ill child's family; visits may be limited during treatment because of immunity and fatigue. If a visit is appropriate, prepare your child in advance: explain how their friend might look, what the hospital setting is like and that the visit needs to be kept short.

What should be done if one of the students is mocking the ill classmate?

This should be dealt with immediately and clearly. It is important to talk with the student who is mocking individually, to try to understand the fear or lack of knowledge behind their behaviour and, if necessary, to meet with their family. A general message about respecting differences and empathy can also be given to the class.

What should be done if the ill student's sibling is at the same school?

It is important to get in touch with the sibling's teacher as well, because they may be going through a big change at home too. The sibling may grow tired of questions from friends or feel invisible because attention is always on the ill child. Setting aside time for them, allowing flexibility with their lessons and reminding them that they can talk to the school counsellor if they wish are all helpful.

• #teachers
• #classroom
• #serious illness
• #talking 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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