Editor's Note: The following was republished with permission from Childmind.org

By Jamie Howard, PhD

Director of the Stress and Resilience Program; Clinical Psychologist, Anxiety and Mood Disorders Center
CHILD MIND INSTITUTE

Q: My brother-in-law is dying from kidney failure. He's been going for dialysis three times a week for a few years now. He was recently diagnosed with nerve damage and can barely walk. He is also retaining water and has gained a lot of weight.

My 8 1/2 year old nephew has had an unbreakable bond with his dad since birth. He sees his father quickly deteriorating and is acting out in school. He keeps making excuses to be sent home to '"take care of his daddy." He's been receiving counseling in school three times a week. However, with recent occurrences it hasn't been helping.

I am writing to get your advice on helping my nephew and find out how to best talk to him about his dad.

A: There's a very good resource I recommend for families in this kind of situation called "Parenting at a Challenging Time." It offers excellent advice from a child psychiatrist, Dr. Paula K. Rauch, who specializes in helping parents explain their serious illness to their kids.

The site helps parents understand how children at different developmental stages think and might react to upsetting news. For instance, your nephew, who's eight, is able to understand permanence in a way that a preschooler isn't, but he might be preoccupied with this is unfair; why is this happening? 
 
Dr. Rauch's tips are really practical. For instance, the parent who is ill might tell a child, "I'm having a really good day today, so you don't have to worry." Kids need those opportunities to take a deep breath and feel they can relax.

And she suggests parents schedule regular check-ins, where they sit down with the child, encourage him to ask questions, and patiently answer them, so he doesn't feel he has to rush home from school to avoid missing some important information.

If his father's situation is grave, your nephew may be picking up cues from the grownups around him. It can feel very scary to a kid when people seem out of control. And that might explain why he needs to be there, to see for himself, and keep some control over the situation. That's why it's important for adults to appear as competent and in control as possible, even when they don't feel it.

If helps if parents are very open to questions and very direct in answering them, but without giving kids more information than they're asking for. And if you're unsure about how to answer something, then I would say, "That's a really good question.  I'm not sure; I need to get back to you." Then make sure that you get back to the child within a day or two, even if it's just to let him know that you need a little more time to answer that question.

It must be scary for your nephew to see his dad deteriorate, so it might help him to have a way to describe the problem and what's being done to help. "Your dad's kidneys aren't working the way they should, and dialysis is a medical procedure to help kidneys work better, and so that's why he has to have that done a few times a week."

And his dad might explain, if he can, "Kidneys help us get water out of our bodies. I have a lot in my body now because my kidneys aren't working right, and that's why I look different."

In a health crisis like this one, the family can be really busy with a lot of tests and doctor's appointments, but it's important to keep some semblance of normalcy, too—if there's one activity that your nephew really loves, you might focus on that. Also try to maintain his routines, like bedtime rituals, because they help kids feel safe—that kind of thing is really important.

And if your nephew can count on about 45 minutes of quality time with his dad every day, time he can take a mental picture of and remember and enjoy, he may feel less need to leave school to be with Dad. Because when kids feel confident that they have a sense of what's going on, and they'll be kept informed, and they'll get quality time with their sick parent, they can feel calmer.

Photo David Castillo Dominici
Published: February 17, 2015