Talking to Children About Stillbirth

A guide to difficult conversations and family healing

When my daughter was 4 years old, she mentioned to a friend that her sister Genevieve had died. The friend responded, with a note of warning in his voice, that "died" was a bad word.

That perspective is understandable. Most parents shield young children from death for as long as possible. But when you lose a baby, you don't have that option. You not only have to talk about death, but you have to explain the death of a baby – something even adults struggle to understand.

I'm grateful we were honest with our 2-year-old daughter Eleanor when her sister Genevieve was stillborn. It created an atmosphere that made her feel comfortable talking about her sister and asking questions, so we can continue to include Genevieve in our family. But those early conversations were very difficult, and I wanted to help other parents who have to explain the unthinkable to their living children.

Be honest
"We live in a death-denying society, and we tend to think that if we don't talk about a death that the sadness will disappear," says Christiane Manzella, PhD, a grief specialist and clinical director of the Seleni Institute. This is untrue, of course. Parents spend years processing their loss, and children can feel bewildered if they don't understand what's behind the changes they see in their parents. "Honesty is the best way to help children cope," says Manzella.

Jen Douglas, a university lecturer in Vancouver, British Columbia, says that she quickly realized she couldn't protect her 3-year-old daughter Emilia after the stillbirth of her baby sister Anja. "I wanted to shield her, to make it as easy and comfortable as possible, but I came to realize that the loss was as profound for her as it was for us," says Douglas. "She needed reassurance and love and comfort."

Molly Ebach, a public relations professional in Germantown, Tennessee, was honest with her nearly 2-year-old daughter Sloane when her brother Hayes was stillborn because she wanted him to always be included in their family. "I knew early on that I wanted his name spoken often, and I worried that sugarcoating his story would somehow make it a taboo topic," says Ebach.

Meet children at their level
"Speak in the language level of the child," says Manzella. Stay away from such euphemisms as "we lost the baby" and "the baby went to sleep," which may only confuse the child more. Instead, use simple and direct language like, "The baby got sick and died. We feel very sad."

By the time children are 18 months old, they can understand that people leave and come back, though they do not yet understand the permanence of death, Manzella says. Young children might ask when the baby is coming back or if they can go visit the baby. By age 4 or 5, children may understand that the body can stop working and that people who die do not come back, she says.

We have seen this shift with Eleanor. When she was 2 and 3, she seemed to mimic our emotions about Genevieve. As she has grown, she has shown more genuine sadness about her missing sister.

How to handle the hard questions
Honesty will bring difficult questions, but direct answers will help children process the loss. The parents I spoke with gave the following answers to some of the most common questions.

Q: Why did she die?
A: "I don’t know. It was an accident. She wasn't supposed to die, but she did, and I miss her very much." — Renel Ralston, a physical therapist in Clovis, California, whose daughter Camille was stillborn when her son Kai was 2.

Q: Where did she go?
A: "We have talked about how her energy went back out into all the living things, so that she is in the flowers, and the trees, and the grass." — Jen Douglas

Q: Where is her body?
A: "Where we live, you can only choose between burying a body in a box or burning the body in a special fire. We decided to burn her body in a special fire. She was dead, and it did not hurt her." — Renel Ralston

Q: Will the new baby die?
A: "We do everything we can to ensure his health and safety, so hopefully he will be with us for a long time." — Molly Ebach

How to handle fears
After experiencing the death of a sibling, it's natural for children to worry about others dying, especially their parents or new siblings. Although it's important to reassure children, it's equally important to be honest. Since we cannot guarantee health, Manzella says to "make no promises, but do assure." She suggests telling children: "We're all well and healthy, and we expect to stay that way."

Take care of yourself
Children do not know when they should bring up difficult subjects. Sometimes they ask the same questions repeatedly or bring up the death of your baby when you feel like you're barely getting through the day.

Eleanor would often ask to look at pictures of Genevieve when I was least prepared – getting ready to go out and meet a friend or curled up in bed crying. At these times, I redirected her to her dad if he was better able to help, or we planned a time to sit and talk later. I wanted her to know that it was ok for her to ask questions, but I sometimes had to delay an emotional conversation.

Talking with others
Most parents I spoke with said they make sure to tell their child's teachers about the loss. This is a painful conversation, but it's better for teachers to be prepared for your child's questions.

Ralston says her son Kai, now 5, "would tell his friends at school that he had a sister but she died. Kids were generally very accepting."

When Eleanor mentions her sister to friends, they typically say little or change the subject, and this can upset her. We have told her that she can talk about Genevieve at any time but that some of her friends might not fully understand.

Keeping the dialogue open
"Families should keep an open dialogue about the loss," says Manzella. "As children grow and reach new levels of understanding, they will sometimes regrieve and have new questions."

We recently brought home our third baby, and while I know that he will have questions, I do not expect the conversation to be as stilted and difficult as it once was. Genevieve is now woven into our lives. He will always hear us speak her name, and he will remember her with us.

Further reading
The Association for Death Education and Counseling has an extensive reading list.

Children's books on death and stillbirth

• Bluebird by Bob Staake
• Michael Rosen's Sad Book by Michael Rosen
• Someone Came Before You by Pat Schwiebert
• We Were Gonna Have a Baby, but We Had an Angel Instead by Pat Schwiebert