How to talk with children about death


Death is a difficult subject to approach with a child especially when someone close to them passes away. You have your own feelings to process and must also provide empathy and strength for your child. Since Dr. Rusty passed recently, I thought this would be an ideal time to review how to speak with children of different ages about death. In my experience, an open, honest, and direct communication based on their developmental understanding is best.


PRESCHOOLERS – The butterfly won’t fly anymore.


Preschoolers have partial logic so when explaining death they may not grasp its permanency. They understand some of the realities of life but can quickly leap into fantasy. Often only a small thread separates the two worlds.

I recommend using the actual words like death yet illustrate the meaning by referring to familiar activities to help them process. For instance, you may tell them that grandpa died this morning and he will not breathe, eat, sleep, or wake up anymore. You can also include other real-world realities that they may have previously experienced like when we found a butterfly on the sidewalk, it had died too. The butterfly will not fly anymore. Preschoolers learn by repetition of simple examples presented in a familiar way.

Death is not a singular event. It is also an adjustment in life and feelings. Make sure you speak about your emotions and help them describe theirs as well. Drawing and free play outside may serve to create expression since connecting words and feelings may elude them.


GRADE SCHOOL – Everyone dies in their time.


Grade-schoolers have concrete thinking rather than imaginative reality like preschoolers. They understand the words used to describe death and its permanency. They will be sad without additional explanation. They may not understand the profound weight this carries for you and the changes this means for their lives.

While they have concrete logic, they do not understand nuanced values and abstract thinking. They see things very black and white. Children at these ages understand that everyone will one day die, while at the same time believing that death does not apply to them. They lack the abstract.

Children can have widely varying behavioral responses as they process their feelings. Often their emotions and words are disconnected. Parents are advised to talk about their feelings as a way to role model growth in identifying and processing emotions. A parent may want to discuss how a death will affect the child’s life. Children may have questions and it is important to try your best to listen to the questions, the reasons behind the questions, and be generous in your honesty and openness. Again, reassure them with presence and love.


TEENAGERS – An invitation to talk.


Teenagers are a narcissistic form of ourselves. They need boundaries and expectations more than monitoring.  Structure and continuity are important for all ages, but especially so for teens.  An invitation to talk without expectation is a powerful communication tool and this may be all they need.

Teens may move quickly in and out of grief.  They understand death through past experiences, music, film, school, religious instruction, and the lens of current events. What they may not do is synchronize the importance of the death into their life. This is normal. Almost everything to a teen is seen through their needs only. Give them space to grieve in this way while being open to their agenda on when they want to talk.

Remember that you are permanently carving their eventual coping skills through your example. The important thing is to reassure preschool-aged children with your presence and love, help your child connect feelings and words, and wait for your teen to cope.

The Sleepover: From a dad, a doctor, and child abuse advocate

One of my daughter’s had her first sleepover. She was invited to a play date and as the day went on the play date turned into a sleepover. The decision to let her spend the night at someone’s house was easy for me. I have wonderful memories from those days and wanted her to have the same. Besides she was super excited at the idea.

Many parents are on the fence about the need for a sleepover. Will my child be better off for going? Will they be deprived if they don’t go? Obviously, I am in favor of them. Maybe naively so but I trust people.

I trust people because I see the worse of what happens to children as the medical director of the Collier County Child Abuse Team. The overwhelming majority of people are trustworthy. Given the number of sleepovers that happen every weekend night and the number of abuse-related cases that end up in my clinic, sleepovers are hardly a concern. Of course, every parent should do their due diligence before allowing their child to sleep away from home.

Here are several good reasons to say yes to sleepovers:

  1. Your kids will get a chance to practice the manners you teach and you will glow when you hear how well they behaved.
  2. Your kids will get to do and try different things – food, games, travel, etc. they may not otherwise, which is all part of making it a treat.
  3. Your kids will make new friends, and so will you.
  4. Your kids will get to learn social boundaries and custom – how to behave in someone else’s house, car, etc. is different than behaving at home.
  5. You and your kids will have a chance to unwind and relax, away from the constant attention of each other.
  6. You and your kids will be on the path of mutual trust.
  7. Your kids will have meaningful connections and happy experiences to look back on and this is what it is all about.


O Xbox, Xbox, Wherefore Art Thou, Xbox?

“How much gaming screen time should be allowed?” is an oft-asked question by parents, my kids and my friends. “But I am a good kid, I make good grades, I play two sports, and rarely get in trouble,” is the reply I often hear as the debate unfolds in my house, at the office, and likely your house.

Regardless of a child or teen’s stated qualifications, TV time, gaming time, or general screen time for more than two hours a day, every day, without a decompression period outside and time for ordinary family interaction is detrimental.

Make no mistake this is a minefield that ought to be carefully navigated because your child may be seeking recognition for their effort as well as arguing for a dopamine hit.  

Inevitably you will be hit with, “But why?”  This is a great question and one your teen should ask. Remember your child is looking for acceptance, mastery and independence. Saying ‘no’ to your child is a poor man’s way of saying, “I love you and need you to learn other skills too. This is also unhealthy.”

Here is reasoning to support more eloquent ‘No’s’:

1. Sitting in front of a screen down-regulates the number of dopamine receptors in the brain’s reward processing area. As a result, the ability to feel pleasure is decreased so more and more stimulation is sought.

2. Heavy use of screen time results in an imbalance of activities of daily living, such as sleep, learning how to empathically communicate, and take on new hobbies.

3. Malcolm Gladwell famously surmised that it takes 10,000 hours to be world class in any field.  That would take 13.69 years spending 2-3 hours a day to become world class. Now that could be spent on social media, games, or in that same time, you could learn how to play guitar, improve grades, train to be a better athlete, serve your community, become an artist, learn to cook, and gain emotional resilience. 2-3 hours a day can solve almost any problem.

4. Even the most cleverly designed games are limited in creativity and offer only the illusion of choice.  Would your child rather work towards someone else’s goals bound by their limitations and rules or create their own goals and lay down their own rules? Your child’s brain has unlimited possibilities when playing without restrictions.

5.  Some games are rich in narrative and layered with Shakespeare-worthy metaphors.  In rare instances, games can be seen through the lens of artistic expression, but those that are worthy of being labeled art are few and far between.  Most games are designed with addictive behaviors in mind and are singularly focused on turning a profit.  For example,
loot boxes are a controversial monetization scheme employed by gaming companies which is no more than a thinly veiled gambling system effectively marketed to children.  

At the end of the day, we are not trying to take anything away from our children and we need to be certain that message comes across.  We are giving them our attention, our love, and encouragement to pursue their interests.  One of the most successful strategies to reach someone is to go to them in their interests and needs.   Commit some time in their space doing their interests with them first.  Turn the game or media into a talking point and a teachable moment, but keep it a two-way conversation.

If all else fails you may need to put your foot down, remove the screens, set boundaries, and suffer some lashing out.  Remember that social media and games hit all the same pathways as substance abuse and there will be some withdrawal.  Have sympathy and sit with them in their pain as you remind yourself in silence that you are their parent and not their friend. 

Good luck. Teaching your children is the best game played.

When Mom has the Flu?

You do not want to give up snuggle time but you also do not want to be Typhoid Mama either. So what is a dedicated mom to do…


You want to generously dole out affection but not germs.


#1 Wash your hands.  Everyone wash your hands with soap and water.  There would be far less infection in the world if everyone washed their hands more frequently.


#2 Keep your distance.  Maintain at least a 3 foot bubble from all loved ones unless you have recently washed your hands and have not sneezed all over yourself.


#3 Wear a mask.  Not just any disposable mask, but a N95 mask that blocks 95% of  particles that are 0.3 microns.


#4 Continue to nurse. New mommies may consider maintaining space from infants, but should continue expressing breastmilk because nothing is as nutritious and helpful to a baby’s immune system as breastmilk.  Mommy should wash her hands and wear a mask when expressing milk while a healthy family member handles feedings if possible.


#5 Disposable tissues. This will help reduce the spread of germs often associated with sneezing and coughing into the air, clothes, or hands.  Flu germs can stay airborne for about 3 minutes, so anyone who walks into the that once empty space you sneezed in may get sick.


Remember illness usually has a lower severity when the virus enters a healthier terrain. Eat well, sleep well, exercise well, hydrate well, relationship well – daily. 

Vaccines: History, Culture, and Countermeasures


This will be a full length three-part lecture on the topic of vaccines beginning in the origins of vaccines, then taking us to current state of social discontent, and concluding with a discussion on the measures you can take a concerned parent.  We are currently seeking an appropriate Naples based venue for the event.  Please RSVP early, or ask to be kept informed about the event by calling us and giving us your contact information.  We will be collecting ticket revenue for this event to offset the costs of the venue with extra revenue being donated to a local children’s based charity.  We look forward to hearing from you and seeing you at the lecture.