Parents are not supposed to outlive their children.

That's why, whenever a child dies, people find it difficult to talk about.

"Children aren't supposed to die," said Jodie Moroco, counselor with Sharon Regional's hospice program. "So nobody wants to deal with it."

The hospice program, which helps terminal patients and their families tailor care to their needs, currently does not have any children in it, although there have been young children in the program in the past, Ms. Moroco said.

"Most people do not understand why bad things happen to children," said Mary Van Sickles, coordinator of grief services at the John Flynn Funeral Home in Hermitage. "The death of a child, first of all, it puts us out of order. Children are not supposed to die before their parents."

According to statistics from the National Hospice and Palliative Care Organization, less than 1 percent of hospice patients are children under the age of 17.

While there is a movement for more palliative care for children, little time, if any, is devoted to pediatric palliative or respite care in accreditation programs or medical schools. Also, training in pediatric palliative care is not required for pediatrics or subspecialties, according to the American Journal of Hospice and Palliative Care.

Palliative care treats the symptoms of a terminal illness to make the patient comfortable without prolonging life or hastening death.

Even if palliative care is available for a dying child, many parents do not want to consider it, Ms. Moroco said. They would rather seek treatments to cure the illness.

"(Parents) need to look at the child's quality of life verses longevity," Ms. Moroco said.

While parents may have difficulty letting their child go, many children can come to terms with their illness very quickly, Ms. Moroco said.

"It's surprising how much perception and awareness children have," Ms. Moroco said, which is why, "It does more harm than good" to keep secrets from a child about their condition.

"Children know. You can't fool a child," Mrs. VanSickles said. "They don't want you to keep secrets from them."

"Children are willing to speak openly about their illness to whoever they are comfortable with," Ms. Moroco said. "They're open to honest discussion. A lot of times children will dictate their treatment at the end."

Ms. Moroco said there are four main concerns regarding death that children need to understand: irreversibility, finality, inevitability an causality.

The terminal illness and eventual death of a child can wreak havoc on a family. Grieving siblings may find they have lost both a sibling and their parents to the whole process. Siblings may cope better if they are involved in the process of caring for their brother or sister, Ms. Moroco said.

The death of a child can also be hard on a marriage.

"Most parents find very little support after a child dies because people don't know what to say," Ms. Moroco said. "The death of a child brings unbelievable strain on a parents' relationship."

Mrs. VanSickles said that sometimes couples actually break up because they can't support each other.

"Men and women grieve differently," Mrs. VanSickles said.

After the death of their child, it is important for parents to take care of themselves both physically and emotionally, to seek spiritual support and expect special days to be difficult, although the anticipation of a special day may be worse than the actual day itself, Ms. Moroco said.

Bereavement groups are also available to help grieving family members talk out their feelings.

"Recognize when you begin to heal," Ms. Moroco said. "It takes time."