The body goes through many changes in the dying process. In some cases, the dying process can be very long. Understanding the physical and mental changes the body goes through as death happens may help ease some fears and falsehoods about death. It may help families and children know what to expect when the changes happen. Always talk with your child's doctor about any concerns or questions.

These are common symptoms that death is near. But each child may experience symptoms differently. Symptoms may include:

• Changes in breathing. Slow and fast breathing or long periods without a breath are common. Moaning may happen with breaths. But this doesn't necessarily mean the child is in pain.
• Noisy breathing. This may be from secretions the child can't clear from their throat or lungs.
• Physical disfigurement. This may be from a progressive tumor.
• Skin color changes. Pale, bluish, mottled, or blotchy skin is common. This is from a decrease in oxygen and the body's circulation slowing down.
• Loss of bowel and urine control.
• Mental confusion. Confusion or reduced alertness may happen just before death.

Death has happened when the child's heart is not beating and there are no signs of breathing.

When a child dies at home in hospice care, it's not an emergency. If paramedics are called, depending on local law and whether documentation is available, they may be required to try to resuscitate the child, even if it's against the family's wishes.

The family is given as much time as needed before the child is removed from the home or hospital. This time is for the privacy of the family and loved ones. You may hold, bathe, and dress the child. You may also have spiritual or cultural rituals.

Even when death is expected, the family will be in shock and will be grieving.