Tamim, a 12-year-old boy diagnosed with relapsed acute lymphoblastic leukemia (ALL), is a testament to the deep emotional awareness children can possess, even in the face of life-limiting illness. A cheerful boy who once loved playing cricket with his friends and attending school, Tamim had to put those joys aside when his condition worsened.

During a recent admission to our department, it became clear that Tamim understood his situation more profoundly than many would expect of a child his age. Contrary to the common belief that children are unaware of the seriousness of their illness, Tamim showed an emotional maturity that was both moving and humbling.

One afternoon, while speaking softly about his family, Tamim suddenly grew quiet. His eyes drifted to his 3-year-old sister, who sat nearby. Within moments, tears filled his eyes, and he began to cry — not with the frustration of a child, but with the deep sorrow of someone carrying an invisible weight. His sadness caught me off guard.

I gently asked him what was troubling him, but he didn’t respond. He just stared out the window, silent, tears falling freely. In that moment, I chose not to speak. I didn’t offer words of comfort or try to explain away his pain. Instead, I simply sat beside him, handed him a tissue, and held his hand. It was a silence filled with compassion and presence.

After a while, his tears slowed, and he turned to me. “I feel better now,” he said quietly, even managing a faint smile. “You can go help the others.” His calm acceptance, his ability to carry both pain and grace, left a lasting impression on me.

That moment reminded me of an essential truth in working with children facing serious illness: they often understand far more than we give them credit for. Their emotional responses, no matter how intense, are not signs of weakness, but of strength and sensitivity.

Sometimes, in our efforts to comfort, we rush to speak or to reassure. But children don’t always need words. They need presence. A nod, a gentle touch, sustained eye contact — these simple, silent gestures can offer deep comfort. By creating a safe space without pressure or expectation, we allow them to process their feelings in their own way and time.

In palliative care, silence is not an absence — it is a form of presence. It’s easy to underestimate its power, but for children like Tamim, that quiet companionship can be one of the most meaningful gifts we can offer.