Originally published 2018-08-09.
In February 2018 Dr Alastair McAlpine, a paediatric palliative care doctor in Cape Town, South Africa, asked some of his terminally ill young patients what they had enjoyed in life and what had given it meaning. Their answers were strikingly simple: their pets, their parents, ice cream, books and bedtime stories, the beach, people who were kind to them, people who made them laugh, favourite toys and, above all, time with family. Nobody mentioned screens, arguments or hospital.
He posted the replies as a Twitter thread on 1 February 2018. Within a day it had passed 82,000 likes and was being reported around the world. Below, each of his tweets is shown with a short explanation, followed by some context on children's palliative care and on how to read a thread like this.
Who Alastair McAlpine is and why he asked
McAlpine is a South African paediatrician whose work focuses on palliative care: medicine aimed at relieving pain and distress and supporting families, rather than curing an illness that can no longer be cured. He explained that the question was part of an assignment, and he passed the answers on because he thought adults could learn from them. He later wrote a memoir, Prescription: Ice Cream, about life as a doctor in South Africa, including his work with dying children and his own struggle with addiction.
The thread opened with a single tweet explaining what he had done. Everything that followed was his summary of what the children told him, often with their own words in quotation marks.
For an assignment, I asked some of my terminal paediatric palliative care patients what they had enjoyed in life, and what gave it meaning. Kids can be so wise, y'know. Here are some of the responses (Thread).
— Alastair McAlpine (@AlastairMcA30) February 1, 2018
It is worth being clear about what this is. McAlpine was not running a formal study, and he did not publish the number of children he spoke to. Some news reports gave their ages as roughly four to nine, but the thread itself does not say. What he shared is a careful doctor's impression of many conversations, and that is how it should be read.
Screens, pets, parents and ice cream
1. What none of them wished for
McAlpine began with the things that were missing. Not one child said they wished they had watched more television or spent more time on Facebook, and none said they had enjoyed fighting with other people or being in hospital. It is a neat reversal of the usual list of regrets: the things that fill many adult days simply did not register.
2. Their pets
Many children brought up their animals by name: a dog whose silly bark made them laugh, a cat that curled up with them at night, a horse they rode along the beach. For a child who is often unwell, a pet offers comfort without asking questions. Hospices and children's hospitals in many countries run animal-visiting programmes for exactly this reason.
3. Their parents, and worry for them
The children spoke warmly about their mothers and fathers, but what stood out was how often they were worried about them. Several hoped their parents would be all right after they had gone, or tried to reassure them. Palliative care teams see this often: seriously ill children tend to understand far more about their situation than adults expect, and they frequently try to protect the people they love.
4. Ice cream
The shortest tweet in the thread was also the most universal: every child loved ice cream. It became the line people quoted most, and it later gave McAlpine's memoir its title.
Stories, being treated normally, and the sea
5. Books and being read to
All of the children loved stories, especially when a parent was the one reading. They mentioned Harry Potter making them feel brave, adventures set in space, and one child planned to become a detective like Sherlock Holmes once they recovered. McAlpine added his own advice to parents: read to your children, because they love it.
6. Worrying less about what others think
Many said they wished they had spent less time worrying about other people's opinions. What they valued were friends who treated them normally: the ones who did not care when treatment made their hair fall out, or who visited after an operation and did not seem to notice the scar. Being seen as themselves, rather than as their illness, mattered a great deal.
7. Swimming and the beach
Plenty of the children loved swimming and the seaside: building big sandcastles, or the thrill of the waves. One was delighted that the salt water had not even stung their eyes. Cape Town sits between two oceans, so for many of these children a beach day was a real memory rather than a holiday dream.
Kindness, laughter, toys and family
8. Kindness
Almost all of them ranked kindness above most other qualities. The examples were small: a grandmother who always made them smile, a friend who shared half his sandwich, and a gentle nurse whose presence made procedures hurt less. Children notice how they are treated, and they remember it.
9. People who made them laugh
Nearly every child loved the people who made them laugh: a clumsy magician, a dad pulling faces, even a noisy neighbour in the next hospital bed. McAlpine summed it up in four words, saying laughter relieves pain. Humour does not cure anything, but it can make hard days easier to live through.
10. Toys and superheroes
Favourite toys came up again and again: a Princess Sophia doll, a teddy to cuddle, and Batman, who McAlpine noted was popular with all the boys. Familiar objects are a source of comfort and control for children in hospital, which is why play specialists are part of many paediatric teams.
11. Time with family
Finally, every child valued time with their family, and McAlpine wrote that nothing was more important to them. They talked about parents being the best, a sister who hugged them tight, and being loved by their mother more than anyone.
His take-home message
McAlpine closed the thread with a short list for everyone else: “Be kind. Read more books. Spend time with your family. Crack jokes. Go to the beach. Hug your dog.” He added that these were the things the children wished they could have done more of, that the rest was details, and that people should eat ice cream too.
The advice is ordinary, which is exactly why it landed. None of it costs much, and most of it can be done this week.
What children's palliative care actually is
A common myth is that palliative care means giving up. The World Health Organization describes it as an approach that improves quality of life for patients of any age, and for their families, by identifying and treating pain and other physical, emotional and spiritual problems early. It works best when it starts early in a serious illness, not only in the final days.
The need is large and mostly unmet. The WHO estimates that about 56.8 million people need palliative care each year, yet only around 14% receive it. Of the children who need it, 98% live in low- and middle-income countries, and almost half are in Africa. That is the setting in which McAlpine and his colleagues work.
If your own child or someone in your family is seriously ill, ask the treating doctor whether a palliative care team can be involved. It is a question about comfort and support, and it can be asked at any stage.
Reading the thread with care
The thread is moving, but it is one doctor's summary, not data about all children with life-limiting illnesses. Children in other places, families and circumstances may name very different things. Its value lies less in proving anything than in reminding adults to ask children what they think, and to listen to the answers.
It also reminded many readers of how easily everyday pleasures are postponed. The children did not talk about achievements or possessions. They talked about animals, stories, salt water, jokes and people. For the rest of us, those are still within reach.
Sources: Alastair McAlpine’s thread on Twitter/X, 1 February 2018 (all tweet screenshots); CTV News, February 2018; Cape Town ETC, 2 February 2018; Pan Macmillan South Africa: Prescription: Ice Cream; World Health Organization: palliative care fact sheet; earlier write-up: Inspire More.
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