Children and young people who are dying after having lived with a life-limiting or life-threatening condition will often be aware of their impending death. Whether that awareness is acknowledged and talked about will depend on the child, the parents and the professionals involved. A review of these three perspectives on truth telling reveals some of the many factors that influence openness, communication and truthfulness. Creation of a truthful care environment requires development of appropriate skills and attitudes in professionals, use of research evidence, ongoing assessment of the child and family’s communication needs and support for members of the multidisciplinary care team.