I like that idea, too.

I think I’d do a grommet, then blanket stitch overtop its rim edges with embroidery floss.

If I were making this quilt, I think, I would make it just like she wants it to look. It will please her so much. She will just love the quilt if it is a hole. She will take care of it with the hole. And she will probably sew around the hole herself just like she did the other one.

You might suggest that she take the actual tattered blanket and put it in a shadowbox.

I would still try to emulate the hole on the quilt you are making. Some good suggestions here to achieve that.

Your faced hole was my first thought also. Could you bind the edges of the hole with a narrow commercial bias tape or a narrow binding to match the outside edges?

I think you are wonderful to be making this for her.

FWIW, I like the idea of doing a lot of free motion circles very tightly together in the corner leaving the center completely stitch free and punching a proper hole through it where you finger fits. That is what her son did and what she wants to replicate I think. I think she wants the fraying so I don’t think a button hole will work.....although I really prefer the buttonhole.

I agree with Blondie, and to reinforce the hole, use iron on interfacing to a piece of netting or lace , then stitch it into the inside area where you are going to make the "Hole", the lace is very strong and will hold the grommet well.

Would she let you use the original baby blanket as the back? If you used a light-weight fabric for backing and then could put the original on it so it was healthy fabric actually making the back but attaching the one with the hole. Or maybe put a very lightweight interfacing fabric on the original and use it as the backing. I'm assuming this quilt will not be in actual use?? The original one may not be up to that?

I am guessing that "how" her son died has a lot of influence on her request - - - - ?

Anyway - does she want a "frayed" hole"?

I am thinking that - say she wanted an actual hole about 1/2 inch in diameter -

After the quilt is sandwiched, one could line up where one wanted the hole to be - and then cut a hole about 1 inch in fusible interfacing and put that in the area where the hole would be on the top and backing - and then remove the batting from about a two inch area so that it would be "flatter" there -

I am attaching a drawing that might help explain the idea -

Assuming one wants a "frayed" hole instead of a "finished" hole - I think I would do the actual puncturing of the fabric with something like a nail or an ice-pick instead of a punch and then maybe let the lady do her own "wearing away" of the fabric?

The interfacing would minimize fraying the indicated area - and perhaps even do something like Fray Check on the interfacing to be able to "stop" the fraying?

Or use fray check on the edge of the hole. I haven't read all the replies, so I don't know if this has been suggested.