Discussing Cancer With Children
Discussing cancer with children can be a daunting task. It may be tempting to want to shield children from the overwhelming, even scary, situation but the truth is that children often pick up on the subtle signals that something isn’t quite right in the household and often their imaginations may lead them to believe things are worse than they really are. The first conversation is often the hardest, but there are several things adults can do to help make it a successful experience.
Practice out loud
Many people find it helpful to rehearse ahead of time what to say. Saying the words aloud when practicing is important; hearing yourself say the words is a different experience than just thinking the words. In addition to practicing the words, make a plan for when you will have this conversation. There will probably never be a “good time”, however targeting a time when the child is relaxed and the environment is not stressful will make it easier for both of you to be fully present during the conversation.
As you become more comfortable hearing yourself out loud while practicing, you will likely find it becomes easier to manage your emotions. It is not necessary (or even good) to bottle up your feelings. Acknowledging and normalizing your own sadness will help children be more comfortable with their own feelings, and they will benefit from seeing you experience (but not be consumed by) your own emotions. Remaining calm, even while experiencing strong emotions, will help reassure your child.
What to say
Use developmentally-appropriate language and familiar terms as much as possible. For young children, it may be enough to simply state “Grandpa has an illness called cancer. It is not something you can catch, and Grandpa is working with doctors to get better. While he is sick he may be extra tired and can’t play as much as before but he would love to hear you read to him”. Older children will likely be able to take in more information and have many questions. Let the children guide how long or deep the conversation is. For some children the initial information will be heard and accepted fairly readily; for others, they may become very upset and cry, and yet others may become overwhelmed and leave the room. Regardless of their responses, it is important that children know that you understand how they feel and you are available if they have any questions. Initiate follow up conversations later that same day, and in the days following, to keep the dialogue open and demonstrate your support for the child. Invite them to ask questions and use this as an opportunity to get ahead of any false ideas they may have picked up from television or friends.
Planning for the future
Treatment for cancer can bring about many changes to the child’s world, including changes to routine, who is managing day-to-day affairs, and even how the parent or grandparent looks. It is important to give children as much developmentally-appropriate anticipatory guidance as possible. For example, with early school-age children drawing pictures can be a helpful way to communicate about the changes they might see or experience. Older children may have questions about how the cancer treatment will impact their academic and socials schedules or what they can do to be helpful. Though the family’s focus is understandably on the cancer, it is crucial for children to continue to participate in normal activities such as school, sports, and spending time with peers to maintain their psychosocial development.
Teens, especially, may have questions about prognosis and treatments. When discussing these be truthful and optimistic without creating false hope or telling happy lies. This will undermine the child’s future trust in you. For some children, it may be helpful to let them see where their family member goes for treatments and to speak with a member of the health care team who can explain the procedures and what the goal of treatment is. A medical social worker can be a helpful asset during this visit if one is available.
It may be helpful to notify your child’s school and other involved adults (such as coaches or the parents of his or her close friends) about his or her recent awareness of a cancer diagnosis in the family. Your child may struggle with the changes occurring in the household and display some behaviors that are out of character; informing trusted adults of the situation will help ensure that your child has a support network no matter when or where he or she is experiencing difficulties.
Discussing cancer with children requires the ability to discuss emotionally and cognitively challenging information honestly and in a way that is understandable to the child. These conversation tips can get the dialogue started, however, your family may want to include a professional to help with the conversation. Seeing a therapist or social worker can help your family address the communication and emotional factors at play.
How old were you when you were diagnosed with metastatic breast cancer?