Wednesday, June 13, 2012

Should You Tell Your Child About Your Cancer Diagnosis?

Ruth Steinman, MD, is a clinical associate professor of psychiatry at the Abramson Cancer Center. Here, Dr. Steinman discusses ways to tell children of all ages about a cancer diagnosis.

Many parents feel overwhelmed about their cancer diagnosis and how it affects their families, especially their children. They may wonder what they should tell their children, or how their children will react to their cancer diagnosis.

Each child copes with a parent’s cancer according to his or her phase of development and his or her coping style. Children can cope far better than parents imagine if there is an understanding of their developmental needs and how to maximize an important support system for their children.

Children old enough to speak should be told about a parent’s cancer diagnosis. Below are recommendations for how to tell children of any age group about a cancer diagnosis and what a parent can expect at certain ages and stages of development.

Infants (age 0 to 2)
Babies and very young children are sensitive to changes in their routine and may respond with increased fussiness to the change in emotional tone in the household. Increased difficulty with separation in not uncommon and sleep may become an issue.
Maintaining consistency in caregiving is very important.

Pre-school children (age 3 to 6)
Preschoolers do not need a lot of detailed information. Magical thinking is common: “My sister was born and then mommy got cancer so my sister caused mommy’s cancer” or “I made my mommy angry and that is what made her sick.” It’s important for parents to tell their children that they did not cause cancer.

Under stress, preschoolers can regress and problems can manifest around separation, toileting and bedtime. Maintaining routine is essential with familiar toys, sippy-cups, and a consistent bedtime routine. These routines may help lower anxiety and worry.

School-aged children (age 7 to 12)
School-aged kids can cope with more information, but they too need to be reminded that they are in no way are responsible for their parent’s cancer. These children often cope by fact-finding so they tend to ask a lot of questions. They worry about how the illness affects them socially. Support consistent engagement in school activities and friendships. Anger often shows before sadness.

Adolescents (age 13 to 20)
Adolescents can understand more abstract concepts about prognosis and uncertainty. Some may stay close and other’s may withdraw, show little emotion and become occupied with peer relationships and activities. Try to limit how much extra responsibility is given to teenagers and continue to maintain as much routine as possible. Support and foster relationships teenagers have with trustworthy adults.

What if they ask if I’m going to die?
If children ask about dying, tell them you are doing everything you can to get better. Reassure them you will be honest with them along the way and that when they have concerns, they should talk to you: “From what I’ve been told, I don’t expect to die from this cancer, but if there are any changes, I’ll talk to you about it.”

Help them learn the difference between when the treatment is making you sick and when symptoms are caused by cancer: “Many people are made better by these treatments but the cancer cells are pretty nasty and I need really strong medicine to make me better,” or “The treatment is making my hair fall out and making me so tired all the time—not the cancer.”

Learn more about talking to your child about your cancer diagnosis.

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