Communicating Cancer to Your Kids
A study just published in the British Medical Journal found that women faced with a diagnosis of breast cancer are having difficulty talking to their children about their disease.
Dr. Jacqueline Barnes of the Royal Free and University College Medical School in London and colleagues said the reason cited most often for this difficulty in communication is fear of what questions the children might ask, particularly about death. In a survey of 32 women with stage I or II breast cancer, the researchers also found that women were concerned about causing too much anxiety and stress for their children, or they thought the children would not understand their illness.
Such assumptions can make a difficult situation dramatically worse for a child. Experts now almost universally agree that communication is essential for children to be able to cope with the illness of a parent. Yet few women receive counseling on how to discuss their illness with their children.
"Parents receiving a diagnosis of cancer need to be offered support and acknowledgement that they are part of a family unit, all the members of which are likely to be profoundly influenced by the illness and its treatment," the authors wrote.
When parents fall ill-even if only with a bad cold, the flu or a strained back-caring for young children becomes challenging. A serious illness, however, presents not only the practical dilemma of how to keep the day-to-day logistics going, but a host of psychological challenges as well. What should you tell the children? When do you tell them, and how much?
Those who work closely with children agree that telling them the truth as soon as possible is crucial.
Sometimes parents are fearful of telling the child because they think the child will be overwhelmed. But when there's a delay, or if it's a family secret, the child builds up resentment. So on top of the shock or dismay, you also have anger. The child says, "Why was I left out? Don't you trust me enough with this information? I have a right to know."
If they are not told, children as young as 4 and 5 can pick up on the tension in the household. And children who suspect parents of concealing something often imagine that the problem is even worse than it is because it's "too awful to be talked about." In addition, when a child is left out, he or she will feel isolated from his parents at a time of tremendous stress.
But how to begin? The approach depends partly on the child's age, but should always be couched in terms of "love and hopefulness," say experts.
Even when a parent's prognosis is really poor, it is still possible to speak truthfully. If a child asks a parent if he or she is dying, a parent can answer truthfully that "I'm not dying right now. Many people with this kind of cancer die, but some people get better. I'm doing everything possible to be one of the people who does great!"
Along with telling the truth, parents need to reassure their children that they will continue to be cared for no matter how family routines may change due to the illness. Parents must also let their children know that their illness is not contagious or caused by anything the child did.
Finally, along with honesty and reassurance, parents should watch for signs that their children are not coping well. These can include a prolonged change in mood or personality, decreased appetite, withdrawal, or acting out at school.
Here are some specific suggestions from the American Cancer Society:
British Medical Journal, August 19/26, 2000; 321:462-463, 479-482
The American Cancer Society (http://www.cancer.org)
The National Cancer Institute (http://www.nci.nih.gov)
CNN Online (http://www.cnn.com)
[Table of Contents] [Archived Issues / Search] [The Breast Center]