June 15, 2009
By Claire McCarthy, M.D.
Boston Children's Hospital
A couple of weeks ago, a friend of mine got some terrible news: She has ovarian cancer. What keeps her up at night isn't worry over her treatment options, finding the right doctor or the side effects of chemotherapy. It's what to tell her children.
When parents face a health crisis of their own cancer, surgery or another medical condition they may need to talk to their children about it. It can be really difficult to know what to say. You don't want to lie to them, but you don't want them to worry either.
Children want to know what's happening. But what they really want to know is if you're going to be okay and if they are going to be okay.
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Just the Facts, Please
Here are my suggestions for giving kids information.
- Keep it simple. A good place to start is to say, "Mommy is sick," or "Daddy needs an operation." Give them a general idea of the part of the body involved.
- Let a child's questions guide you. Small children (preschool to early elementary) may not need more than a simple answer. For example, a child may ask, "What is the doctor going to do to Daddy's knee?" The answer can just be, "He's going to fix it."
- Respect an older child's request for more information. Answer the questions as best you can. Let the information sink in. Tell them you are available if they have more questions.
- Use simple terms, not medical jargon. You may want to talk to your doctor, or your child's doctor, for help choosing the right words.
- Use the word "cancer" if that's what you have, even though it sounds scary. It's better that a child hears it from you rather than someone else. Plus, you can put your own spin on it, which leads us to. . .
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Answering the Tough Questions
Here's what you can say when your child asks:
"Will you be okay?"
- If the answer is clearly "yes," make sure your kids know! Don't assume that they do. If you're nervous about a medical procedure or upset about missing work, they may misinterpret that and think you are in danger. Let them know that the doctors will give you medicines so that the procedure or surgery won't hurt. Tell them what it will be like when you get home, so they know what to expect.
- If you have a serious illness or your treatment could have complications, the answer might be "maybe." Talk with your child about how you have really good doctors who are doing everything they can to make you all better. Explain that you are going to do your best to get better, and that you are optimistic. This is actually a good way for you to think anyway!
- If your illness or treatment could leave you with a disability, explain that you are still okay, just different. I'd count that as deserving a "yes" or possibly "maybe" answer.
- If your illness is clearly terminal, then the answer should be "no." Be honest. At the same time, tell your child that the doctors are taking really good care of you and that you're going to do everything you can to be alive as long as possible. This leads us to the next tough question. . .
"Will I be okay?"
It's perfectly normal and expected for a child to ask this. It doesn't mean that they are self-centered and don't care about you. To a large extent, their lives are organized around you, so when you are sick it shakes up their world in a scary way.
- If your child's routines will change because of your illness, even briefly, let them know exactly what will happen. With small children, this may take some repetition.
- If you will be spending less time with your child or your time together will be different, talk to them about it. Let them know who will be caring for them when you can't. Make sure they know that you will be with them whenever you can.
- If your illness is terminal, consult your child's doctor and a mental health professional as soon as you can. Your family will need help creating a supportive environment for your child in the days to come and the future.
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Help Is There
Take advantage of the great books that are available for kids on this topic. They can help everyone cope with a family illness or injury. Your local librarian can be a great resource when it comes to finding one that fits your particular situation.
Remember that the most important things are to love your child and make sure he or she knows it. If you do those two things, everything else will fall into place.
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Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.