Your first question may be, "Should I tell my child about the cancer?" You may want to protect your child, but children usually know when something is wrong. Your child may not be feeling well, may be seeing the doctor often, and may have already had some tests. Your child may notice that you are afraid. No matter how hard you try to keep information about the illness and treatment from your child, others — such as family, friends, and clinic or hospital staff — may inadvertently say things that let your child know about the cancer. In addition, it will upset your child to find out that you were not telling the truth; your child depends on you for honest answers.
Why Should I Tell My Child?
Telling your child about his or her cancer is a personal matter, and family, cultural, or religious beliefs will come into play. It is important to be open and honest with your child because children who are not told about their illness often imagine things that are not true. For example, a child may think he or she has cancer as punishment for doing something wrong. Health professionals generally agree that telling children the truth about their illness leads to less stress and guilt. Children who know the truth are also more likely to cooperate with treatment. Finally, talking about cancer often helps to bring the family closer together and makes dealing with the cancer a little easier for everyone.
Parents have many questions about talking with their children about the diagnosis. Perhaps you have asked some of these yourself.
When Should My Child Be Told?
Because you are probably the best judge of your child's personality and moods, you are the best person to decide when your child should be told. Keep in mind, though, that your child is likely to know early on that something is wrong, so you may want to tell your child soon after the diagnosis. In fact, most parents say it is easiest to tell them then. Waiting days or weeks may give your child time to imagine worse things than the truth and develop fears that may be hard to dispel later. Certainly, it would be easier for your child if he or she is told before treatment starts.
Who Should Tell My Child?
The answer to this question is personal. As a parent, you may feel that it is best for you to tell your child. Some parents, however, find it too painful to do so. Other family members or the treatment team — doctor, nurse, or social worker — may be able to help you. They may either tell your child for you or help you explain the illness.
Thinking about what you are going to say and how to say it will help you feel more relaxed. But how do you decide just what to say? Family and close friends, members of the treatment team, parents of other children who have cancer, members of support groups, and clergy members can offer ideas.
Who Should Be There?
Your child needs love and support when hearing the diagnosis. Even if the doctor explains the illness, someone your child trusts and depends upon should be present. Having the support of other family members at this time can be very helpful.
What Should My Child Be Told?
How much information and the best way to relate this information depends on your child's age and what your child can understand. Being gentle, open, and honest is usually best.
The following sections describe what most children in various age groups are likely to understand. These guidelines are general; each child is different. Your child may fit into more than one or none of these categories.
Up to 2 Years Old
Children this young do not understand cancer. They understand what they can see and touch. Their biggest concern is what is happening to them right now. They worry most about being away from their parents.
After children are a year old, they think about how things feel and how to control things around them. Very young children are most afraid of medical tests. Many cry, run away, or squirm to try to control what is happening.
Because children begin to think about and understand what is going on around them at about 18 months, it is best to be honest. Be truthful about trips to the hospital and explain procedures that may hurt. You can tell your child that needle sticks will hurt a minute and that it is okay to cry. Being honest lets your child know that you understand and accept his or her feelings and helps your child trust you.
When you can, give your child choices. For example, if a medicine is taken by mouth, you might ask if your child would like it mixed in apple juice, grape juice, or applesauce.
2 to 7 Years Old
When children are between the ages of 2 and 7, they link events to one thing. For example, they usually tie illness to a specific event such as staying in bed or eating chicken soup. Children this age often think their illness is caused by a specific action. Therefore, getting better will "just happen" or will come if they follow a set of rules.
These approaches might help when talking with a child in this age group:
- Explain that treatment is needed so the hurting will go away or so the child can get better and play without getting so tired.
- Explain that the illness or treatment is not punishment for something the child has done, said, or thought.
- Be honest when you explain tests and treatments. Remind the child that all of these things are being done to get rid of the cancer and to help him or her get well.
- Use simple ways to explain the illness. For example, try talking about the cancer as a contest between "good" cells and "bad" cells. Having treatment will help the good cells to be stronger so that they can beat the bad cells.
7 to 12 Years Old
Children ages 7 to 12 are starting to understand links between things and events. For example, a child this age sees his or her illness as a set of symptoms, is less likely to believe that something he or she did caused the illness, understands that getting better comes from taking medicines and doing what the doctor says, and is able to cooperate with treatment.
You can give more details when explaining cancer, but you should still use situations your child may be used to. You might say that the body is made of up different types of cells, and these cells have different jobs to do. Like people, these cells must work together to get the job done. You might describe the cancer cells as "troublemakers" that get in the way of the work of the good cells. Treatment helps to get rid of the troublemakers so that other cells can work well together.
12 Years and Older
Children over 12 years old can often understand complicated relationships between events. They can think about things that have not happened to them. Teenagers tend to think of illness in terms of specific symptoms, such as tiredness, and in terms of limits or changes in their everyday activity. But because they also can understand the reason for their symptoms, you can explain cancer as a disease in which a few cells in the body go "haywire." These "haywire" cells grow more quickly than normal cells, invade other parts of the body, and get in the way of how the body usually works. The goal of treatment is to kill the "haywire" cells. The body can then work normally again, and the symptoms will go away.
NATIONAL INSTITUTES OF HEALTH, National Cancer Institute
Current as of December 10, 2009