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 Learning
that your child has cancer is perhaps the hardest news you ever
have had to face. As a parent, you must now decide how to tell your
child. The questions that many parents ask are: "What should
my child be told?" "Who should tell my child?" and
"When should my child be told?" The following information
from the National Institutes of Health and National Cancer Institute
will help you answer these questions.
Should
I tell my child about the cancer?
You
probably already are asking, "Should I tell my child about the cancer
at all?" In the past, children were often shielded from the diagnosis.
But, studies show that most children know they have a serious illness
despite attempts of parents and health care workers to protect them.
Most
likely, your child already suspects that something is wrong. He
or she may not feel well, is seeing the doctor more often, and has
had some uncomfortable and frightening tests. Your child also may
sense the anxiety and fears of family members and close friends.
Children
who are not told about their illness often depend on their imagination
and fears to explain their symptoms. Many children with cancer believe
their illness is punishment for something they have done; as a result,
they may feel unnecessary anxiety and guilt.
Health
professionals generally agree that telling children the truth about
their illness decreases stress and guilt. Knowing the truth also
increases a child's cooperation with treatment. In addition, talking
about cancer often helps bring the family closer together and makes
dealing with illness a little easier for everyone.
Who
should tell my child?
The
answer to this question is personal. It depends on the relationship
you have with your child and on your own feelings and attitudes.
You may want to tell your child yourself, or you may want your child's
doctor to help explain the illness. Either way, you or someone close
to your child should offer support, encouragement, and love.
If
you choose to tell your child yourself, talking to others might
help you decide what to say. Health professionals such as your child's
doctor, nurse, or social worker can offer ideas. Talk with parents
of other children with cancer. Thinking about what you want to say,
talking it over with other concerned adults, and rehearsing it with
someone close to you will help you feel more at ease.
When
should my child be told?
Because
you are the best judge of your child's personality and moods, you
are probably the best person to decide when your child should be
told about the illness. There is no "right" moment to
tell a child he or she has cancer. Try to choose a quiet time and
place where you and your child can be alone.
This
will create a calm and supportive atmosphere. It is probably best
to talk with your child soon after diagnosis. Waiting days or weeks
gives children more time to use their imagination and develop fears
that may be hard to get rid of later.
What
should my child be told?
Before
you speak with your child, you need to understand the type of cancer
he or she has and the treatment that will be given. This way, you
will be prepared for questions. Your child will feel more secure
if you can provide the correct information.
The
amount of information and the way it should be told depend on the
child's age and intellectual maturity. As a rule, a gentle, open,
and honest approach is best. The following describes general stages
in child development and what children are likely to understand
about a serious illness at different ages. Please keep in mind that
these are only general guidelines. Your child may fit into more
than one or none of these categories.
 Newborn
to 2-Year-Olds
Children
this young can't understand an illness such as cancer. They can't
see it or touch it. They are more concerned with what's happening
to them. Separation from their parents is a major worry. Children
more than a year old are concerned with how things feel and how
to control things around them. Very young children are most afraid
of medical procedures and tests. Many cry, run away, or squirm to
try to control what's happening.
After
18 months, children begin to think about what is going on around
them. That's why an honest approach is best. Be truthful about trips
to the hospital and procedures that may hurt. You can tell your
child that needle-sticks will hurt for a minute and that it is okay
to cry. This lets your child know that you understand and accept
his or her feelings. Your honesty also helps build trust.
Being
able to make choices, as long as they do not interfere with treatment
or harm health, can increase your child's confidence and sense of
control. For example, if a medicine is taken by mouth, your child
could choose to have it mixed in apple juice, grape juice, or applesauce.
2-
to 7-Year-Olds
Children
ages 2 to 7 are better able to understand illness. They tend to
look at things from one point of view-their own-and believe that
the world revolves around them. They link events to one thing.
For
example, they usually tie illness to a specific event such as staying
in bed or eating Jell-O or Popsicles. Children at this age often
think their illness is caused by a specific action. Therefore, getting
better will happen automatically if they follow a set of rules.
Younger
children, in particular, need to be reassured often that they did
nothing to cause their illness and that their cancer treatment is
not punishment for something they have done, said, or thought. Children
in this age group also need to have medical procedures explained
honestly and realistically. It helps to remind children that all
of the tests and treatments are done to help them feel better.
Simple
explanations about cancer are also important. Stories that relate
cancer to familiar ideas will help in explaining the diagnosis.
These comparisons may be tailored to the child's specific cancer
type. The 2- to 7-year-old, for example, understands good and bad.
Try
explaining cancer and treatments in terms of a battle between "good
guy cells" and "bad guy cells." Taking medicine will
help the good guys become stronger so they can beat the bad guys.
7-
to 12-Year-Olds
Children
ages 7 to 12 years are still limited by their own experiences but
are starting to understand relationships among several events. Thus,
they see their illness as a set of symptoms.
They
are less likely to believe that their illness resulted from something
they did. They understand that getting better comes from taking
medicines and doing what the doctor says. Children at this age are
able to cooperate with treatment.
An
explanation of cancer to this child can be more detailed but should
still include familiar situations. Comparisons also are useful in
explaining cancer to children in this age group. You might say that
there are different kinds of cells in the body, and these cells
have different jobs to perform.
Like
people, these cells must work together to get their jobs done. Cancer
cells can be described as "troublemakers," that disrupt
the work of the good cells. Treatment helps to get rid of the "troublemakers"
so the other cells can work together once again.
Although
the understanding of death varies among 7- to 12-year olds, many
children in this age group think or worry about dying. However,
they often are afraid to say anything to you. Be open and honest
with your child.
Tell
your child that you, the doctors, nurses, and others are doing everything
they can to make the cancer cells go away. Reassure your child that
a lot of children with cancer get better, but no matter what happens,
you'll be there. If you are not sure what to say, ask the doctor,
nurse, social worker, or chaplain for help.
12
Years and Older
Many
children older than 12 years are able to understand complex relationships
between events. They are able to think about things they have not
experienced themselves. Teenagers still define illness by specific
symptoms such as tiredness, and by limits on everyday activities,
but they also understand the reasons for their symptoms.
Thus,
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 disrupt normal body functions. The goal of treatment is to kill
the "haywire" cells. Then the body can function normally
again, and the symptoms will go away.
Teenagers
understand that cancer can lead to death. They need to be reassured
that much progress has been made in treating childhood cancer. They
also need to know that many children who have cancer survive their
disease and live normal, healthy lives. In fact, the number of survivors
is increasing all the time.
Keeping
lines of communication open
Throughout
treatment and follow-up care, you should continue to talk openly
with your child. Like many other children, your child may, with
time, ask more complex questions. Setting up patterns of open communication
early will support your child now and strengthen your relationship
for years to come.
At
times, you may feel strong emotions when you are with your child.
You do not want to burden your child with your fear, anger, or sadness.
But children often are aware of how you feel. In fact, children
may hide their own feelings to protect their parents.
You
may want to discuss your feelings with your child if you think they
interfere with your relationship. You can tell your child why you
are sad. This reassures your child that you are not angry with him
or her and also lets your child express feelings. Let your child
know that it is okay to cry and be sad. This gives him or her permission
to show feelings.
During
treatment, it is important to remember that you, your child, and
the health care team are partners. Children who truly feel like
a member of this team are more likely to cooperate and to accept
treatment. You can help your child by explaining what will happen
and allowing him or her to make simple, safe decisions about care.
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