By Dr. Bruce Waslick, chief of child psychiatry at Baystate Medical Center
A diagnosis of cancer is an emotional and stressful time for you and your loved ones with special considerations and challenges in sharing this news with your children.
There are some important things to consider when sharing your diagnosis with your child, but ultimately how you share the news with your child is a very personal process with few rights and wrongs.
The ideas suggested here are meant to maintain a balance between sharing useful and necessary information with your child and supporting and protecting them from undue stress, worries, and anxiety.
Come to terms with your diagnosis
The first step is that, to the extent possible, you have to come to terms with the diagnosis yourself.
Receiving a diagnosis of cancer may come to you as a complete shock, or an expected confirmation of something that you may have been suspecting. Whatever the case may be, it is important for you to take the time to fully come to terms with the diagnosis, how it is going to affect your life moving forward, and getting some appreciation for what the diagnosis means for your future.
You may need to reach out for support from loved ones, trusted friends, and medical providers in this initial step.
This step cannot be rushed through. You should take the needed time to adjust to the news prior to trying to move too quickly to sharing the news with your children.
Share the news with your children
Once you have moved through this the initial “coming to terms” step, it makes sense for you to share the news with your children. This news, in most situations, should not be learned accidentally or through secondhand information.
You may have to prepare a bit, but for most children the news should mainly be delivered by you to your children. You are likely going to be the best judge of how to deliver the news, taking into account the different characteristics of your children and the relationships you have with each individual child.
Here are six considerations when planning to talk to your children about your cancer diagnosis:
1. Age
Think about the developmental age of the child being told in determining how to best let them know about the illness.
Young children will probably need to know about the “big picture,” but will likely not need to know a lot medical details.
Older children will probably have questions about what the future holds in terms of the actual illness and what to expect from treatment programs.
Telling a younger child about the cancer diagnosis may be done very differently than telling an older child, and one way of telling a child is not the best for all children. You will likely have to prepare a message that works most effectively taking into account your child’s age and individual personal characteristics.
2. Amount of detail
Honesty about the major issues is important but too much detail is probably not needed in your initial conversation.
Let your child know that you have been told that you have a serious illness, that the name of the illness is called “cancer,” and that you will need to have some amount of ongoing treatment for the cancer. Afterwards, watch for your child’s reaction to the news and process with him or her the impact of the news.
Children and adolescents will naturally have questions, so it is important to give your child the opportunity to share any reactions or ask any questions they might have. You don’t have to be an expert in answering questions. It is more important that you are opening up communication regarding your child’s concerns and conveying that you care about how they are handling the news.
Make it clear, especially to younger children, that your child was not responsible for your illness and that they won’t “catch” the illness from you.
This conversation likely will be the initial conversation in an ongoing dialog about your illness that will continue over the ensuing weeks, months or years.
3. Separate talks
If you have more than one child, and they are of very different ages, then you might consider having separate talks with each, perhaps starting with the oldest and working downward in age.
If your children are of similar ages and developmental levels, then it may often work best if they are told together at the same time.
In certain situations, it may be helpful to have other important adults present, such as your partner, or other close family members or friends, to provide emotional support for both you and your children while you are sharing this news with them.
4. Your prognosis
It is probably most helpful, in the early stages of dealing with cancer, to try to maintain a hopeful and positive attitude towards effectively dealing with the cancer through medical treatment.
If the prognosis is very negative, you may need to share the reality of your situation over time and through multiple conversations, but in the initial conversation the full details of the prognosis don’t need to be revealed in most cases.
If your prognosis is extremely negative in the short-run, you may need to early on give your children some realistic information about what lies ahead. Ideally, include the message that no matter what happens in the future they will be okay and well-cared for.
5. Short-term impact on the family
It may be useful to let your child know how the cancer is going to impact the way you will behave in the near future and how it might cause changes in family life.
If you are going to be sick from the illness or your medical treatment, you can discuss this and plan for it looking ahead. Your child may feel the need to be helpful to you and this can give them a healthy sense of some empowerment. Asking children to help with some chores or responsibilities that you may need to let go of, even on a temporary basis, can help them feel some positive control over their situation.
6. Sharing outside the family
Once you have told your child about your diagnosis, it may be useful to share this news with important responsible adults in your child’s life, such as teachers at the child’s school.
Providing this information can help them be aware when interacting with your child. Perhaps they can be helpful in monitoring how your child is adjusting to the news. Some children may have difficulty dealing with the news of the diagnosis and could show signs of emotional troubles or behavioral changes.
Sharing this news with others is a balance between maintaining your privacy and opening up to people. But there may be important adults in your child’s life with whom sharing the diagnosis may be helpful and supportive to both you and your child.
Getting professional support
Dealing with a new diagnosis of cancer is going to be stressful for you as well as your loved ones, including children.
There are few absolute rights and wrongs about how and when to share the news of a diagnosis with your child. As a parent, use your best judgment about how to best include your children in your medical care. If it becomes clear that your child is showing signs of significant emotional or behavioral changes in the aftermath of sharing information about a cancer diagnosis, feel free to consult your child’s primary care provider or even a mental health professional that specializes in working with children for help and guidance.
Children can experience growth in dealing with challenging situations in healthy ways. Helping a child learn to cope with stressful situations using healthy coping skills may be an unexpected “silver lining” to what may appear to be a dark cloud of a cancer diagnosis.