To tell or not to tell

Honesty helps children establish and maintain a bond of trust. The truth, even when it is painful, is vital. If a child learns of a parent's deception, they will have a problem being comforted later by words/actions wondering if the parent is telling the truth. By being truthful, you can also feel assured that the child can be guided to accurate, healthy and hopeful interpretations of events and you can help them to learn coping skills.

Sometimes parents are fearful of telling the child about their cancer because they fear children will be overwhelmed. But, if and when there's a delay, or if it's a family secret, the child can build up resentment. In addition to the shock or dismay, children may also have to deal with anger. If they are not told, children as young as 4 and 5 will pick up on the tension in the home. Experts say that children who suspect parents of concealing something often imagine that the problem is even worse than it is because it is "too awful to be talked about." Children may also feel isolated from their parents at a time of tremendous stress.

Who should tell them?

  • The parent with cancer should tell their children--if they feel comfortable. It is OK to cry. Seeing a parent cry gives the children permission to cry also. If you feel you will be unduly upset, it might be best to have someone else tell them. You probably will know if you can be the one to tell them.
  • If you cannot tell your children, then a spouse, close relative, your doctor, or member of the health care team can tell them.

When to tell them?

  • Once you receive the diagnosis and treatment plan, it is best to tell them right away. Tell your child what is wrong using simple terms they can understand.

What to tell them?

  • Give your child enough information to help them deal with their world. Provide enough facts to lessen their fears. Be as hopeful and positive as you can be.
  • Reassure them that they will be kept informed of any changes. Tell them how you will be treated and any side effects they will notice. Let them know if changes will occur at home and how they will be affected because of the treatment.
  • Tell your child that he/she will be taken care of while the parent is ill. Reassure them that their welfare/happiness is very important to Mom/Dad.
  • After telling the child, reassure them that they cannot "catch" the cancer from you.
  • Listen to your child and his/her reactions. Answer questions truthfully. It is OK to say, "I don't know." If your child doesn't talk or ask questions, don't push them.
  • Don't be afraid to share your feelings with your child. "I feel sad," "I feel angry," "I feel scared."
  • Reassure children, once treatment is completed, that you will tell them of any changes in your health.

Age Differences

3-5 years

  • The most stressful part of a parent's illness is the separation from the primary caregiver.
  • At this age children feel they have magical powers and what they wish will come true. They may blame themselves that a parent is ill, or about having bad thoughts about that parent. They need to know that nothing they have done caused their parent's illness.
  • Children in this age group do not understand the concept of death.

6-11 years

  • Children in this age group can become overly concerned about a parent's health. Be aware, so as not to worry them with details.
  • Tell the children's teacher or school counselor about your condition as soon as possible.
  • Changes in eating, sleeping, school work, and friendships may occur.
  • Children may regress in behavior.

Teens

  • Teenagers have an especially hard time because their own emotional balance may be on a roller coaster. They may be trying to be independent, and now the parent may need to depend on them.
  • Some will rebel and regress in their behavior.
  • Some may tend to take on too much responsibility and mature too rapidly.
  • Some will just take the experience in stride.

Points to remember:

  • Children are good observers, but poor at interpretation. (Example: Grandpa went to the hospital and died. Daddy is going to the hospital so he will die too.)
  • Instead of dwelling on uncertainty, focus on the hopeful facts: "everything possible is being done, Mommy is young and strong and can get better."
  • If you never show a child your feelings, chances are they will not show theirs either. Covering up strong emotions in this instance, may not always be a good idea. A child may become frightened of his/her own feelings instead of accepting them as being OK.
  • Take your children's feelings seriously. It is common for children to have many different reactions when they are told a parent has cancer. These can include anger, sadness, guilt, fear, confusion and even frustration. Let them know it is OK for them to have lots of different feelings.

When the news is really hard...

Even when a parent's prognosis is really poor, it is still important to speak truthfully. If a child asks a parent if he or she is dying, a parent can answer 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 gets better." Parents also may want to simply explain the medical treatments they are receiving and how they may make the parent better.

Along with honesty and reassurance, parents should watch for signs that their children are not coping well. These signals, according to experts, include a prolonged change in mood or personality, decreased appetite, withdrawal from friends and family, acting out at school or physical complaints such as headache or stomachache. Nearly all children will have some of these symptoms for a while. If it continues too long (more than 2 weeks) or interferes with daily functioning, then it's time to be concerned. Parents who are concerned with how their child is coping should talk to the child's pediatrician, teacher, school counselor, or contact the social service department of their local hospital for referrals to social workers or counselors who specialize in helping children and families cope with illness.

Peer Review Status: Internally Reviewed by the Cancer Information Service

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