Talking with Your Child
Parent's Questions Questions Children May Ask
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.
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 (you can find information about them at the end of
this booklet), 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.
Children are naturally curious about their disease and have many questions
about cancer and cancer treatment. Your child will expect you to have answers
to most questions. Children may begin to ask questions right after diagnosis or
may wait until later. Here are some common questions and some ideas to help you
answer them.
Why Me?
A child, like an adult, wonders "Why did I get cancer?" A child may feel that
it is his or her fault, that somehow he or she caused the illness. Make it
clear that not even the doctors know exactly what caused the cancer. Neither
you, your child, nor his or her brothers or sisters did, said, or thought
anything that caused the cancer. Stress also that cancer is not contagious, and
your child did not "catch" it from someone else.
Will I Get Well?
Children often know about family members or friends who died of cancer. As a
result, many children are afraid to ask if they will get well because they fear
that the answer will be "no." Thus, you might tell your child that cancer is a
serious disease, but that treatment - such as medicine, radiation, or an
operation - has helped get rid of cancer in other children, and the doctors and
nurses are trying their best to cure your child's cancer, too. Knowing that
caring people - such as family, doctors, nurses, counselors, and others -
surround your child and your family may also help him or her feel more secure.
What Will Happen to Me?
When your child is first diagnosed with cancer, many new and scary things will
happen. While at the doctor's office, hospital, or clinic, your child may see
or play with other children with cancer who may not be feeling well, have lost
their hair, or have had limbs removed because of cancer. Your child may wonder,
"Will these things happen to me?" Yet, your child may be too afraid to ask
questions. It is important to try to get your child to talk about these
concerns. Explain ahead of time about the cancer, treatment, and possible side
effects. Discuss what the doctor will do to help if side effects occur. You can
also explain that there are many different types of cancer and that even when
two children have the same cancer, what happens to one child will not always
happen to the other.
Children should be told about any changes in their treatment schedule or in the
type of treatment they receive. This information helps them prepare for visits
to the doctor or hospital. You may want to help your child keep a calendar that
shows the days for doctor visits, treatments, or tests. Do not tell younger
children about upcoming treatments far ahead of time if it makes them nervous.
Why Do I Have to Take Medicine When I Feel Okay?
With cancer, your child may feel fine much of the time but need to take
medicine often. Children do not understand why they have to take medicine when
they feel well. You may want to remind your child of the reason for taking the
medicine in the first place. For example, a child could be told: "Although you
are feeling well, the bad cells are hiding. You must take the medicine for a
while longer to find the bad cells and stop them from coming back."
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