By Melanie Bierenbaum, M.S. and Dr. Kelly McGraw Browning, Psy.D.
Being diagnosed with cancer is devastating. Even though treatments have significantly improved survival rates, the unknown can feel terrifying. Parents have reported the only thing worse than being diagnosed with cancer is trying to figure out how to talk to their children about it. Furthermore, treatment for cancer may be very invasive and can alter your physical appearance and impact your regular family routine. You may find it impossible to balance being a “good mother” and “good patient.” So how do you talk to your children about having cancer? What do you say about the expected course of treatment? If the type of cancer you have been diagnosed with is advanced and aggressive, how do you address issues related to death and dying?
What children understand about health and illness depends on their age and developmental level. Research shows that in general, being informed about illness and treatment helps to decrease fear and stress. This may be in conflict with the innate desire to protect children from being frightened and worried. However, it is essential to be open and honest with children and communicate in a straight-forward, age-appropriate manner. Here are some important issues to keep in mind when determining what to discuss and how to talk to your child.
Children’s beliefs about illness:
- Trying to protect children from information may have significant ramifications. Children will try to make sense of events and will fill in gaps in knowledge, which may be far worse than the reality of the situation.
- Younger children tend to believe that all illnesses are contagious. It is important to discuss that you can not “catch” cancer from another person.
- Some children may blame themselves for a parent’s illness. This should always be explored and discussed with the child.
- Younger children have difficulty understanding that it is possible to live without certain organs or body parts.
Promoting open communication & preparation:
- Children need to be allowed and encouraged to ask questions and express their feelings.
- Use language and terms that the child can understand according to his or her developmental level.
- Preparing children for alterations in physical appearance is important. Especially for women, a loss of hair associated with chemotherapy may be difficult for children when their friends begin to ask questions. Explaining side effects of treatment, particularly changes in energy level is important to help children cope and prepare for change.
- Practicing role plays with your children on how to address questions about the cancer, particularly from friends/peers, will help them feel more in control of the situation.
- Communicating with your child’s school can help teachers and staff provide additional support for your child.
- Read children’s books about cancer together. There are many books on this topic including: “When Eric’s Mom Fought Cancer”; “When Someone You Love Has Cancer: A Guide to Help Kids Cope”; “What is Cancer Anyway? Explaining Cancer to Children of All Ages”.
If the prognosis is not favorable, discussing issues related to death and dying may be difficult but helpful. One-on-one conversations are generally preferable as children may not feel comfortable expressing their true feelings in front of others, and children have different beliefs about death according to developmental level. In general, children around age nine are able to see death as final and inevitable. Adolescents are better able to grasp the concept of death and its consequences for the family. Having a solid social support system of family and friends in addition to professional support has a protective effect for children, teens and families facing the loss of a family member. This may, in turn, assist with the grief process. Grief reactions can often occur before an actual loss. Common expressions of grief in children are:
- Shock, numbness, disbelief, denial
- Difficulty with concentration, disorganization, school problems
- Anger and blame
- Guilt and shame
- Depression and social withdrawal
- Anxiety and fear
- Physical symptoms such as stomachaches, headaches
- Regressive behavior such as thumb-sucking or bed wetting
Being open, honest and providing information to children in an age-appropriate manner will help decrease uncertainty and fear associated with a parent having cancer. Discussing difficult issues does not need to occur in isolation. Utilizing your social supports and seeking professional assistance can help all family members affected by the diagnosis. If you and your family are having difficulty coping with the impact of diagnosis and/or treatment, mental health professionals can assist you with stress management and problem-solving around difficult issues.
Image from: www.karenvaughn.com
Melanie Bierenbaum is a doctoral candidate in clinical psychology at Spalding University. Dr. Kelly McGraw Browning, Psy.D., is an adjunct professor of psychology at Spalding University and practicing child psychologist at Pediatric Psychological Associates, a private practice specializing in children, teens and families with a variety of emotional, behavioral and developmental problems. For more information visit www.helpingkidsreachhigher.com or call (502) 429-5431.