Practical Strategies for Tough Conversations
By Amanda L. Thompson, PhD, and Shari Langer, PsyD
Amanda Thompson, PhD, is the Chief of Pediatric Psychology and Director of Pediatric Programs for Life with Cancer, a program of the Inova Schar Cancer Institute. Shari Langer, PsyD, is a pediatric psychologist with Life with Cancer at the Inova L.J. Murphy Children’s Hospital. Drs. Thompson and Langer specialize in supporting children, adolescents and families impacted by cancer; however, the information below is applicable to many other serious medical conditions.
A new diagnosis of a serious illness like cancer can have a powerful impact on the entire family. It can bring up many worries, including how to talk to your children about the disease, what is involved in its treatment and how life may change for each member of the household. Some parents may be hesitant to share information, thinking, “My child is too young to understand,” “I don’t want to worry them,” “They need to focus on school,” or “I don’t want to get upset in front of them.”
While all of these concerns are valid and understandable, we also know that honesty and good communication during stressful times helps to reduce children’s worry and fear. In fact, anxiety in children decreases when they are told good-quality information about what is happening to their loved ones. Children notice more than we realize, and if they are not provided with age-appropriate information, they may make up stories about what is going on – and these stories and their fears may be worse than reality.
Communicating can be difficult though, especially when emotions are high and when we are speaking to young children, as they have a different understanding of illness than we do as adults. Consider these helpful strategies when having challenging and important conversations about illness in the family:
- Set the tone. Think about what you would like to share before you talk with your child. If you need to, practice beforehand with someone you trust or with a mental healthcare professional who specializes in working with children and adolescents. Choose a time to talk to your child when it is quiet, you will not be distracted, and your child’s needs are met (meaning that they are not hungry, sleepy, etc.).
- Give accurate, age-appropriate information. Children’s understanding of illness gets more sophisticated, accurate and logical with age. For toddlers and young school-age children, stick to basic, concrete information. With cancer, for example, include the name of the cancer, where the cancer is located in the body, how the cancer will be treated, and – most importantly – how their lives will be affected. Although it can be difficult, be sure to use the word “cancer,” as they are likely to hear it from others and calling it by its name can make it feel less scary (think of Harry Potter bravely calling “He-who-shall-not-be-named” by his name – Voldemort).
- Follow your child’s lead – they may have many questions or they may have none.
- Answer your child’s questions honestly – if you do not know the answer to a question, let them know that you will find out. It’s ok to not have all the answers.
- Reassure your child. Let your child know that their needs will be met throughout treatment and that friends and family will be stepping up to help along the way. Correct any inaccurate beliefs. For example, tell them that nothing they did caused your cancer and that they cannot catch your cancer. Toddlers engage in magical thinking, believing that unrelated events are directly connected. This can result in worries that something they did caused their loved one’s cancer, that cancer is punishment for bad behavior or even that cancer can go away if they are “good enough.”
- Dedicate time to ongoing, open communication. Make ongoing communication a priority, as talking to children about diagnosis and treatment is not a one-time conversation. Let your child know that they can continue to ask you any questions that they think of and that the door to talk remains open. For older children, discuss how much they would like to know and communicate accordingly. Encourage them to reach out to family, friends and other supportive adults.
Children can experience a wide range of reactions to a parent’s diagnosis of a serious illness like cancer, and many adapt well, especially in an environment of honest, age-appropriate information from supportive loved ones. Some children, however, will experience more significant challenges that impact their daily functioning and will require intervention by mental health providers. If you notice any of the following changes in your child, contact a mental healthcare professional for more support:
- Difficult-to-manage behavior challenges
- Increased sadness, worry, irritability or isolation
- New academic or social troubles at school
- Decreased interest in activities they used to enjoy
- Significant changes in sleep or appetite without a medical cause
- Thoughts of wanting to hurt themselves or wanting to die
If you need help communicating with your child about your diagnosis, or if your child is struggling to adjust, Life with Cancer’s pediatric team is here to help. Life with Cancer provides evidence-based support services to children, adolescents and families impacted by cancer. Based on your child’s unique needs, we offer individual therapy, art therapy, bereavement support, parent consultations, groups, education, resources and other programs – all at no cost.