Talking to your child about serious illness

Heather Waldron

doi:10.1542/aapnews.2010316-31e

While being diagnosed with a serious illness is devastating for anyone, those with children may have a host of concerns beyond their own health.

Many parents don’t know how they should go about talking to their child about their or their spouse’s serious illness. While difficult, it is necessary to be honest. From a young age, children can detect when something is wrong.

Parents need to frame the issue in terms of the child’s developmental stage, and use language that their child can understand, according to Ben Siegel, M.D., FAAP, chair of the American Academy of Pediatrics’ Committee on Psychosocial Aspects of Child and Family Health.

For children ages 2-6 years:

Explain things simply. For example, tell your child, “Mommy is sick and has to go to the doctor.”
To address physical changes, such as from chemotherapy, explain that losing weight or hair just happens to be part of the treatment.
Many young children think their parent’s illness is their fault because they behaved badly. Stress that this is not your child’s fault and that he or she did nothing wrong.
Some young children believe that cancer or death is contagious, so make sure they know this isn’t the case.

For youths ages 7-11:

Go into some detail, saying, “Mom is sick. She has cancer. Do you know what cancer is?” If the child doesn’t know, explain cancer by saying something simple, like “things grow in the body that shouldn’t be there.”
Let kids know that there might be side effects from the treatment, such as nausea or fatigue, and the parent may not be as available as usual.
Address Internet use. Dr. Siegel said kids might Google search illness-related topics. Tell your child you would like to look up information together and discuss it.

For adolescents ages 12 and older:

In times of family crisis, adolescents want information. If you are not upfront, they may get angry, asking “Why didn’t you tell me sooner?”
Discuss treatment in detail and even uncertainty about the illness.
Recognize that it might be easier for adolescents to talk to an adult other than a parent, such as their pediatrician.

Parents also should gauge the child’s reaction and be prepared to deal with a range of emotions. Children under 7 may wet the bed, throw temper tantrums or refuse to eat or sleep. Children between 7 and 11 may stop paying attention in school, and become argumentative, depressed or angry. Adolescents may shut down.

Parents may want to turn to their pediatrician for help and emotional support. Children probably will have many questions, which the pediatrician can answer. And if necessary, the pediatrician can offer a mental health referral.

Maintaining a sense of normalcy for your child also is essential, Dr. Siegel stressed. That could be sticking to your nightly routine of a bath and bedtime story or keeping the child in school and up-to-date with homework.

For a school-age child, keep the lines of communication open with teachers and school administration.