adapted from "Cancer Care Briefs"

When someone has cancer, it affects the entire family, particularly children. Cancer is a complicated disease to understand, even for adults. There are many types of cancers and no easy way to describe them in simple terms. But if you, your child, or someone in your family has cancer, discussing it with your children may be the most important thing you can do.

Protecting Children Can Make Things Worse
When cancer strikes a family, children sense that something is wrong, even if they don't know what it is. Talking it over with them, in words they can understand, is always better than hiding it. If you keep things from them, children think that things are worse than they really are.

For example, it is not uncommon for young children to think their actions somehow caused a parent or sibling to get cancer. It is important to not only communicate with your children, but to listen to them, and make sure they understand what is happening. No matter what their age, there are ways to communicate with children about cancer, treatment, and, if necessary, life and death.

How to Tell Children That You or Someone in Your Family Has Cancer
When a child's life is touched by cancer, it can cause a great deal of emotional trauma -- mostly because any kind of serious illness is scary to a child. Fortunately, as a parent, you can help your child overcome many of his or her fears by simply explaining the situation in a calm, reassuring way.

The following are tips on how to talk to your child about a family member who has cancer:

• Tell them about the illness. Although cancer is complicated, there are appropriate ways of discussing it with children of any age. "Mommy is very sick, so she has to go to the hospital to get well again," is usually enough for very young children; for older children, a more detailed explanation is better. The more they can know, the less helpless and afraid they will feel.
  
• Practice your explanation beforehand. It will be a great help to your child if you can be as calm and objective as possible when you discuss cancer, especially if you are the one who is ill. You should practice the conversation with your spouse or a friend, so that you can focus on your child's fears and put aside your own for the time being.
  
• Avoid blame. The younger children are, the more they think the world revolves around them, and the more likely they are to feel responsible for a parent or sibling's illness. Assure them by saying that nothing they or anyone else did caused the cancer.
  
• Explain to them that cancer is not contagious. Most children first experience sickness when they get a cold, measles, or some other childhood disease that might have been fairly contagious. It is important that you explain to them that cancer is not contagious. They will probably already be afraid that someone else in the family will get it. Assure them that this is not true.
  
• Try to balance optimism with pessimism. Telling your child that someone will be "all better" will only make him or her more confused and upset if it is not true. On the other hand, being very pessimistic can scare them needlessly. It is usually best to try to offer a realistic but hopeful assessment of the situation.
  
• Keep in touch with your children. If you are in the hospital for any extended period of time, your children may think that you don't want to be at home with them. Staying in touch will help reassure them that your illness has nothing to do with how much you love them.
  
• Take your children's feelings seriously. It is common for children to have many different reactions when they learn that a parent or sibling has cancer. These can include anger, sadness, guilt, fear, confusion, and even frustration. All of these responses are normal. Let them know that it is okay for them to have lots of different feelings and that you have many of them, too.
  
• Answer questions honestly. Discussing cancer with a child can be difficult, especially when there are so many questions that adults or even doctors cannot answer. It is best for you to be as honest as you can with your child, and not be afraid to say, "I don't know" if you don't. For children, the amount of information you give them is usually less important than making them feel comfortable with what you say.
  
• Help children understand treatment. Children often fear the unknown. They can think that a situation is worse than it really is. Explain the treatment process in a way that is appropriate for their age, but don't forget, it is easy for a child to imagine something like chemotherapy or radiation therapy as bad because it can cause hair loss, nausea, and other unpleasant side effects.
  
• Prepare your children for the effects of treatment. Cancer and cancer treatment can often dramatically affect someone's appearance. A physical change such as hair or weight loss can sometimes frighten them, or make them think a person has changed or is different. It is best to explain this to them beforehand so they are prepared. For example, you can say, "When mommy was sick in the hospital, she lost weight, and her hair fell out - but don't worry, it will grow back. She is still the same mommy on the inside."
  
• Let children help but don't burden them with responsibility. It is important to let children know that they can help their parent feel better; it will make them feel less helpless if you let them run an errand, fetch a glass of orange juice, or perform some other task that is appropriate for their age. But be careful not to burden them with too much. The stress of having someone ill in the family can be great. They will need lots of time to just play, relax, and be children.
  
• Be prepared to discuss death. This is a complicated topic, but if you or your family member is very ill with cancer, you should be prepared to discuss death with your children. Given the limitations of this information, it is impossible to suggest ways to discuss this with your child. You may want to consult a trained counselor or clergy first. One of the most important things to remember is to take your child's age into account when discussing death. Preschoolers, for instance, do not understand that death is final. School-age children tend to know that dead things don't eat, breathe, or sleep and by the age of ten, children begin to understand that death is the end of life. There are helpful books and other resources available to you to help facilitate the discussion of death with children (refer to "Resources for End-of-Life Issues")

Regardless of your child's age, when discussing death, remember three things:

• Try to use very clear, specific terms. Being vague will only confuse your child.
  
• Do not use terms like "sleeping forever" or "put to sleep," because children will think sleeping is like death, or be afraid that if they sleep, they might die.
  
• Finally, be patient. It will take a long time for a child to fully understand, and to accept, any type of loss. They certainly will not understand the first time you try to tell them.

Remember that when cancer strikes a family, children know something is wrong. Trying to protect them will only make them imagine the worst, and will prevent you from helping them to understand and eventually accept what is happening. If you need help in talking to your children, don't be afraid to ask for it. As a parent, you may not always be prepared for every situation. Being unsure of what to say is no reason to be ashamed.

Source: UCSF Cancer Resource Center (cc.ucsf.edu)