How to Tell a Child a Parent Has Cancer

"How should I tell my children I have cancer?" is one of the questions newly diagnosed cancer patients ask their nurses. Although the answer will vary among families, there are a few guidelines I have shared with patients that I have found helpful, both as a cancer survivor and as an oncology nurse.

• Wait until you understand your treatment plan. When your questions about your diagnosis have been answered, you are better able to answer your child's questions.
• Keep the conversation age-appropriate. Small children may not know the meaning of the word "cancer." Simply saying "Mommy is sick and is getting 'special medicine' that will make her hair fall out and very tired sometimes" might be enough information for a small child. I describe chemotherapy as "special medicine" because it's important for small children to understand that the amoxicillin their pediatrician prescribed for their earache won't make their hair fall out.
• Make sure the child doesn't assume responsibility for his or her parent's cancer. This may sound far-fetched, but I learned it the hard way. Before my diagnosis, my teenage daughter and I experienced mother/daughter issues, resulting in her blaming herself for causing the cancer: "I gave you cancer. Stress causes cancer, and I caused you stress" were her words. We had many discussions about the biological causes of cancer, my responsibility for managing stress, and how much we love each other. Children may also believe that mommy or daddy will get well or worsen depending upon their good or bad behavior. They should not be encouraged in this kind of magical thinking. It is too big of a burden for small shoulders.
• Provide children with constructive ways to help. Older children can help with simple meal preparation, assisting younger siblings with homework, or light housework. Small children can learn to occupy themselves quietly while a parent naps after chemo. Take the kids along while shopping for your wigs and hats. Give them magazines to cut pictures from of colors and hairstyles to paste in a scrapbook for you to try when your hair grows back. Maybe you would look good in a Mohawk!
• Be stably flexible.While keeping your child's life as normal as possible in the presence of cancer is admirable, learning flexibility is part of growing into adulthood. Developing a sense of community begins within the family unit.
• Be a role model character for your children. As scary as cancer is, this is an opportunity to show your children how to handle crisis. This does not mean exhibiting stoicism. Learning how to express fear, anger, and grief through nondestructive means is more important to character development than pretending everything is OK, when clearly it is not.

I am not the only blogger for TheONC with a personal cancer experience. What advice do others have about raising children in the presence of cancer? Some of you are pediatric oncology nurses. What advice do you have about age-appropriate cancer conversations? What resources do those of you who are chaplains or social workers recommend?