How to talk to kids about a cancer diagnosis, according to experts

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By Madeline Holcombe and Sandee LaMotte, CNN

(CNN) — In the time Catherine, Princess of Wales, spent away from the public before revealing her cancer diagnosis, one of her biggest priorities was finding the right way to tell her children, she said.

“Most importantly, it has taken us time to explain everything to George, Charlotte and Louis in a way that’s appropriate to them and to reassure them that I’m going to be OK, she said in a video statement released Friday.

After weeks of speculation about why the princess hadn’t been seen in public since having abdominal surgery in January, Kate released the video explaining that she was recovering to prepare for preventative chemotherapy treatment.

Talking to children about the cancer diagnosis of their parent or loved one is important, and while families may have an instinct to protect their child from the scary feelings that come with it – clear communication is helpful for kids, said Dr. Claudia Gold, a pediatrician and early relational health specialist in Massachusetts.

Exactly how to have conversations around cancer will vary depending on the individual child and family, but there are guidelines that can help direct adults, said Hadley Maya, a clinical social worker at Memorial Sloan Kettering’s Center for Young Onset Colorectal and Gastrointestinal Cancers.

“This is one of the most difficult conversations that parents and adults ever have to have with the children in their lives,” said Maya, who is also one of the coordinators for Talking with Children about Cancer, which provides support and guidance to parents and families facing a cancer diagnosis.

Conversations by age

Take the child’s age into account when talking to a young person about a parent’s cancer diagnosis, expert say.

Preschool and younger: Children three and under will be most concerned about separation, abandonment and change in their daily lives, according to the American Cancer Society.

“If there is a change to their routine, babies and toddlers might get easily confused, become more clingy, and might have changes to their usual sleeping, eating, or other daily habits,” the society states on its website.

Suggestions include frequent cuddles and hugs, having a person the child is close to nearby to keep their routine as normal as possible, and using allowing the child to see a parent in the hospital in real time via video, phone or other technological means.

Kindergarten and early elementary: For children between the ages of 4 and 6  — Prince Louis is 5 — being sick is often equated to having a cold or other contagious disease. Therefore, the child may worry they can “catch cancer,” the society said. Children this age may also feel as if the sadness and distress the family is feeling may be in some way their fault.

Routine is still very important, as is having a familiar, reliable caregiver. Always use clear and simple language when communicating with children in this age range. Consider using playtime and art to help them understand the concept of cancer. Follow up by encouraging the child to role play with toys which may undercover misconceptions or misunderstandings.

Elementary age children: Children between the ages of 7 and 12 — Princess Charlotte is 8, and Prince George is 10 — are more likely to understand the concept of cancer and be able to anticipate the future, the society said. However, they may also hide their feelings in order not to further upset loved ones.

“For older children, more detail about the cancer can be given, as appropriate. Try not to overwhelm them with information, but be open and honest in answering any questions they might have,” the website said.

“Listen for unasked questions, especially about the child’s own health and well-being. It’s OK for the child to see the parent cry or be angry if the child understands that they’re not to blame for these feelings. Try to help them understand that it’s normal to have strong feelings and it’s good to express them.”

Keep the child in school and in after school activities, if possible, and inform any teachers, coaches or school staff about the illness, the society recommended. Tell the news to the families of their friends and assure the child that having fun is OK.

Teenagers: Because they are old enough to understand the significance of a cancer diagnosis and the possibilities for the future, teens may worry more and need to be reassured that nothing they did or said caused the disease. Like younger children, they may also try to hide their sadness, anger or fear so as not to cause others further pain. Routine is still helpful, as are honest and open updates about the parent’s illness.

“Give detailed information about the parent’s condition, symptoms, possible side effects of treatment, what they might expect, and other information, if they’re interested,” the agency said. “Keep open lines of communication and let them know they can talk to you at any time and ask any questions.”

At this age, friends and social influences are key, so a teen may turn to the internet or lean on friends for help. Ask a friend or relative to pay special attention to each teenager in the family and assure the child that it’s OK to have fun and not feel guilty about it.

“Teenagers experiencing distress might act out, withdraw from friends and family, and feel overwhelmed. Reassure them that it is OK to have these feelings and encourage them to learn how to respond and cope in healthy ways,” the society suggested.

Are you going to be OK?

One of the most difficult and perhaps most pressing questions from a child when they learn their loved one has cancer is “are you going to be OK?”

Even as the adult, you may not know the answer to that question.

“You can always say, you know, I’m not ready to answer that question right now, or I don’t know right now, but I promise I’ll come I’ll get back to you,” Maya said.

The most important things to give your child in that answer is reassurance that they are loved and protected no matter what, she said,  modeling that it is OK to be unsure and sit in the difficult feelings.

“That’s the most important thing, acknowledging it’s really hard to sit with uncertainty. That’s such a such a scary feeling,” Maya said.

You don’t need the ‘right thing’ to say

Parents often come to Maya looking for a script of the right thing to say, but the truth is that there isn’t one perfect way to talk about it, she said.

In fact, it is often better when you don’t know exactly what to say and instead listen and respond to how your specific child reacts, Gold added.

And don’t worry about having all the answers or addressing every feeling in the first conversation, because it is just that – the first of many conversations, Maya said.

Some families like to set up regular check ins all together after doctor appointments to give updates. Others like to set up one on one time to talk about concerns or questions. And some children like to be involved – sending written questions for the doctors or seeing pictures of their toy at the treatment center or with the doctor, she added.

The important thing is to take cues from your child and keep an open-door policy so that they know they can still come to you for support and love,  Maya said.

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