You can do this: How to talk to your kids about Cancer.

It’s the last thing you want to have to do. Internalizing, grieving, accepting, then living with a cancer diagnosis is hard enough. Telling your children that their strong, confident, superhero mom (or dad) is sick and might get really sick might just be more than your heart can bear.

In the eyes of your children, you are the doer of all things, the one who makes everything right. The kisser of boo-boos, the solver of problems, the finder of missing things. You are the strongest, the tireless, the one whose hugs just makes the world better.

What happens now? The hard questions relentlessly flood your mind. Above all, you ask yourself, How will your children be ok? How will they thrive? How is this going to impact their life? What if they need you and you can’t be there? And what happens if, one day, your worst nightmare comes true and they have to do life without you?

To this, I say, let the questions come and come. Let the tears flow. Let the what ifs explode. Realize that you have no answers – yet. Then STOP. And BREATHE. And REMEMBER this one truth: Your children are resilient. And, so are you.

Sometimes the hardest part is getting started. You look at your children, knowing you are about to drop a bomb on them, and you don’t have the slightest idea how to begin. I’m sure that there are no right first words, but there are definitely wrong ones. Remember, these are your children and they love you. They are strong and together your family is stronger. 

Here are the best steps to share difficult information with your kids.

Step 1: Collect your emotions. Step 2: Breathe. Step 3: Approach this tough conversation with grace and try using these strategies:

1)    Be Honest.

2)    Break things down into manageable, developmentally-appropriate pieces.

3)    Accept you may not have all of the answers immediately.

4)    Talk about it again, and again, and again if needed. Be available.

Let’s talk about each one.  

Be Honest: In any relationship, trust is one of the most, if not THE most important core value. This is no less true with your kids. You need to be able to trust them. You need to know that if they say they are going to be somewhere, do something, complete a task, or answer a question that you can take them at their word. Your kids need the same from you – perhaps even more so. No matter what their age, honestly matters. Your children need to know that what you have told them is the truth. They need to know that they have the whole story and you aren’t going to surprise them later with worse or different news. Otherwise, how can they have any confidence that anything you tell them is real – good or bad, and how can they truly process the news if they only have a portion of the information?

When kids are only given half-truths you are depriving them of the opportunity to understand. To understand, kids need to be able to ask questions – and lots of them. If they don’t have complete information, we are not giving them the ability to fully be able to make sense of changes to their lives, make appropriate connections in their minds, and be able to make inferences and process future information.  

Do not think that hiding the truth from your kids is protecting them, no matter how hard you think that information might be for them to hear. Not only are kids resilient, kids are smart. They will figure it out and learn the real answer, eventually. And when they do, they should and likely will ask why you lied to them. Did you not think they were strong enough? Not smart enough? Not capable enough? I guarantee that trying to explain that you were just trying to protect them, will not be an acceptable answer. Nor should it. You need to be able to confidently say, “This is the information we have now. When we learn more, we will tell you.” You need your kids to believe you.

This is especially important for kids with anxiety. Anxiety is so often a fear of the unknown, a fear of what could happen. When kids don’t have enough information, they will often start to fill in the details and draw often irrational conclusions. We know that kids’ minds can get very creative and in these situations, their minds are not doing them any favors. It can be very unhelpful and even damaging. If kids are always worrying that there might be more that you aren’t telling them, it is only going to make their anxiety worse.

In order for kids to process difficult information, they need to be given the opportunity to do so. They need as complete of information as is developmentally appropriate and they need it to be delivered to them in ways that are manageable.

This is where part 2 comes in: Break things down into manageable pieces.

 When you have hard news to deliver, it is often helpful to give it in bite-sized pieces. These pieces may come during the same conversation, but they do not need to be in the same sentence. Give one piece of information and pause. Let your kids digest it. Let them think, reflect, and ask questions. If those questions lead to more, new information then be honest, deliver that information, and pause again.

 Be very careful NOT to speak in absolutes. As much as you may want to say, “Mommy is going to be completely fine.” – you don’t truly know this. You can be confident and say, “We have a great team of doctors helping Mommy, and we are going to do everything we can to help her get better.” That is honest, but not false hope. You do not want your children to ever come to you and say that you promised them Mommy was going to be ok, and that you lied. Remember, kids are resilient and can handle hard things too. It is not our job as parents to protect our kids from hard; it is our job to help them learn how to manage it.

Part 3: You may not have all of the answers immediately.

 When living through a diagnosis like cancer, there are bound to be a lot of unknowns. For most people, this is completely uncharted territory. Much of the medical language is new and often scary. The treatments and procedures are intimidating. Your response to therapy may be questionable and unclear. The prognosis is often uncertain. There is going to be so much you just do not and cannot possibly know – at least not immediately.

 It is ok to not know. It is not ok to make up answers. Kids will ask a lot of questions. Give them honest answers. If they ask you a question and you do not or cannot have an answer, tell them that. If it is something that you can find out, tell them that too – and then do it. Our kids don’t need us to immediately know everything, but they do need us to be a resource to help them learn—and to teach them how to navigate complexity and uncertainty. Just as it is ok for our children to not have answers and say, “I don’t know”, the next step should always be to find out. Model this for your kids. Be honest, get educated, and report back.

Part 4: Be available and allow your kids time to ask you questions again. And again. And again.

Importantly, kids need to know that there are no time restrictions on this conversation. Keep the door open and welcome questions at any time. Many kids will lay in their beds at night thinking. This may be a great time to gently ask if they have any questions or concerns. Asking periodically can be a helpful reminder that you are open to continuing the conversation, but also letting them know that it is ok if they don’t have any questions. Some kids may just need space to sit with new information as it comes, so remember to allow your kids time to adjust.

All of this being said, it is likewise important to be observant and notice when your child is turning inward too much. I have always been a strong believer in getting mental health providers and therapists involved in kids’ lives early and often. Some kids may be afraid to ask you hard or sensitive questions that they are afraid might make you sad or worry. Some kids just don’t know how to process all of the information in their heads and can benefit from having a professional help them sort through the feelings of being overwhelmed. Other kids may develop new or worsening anxiety. It is hard to know exactly how your child is going to respond to this hard news, not to mention the next many months as you proceed through treatment. The benefits of involving a therapist dramatically outweigh any perceived negative associations. Likewise, remember that there are many support groups for families and children who are touched by Cancer. Ask your oncology team for resources and seek these out. For many children, these support networks can be truly life-changing.

I never wanted to have to have this conversation with my daughter. It was one of the hardest things I’ve done. We cried. A lot. She asked a lot of hard questions and has continued asking. Most days she is doing great. Other days, not so much. She asked me, point blank, what happens if you are not ok? I told her, I didn’t know but that her daddy and I and all of the people in our life love her very much and together we would figure it out. She shook her head in agreement and gave me an even bigger hug. I hope to never need to answer that question, at least not soon.

Here's to fighting the good fight.

Dr. Keili