How to tell your children about cancer? Experts give tips

In the time that Kate Middleton Princess of Wales, stayed away from the public before revealing her cancer diagnosis one of her biggest priorities was finding the right way to tell her children, according to her.

“The most important thing was to take time to explain everything to George, Charlotte and Louis in a way that suits them and to reassure them that I will be fine,” the princess said in a video statement, released on Friday (22 ).

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

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

Exactly how to have conversations about cancer can vary depending on the child and family, but there are guidelines that can help adults, says Hadley Maya, clinical social worker at the Center for Early-Onset Gastrointestinal and Colorectal Cancer at Memorial Sloan Kettering.

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

Conversations by age

Experts advise taking the child's age into consideration when talking to them about a parent's cancer diagnosis.

Children of preschool age and younger : Children aged three and under will be most worried about separation, abandonment and change in their daily lives, according to the American Cancer Society.

“If there is a change in their routine, babies and young children can become easily confused, become more clingy and may have changes in their sleeping habits, eating habits or other usual daily activities,” says the society on its website.

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

Preschool and early elementary school : For children ages 4 to 6 — like Prince Louis, who is 5 — being sick is often associated with having a cold or another contagious illness. Therefore, the child may worry about “getting cancer”, says the society. Children this age may also feel that the sadness and suffering the family is experiencing may, in some way, be their fault.

Routine is still very important, as is having a familiar and reliable caregiver. Always use clear and simple language when communicating with children in this age group. Consider using play and art time to help them understand the concept of cancer. Then encourage the child to play with toys that may reveal misconceptions or misunderstandings.

School-aged children : Children between the ages of 7 and 12 — like Princess Charlotte, who is 8, and Prince George, who is 10 — are more likely to understand the concept of cancer and be able to anticipate the future, the society says. However, they may also hide their feelings so as not to make loved ones worry even more.

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

“Be aware of unasked questions, especially about the child’s own health and well-being. It's okay for a child to see their parent cry or get angry if they understand that they are not to blame for those feelings. Try to help them understand that it’s normal to have strong feelings and it’s okay to express them.”

Keep the child in school and extracurricular activities if possible, and inform any teacher, coach or school employee about the illness, the society recommends. Tell the news to their friends' families and reassure the child that having fun is okay.

Teenagers : Because they are mature enough to understand the meaning of a cancer diagnosis and the possibilities for the future, teens may worry more and need reassurance that nothing they did or said caused the disease. As younger children, they may also try to hide their sadness, anger, or fear so as not to cause more pain to others. 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 can expect, and other information if they are interested,” the agency said. “Keep lines of communication open and let them know they can talk to you at any time and ask any questions.”

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

“Teens who are in distress may act recklessly, withdraw from friends and family, and feel overwhelmed. Reassure them that it's okay to have these feelings and encourage them to learn to respond and cope in a healthy way,” the society suggested.

You'll be fine?

One of the hardest and perhaps most pressing questions a child has when they learn a loved one has cancer is “will you be okay?”

Even as an adult, you may not know the answer to this 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 get back to you,” says Maya.

The most important things to give your child in this response are reassurance that they are loved and protected no matter what, she said, modeling that it's okay to be uncertain and deal with difficult feelings.

“That's the most important thing, recognizing that it's really difficult to deal with uncertainty. It’s a very scary feeling,” she states.

You don’t need the “right thing” to say

Parents often look to Maya for a script of the “right thing” to say, but the truth is there is no perfect way to talk about it.

In fact, it's often better when you don't know exactly what to say and instead listen and respond to your child's specific reaction, Gold adds.

And don't worry about having all the answers or addressing all the feelings in the first conversation, because it's just that—the first of many conversations, says Maya.

Some families like to schedule regular check-ins together after doctor appointments to give updates. Others like to schedule time alone to talk about concerns or questions. And some kids like to get involved — sending written questions to doctors or looking at photos of their toys at the treatment center or with the doctor, she added.

The important thing is to follow your child's cues and maintain an open door policy so they know they can still come to you for support and love, Maya said.