Saturday 24 March 2018

Don't shy away from the C word

Come to terms with your own diagnosis before telling your children

David Coleman

David Coleman

Talking to children about cancer can be a daunting prospect. Coming to terms with your own cancer diagnosis, or the diagnosis of someone close to your family, is difficult and we may want to protect our children from the distress we have experienced.

It might be tempting not to tell them, or to delay telling them, to save them from the worry or upset that we can anticipate they will feel.

But, not telling children, or putting off telling them, will do them no favours. Not telling them doesn't necessarily spare them from anxiety or stop them from realising something is wrong.

Children are often aware that something is up within their family. They are attuned to your emotional signals that things are good or bad, calm or anxious and so on. They will pick up on your unexplained absences, if at hospital, for example. They will sense the mood.

When they are left in a vacuum of no information, they will have to create explanations for themselves, for this mood they sense. The explanation they create may be even more traumatic, or may be directed at some perceived failing of themselves.

The uncertainty they may feel, without direct information from you, could be as hard to deal with, and live with, as the truth.

Finding out, by accident, from another relative, or from a hospital letter left on a counter-top may lead children to feel hurt that you couldn't, or didn't, tell them directly. They may feel isolated and excluded from what is going on in their family.

Another consideration is choosing when to tell children. There may be no "right" time to tell them. You may need to come to terms with your diagnosis first, such as you can.

Telling them early allows them to be part of the whole treatment process. This allows them to make sense of the different events or occurrences, like hospital visits or recovery times from treatments.

Indeed, you may choose to tell them because you are aware that some obvious change is about to occur, like hair loss because of treatment, or having to be admitted to hospital for a period of time.

Children will probably appreciate being told by someone very close to them, who knows them and who they feel comfortable with. Typically, that will be you or your partner, or a very close family relative.

In much the same way, you might choose to talk to them in a place that is also comfortable and where they feel secure. Having somewhere, like their own bedroom, to retreat to afterwards, to process some of what they have heard might be a nice thing.

Nobody can fully predict their response to being told. But having security and comfort gives them the freedom to be fully authentic (rather than, for example, feeling like they have to "put on a brave face").

If you have children of varying ages, you may choose to tell them separately. This allows you to give differing amounts and complexity of information and also respects the maturity and capacity of your different children to deal with the news.

By speaking individually with them, you also can give them your full attention as they try to make sense of what this illness means for you, for them and for their family.

You may also be surprised by how able children are to hear information that is sad, frightening or upsetting. Naturally, we cannot prevent them from having an emotional response to the news, nor do we want to. Indeed, creating the circumstances where we can help them to deal with their feelings is the ideal.

We also need to be prepared ourselves. Children can often be very direct and blunt with their questions and their feelings. Depending on their age, they may not filter their reactions in any way.

Do put time and thought into what you want to tell them too. There are some things that you definitely need to explain to them.

Firstly, you must explain your illness using the word 'cancer' and how you best understand that it might affect your health, now and in the future. You need to explain about any treatment and how that might impact on you and your child (like with changes to their routine, for example).

You need to be honest about the uncertainty that always exists with cancer and its treatment. Be careful not to promise anything (like your certain recovery) when there are still many variables that might affect the outcomes.

Remember that telling your child is just the start of a process for them and for you, of coming to terms with what this all means for your family. Your child may not take in all of the information the first time, so be prepared to repeat and explain more than once.

Accommodating to the enormity of what cancer might mean for you and for them may also take a long time for them to process. During that time they may struggle with lots of strong feelings.

Sometimes they may come to you to talk about what is going on inside. Other times you may spot that they seem withdrawn, clingy, upset, angry or have disturbed sleep or changes in their appetite. These may be signs that you need to facilitate more discussion of their feelings.

There are lots of supports for parents in talking with children about cancer. This is not something you have to approach alone.

The Irish Cancer Society has a detailed and helpful guide to talking with children about cancer.

If you phone their Nurseline Freephone 1800 200 700 you can get advice and guidance.

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