When Illness Hits Home
It's one of the toughest conversations you'll ever have. Here's what to say to help your child feel safe.
By Megan Othersen Gorman, Prevention

If you're a parent and get bad news from the doctor, your first question may be, "Am I going to live?" But the second is probably, "What do I tell my kids?"

For most people, the honest answer is, "Not a thing." A dire diagnosis takes your breath and your words away. It's a reaction that's natural, understandable, even wise. But silence shouldn't be your final answer because it won't protect your children.

"From a very young age, children are attuned to their parents' moods," says Paula Rauch, MD, founder of Parenting at a Challenging Time, a counseling service at Massachusetts General Hospital in Boston that helps moms and dads discuss illness with their children. "They sense your worry even if you don't actually voice it.

"Our culture severely underestimates how many families are living with serious illness," adds Rauch, an assistant professor of psychiatry at Harvard Medical School. "One in three women with breast cancer has children under 18. These days, people are able to live longer with chronic diseases, and they're having children later in life. Everyone needs to know how to talk to kids about illness. Everyone."

Here's what to say and what to avoid to help your child feel safer during a scary time.

You: Have a health test coming up, and the results may not be good.

DO: Keep your kids in the loop.

Let your child know that planned tests are making you nervous. Kids relate to dreading a doctor's visit — that makes it easier to communicate how you feel without unduly worrying them. You might say: "You've probably noticed that I've been coughing. Dr. Bailey wants me to get some tests. As soon as I find out what's what, Dad and I will let you know.

DON'T: Allow your children to find out about your worries by overhearing you.

The worst way to hear about something is to overhear it, says Rauch. You won't be able to give your child any context — and she's likely to assume that something that can't be spoken about directly must be very scary.

You: Receive a frightening diagnosis.

DO: Start by sharing the simple stuff.

Tell your child the name of your illness and the tests you're having then let her guide the talk. "You can flood a kid with details and do nothing but muddy the waters," says Rauch. "Find out your child's worries and address them."

DO: Look for fears behind the questions.

Often, a child is frightened at the thought of being left on her own, says Dan Gottlieb, PhD, a Philadelphia-based family therapist and host of the public radio program Voices in the Family.

"When my wife was diagnosed with malignant melanoma, my daughters were both under 5," Gottlieb says. "We told them, 'Mommy has a disease called cancer in her leg, and she's going to need lots of treatment for it.' The first question the girls asked was, 'Who will take care of us?' We laid that out very carefully. The second was: 'Will Mommy die?' We told them, 'We don't know, but we hope the treatments will make her better.' That was enough to make them feel better."

DON'T: Use a euphemism.

Vague language can confuse a child. "Name the illness as best as you can, no matter what the child's age," says Rauch. "If it's breast cancer, call it that not a lump or a boo-boo."

DON'T: Say "You shouldn't worry."

"You may be trying to protect your children," says Gottlieb, "but 'don't worry' tells them not to feel what they're feeling." Get a dialogue going by asking for questions. You don't have to answer right away — if you're stumped or not ready for a discussion, say you need to think about it or consult someone before getting back to them. Then do just that.

You: Want to talk about it; your child doesn't.

DO: Seek situations in which the pressure's off.

If your kids tend to open up when you're driving them to the mall, make that a priority. When your child does ask a question, don't pounce. If you're doing the dishes, continue to scrub instead of facing him. Emotions can feel more manageable when a speaker and listener aren't looking at each other, experts say.

DON'T: Clam up entirely.

If your child doesn't want to engage in a back-and-forth, give news bulletins: "Dad may go to Baltimore to see another doctor, and I didn't want you to overhear us talking about it."

You: Broke down when you were telling your child about your condition, and now you're worried she's terrified.

DO: Put your tears into context.

"Some people cry about lots of things," says Rauch. "If this describes you, just remind your children that when you get upset, you cry." If you never cry, give kids new perspective. You might confide: "There are days when I feel really down about this, but crying actually makes me feel better."

"It's a chance to show your kids that no one's happy all the time especially when hard stuff is going on," Rauch says. "And also, that people can cry and not break."

DON'T: Hold yourself to an impossible standard.

"If you had to have knee replacement surgery, you wouldn't expect yourself to say, all smiles, 'Guess what I'm going to have my knee replaced!'" says Rauch. "But with a grim diagnosis, people often do and it isn't possible." It isn't authentic, either. Kids want words that match emotions.

You: Feel overwhelmed by your own fears.

DON'T: Miss the opportunity to let your kids lead you.

"Many adults tell me what a huge role their children play in helping them cope with their illness," says Rauch — not just as a distraction but as a model. "It's often hard for adults in the midst of dire situations to grasp that they can do something to make things a little better" take a walk, play a game, watch a movie. Kids understand that. Let them remind you.

For help talking about cancer, see the family reading list at hurricanevoices.org.