As a child psychiatrist, Dr. Lynn Bornfriend had been discussing different issues with kids for years. But her last two years at the Cancer Treatment Centers of America (CTCA) in Philadelphia brought a new struggle to light: the difficulty parents with cancer face in discussing their diagnosis with their children.
“It seemed that the parents [with cancer] had an extra burden: How do I protect my child? How do I plan for my child?” Dr. Bornfriend tells Metro. “And very quickly we became aware that this is something we have to spend more time on and come up with more resources for.”
According to Bornfriend, the first hurdle is changing the outlook of parents who believe a discussion will only frighten their child. “Children are very perceptive, and they know when something is wrong even if you’re not speaking about it,” she says. “So if you don’t tell them what is going on, they’re likely to think that it’s worse than it really is, or that they’re the cause of the problem.”
Dr. Bornfriend’s recommended course of action is honesty. “Your degree of honesty is tailored to what their developmental stage is and their cognitive abilities,” she says. Essentially, the transparency of your discussion will vary with the age of your kids.
Preschoolers need to be prepped for the physical changes they will see in a parent.
“You have to make clear to them that mommy or daddy is pretty sick,” Dr. Bornfriend says. “You make them aware of some of the things they may see: Mommy or daddy may be laying on the couch more. You talk to them about how you’ve made a choice, you’re going to get treatment, and you have a plan. You explain to them what it is and what it is not.”
But Dr. Bornfriend warns not to get too caught up in the details. “Young kids take what they can hear and then they’re ready to move on,” she explains. “You’re ready to be explaining about chemotherapy and radiation and they’re gone.” Make sure to use understandable language like “strong medicine” or “boo-boo.”
Dr. Bornfriend relates how a cancer conversation may play out with a three-year old:
Parent: “I’m very sick; I have a disease called cancer.”
Child: “Can I catch it?”
Child: “Are you going to be able to make me my favorite mac and cheese?”
Child: “OK! Bye.”
Teenagers, on the other hand, require much more transparency. “You have to give them specific information because they’re going to have specific questions and they want to know what’s going on in a clear way,” Dr. Bornfriend says. Additionally, emotions may run high. “There may be a very dramatic response to your news, and you sort of have to batten down the hatches. Or they’re going to want their own privacy in the way they deal with things,” Dr. Bornfriend says.
Your teenager may not want to talk to you. Maintaining normalcy to the best of your ability is important, Dr. Bornfriend says. “You have to make clear to the kids that you expect that they continue to meet their responsibilities,” she says. “There will continue to be consequences if they don’t.”
Dr. Bornfriend explains normalcy also means that kids get to be kids. “It’s OK for them to have fun, it’s necessary for them to have fun,” she says. She suggests reaching out to family and friends to help maintain children’s schedules. “School-aged kids especially are very into rules and order, and cancer treatment can be very disruptive to them because it changes,” she says. “But use other people — family members, friends — so that their schedules persist. Kind of that ‘it takes a village’ notion.”
Regardless of children’s age, parents need to allow for questions and open communication. “The worst thing is when kids are trapped by themselves and alone in their minds and don’t feel that they can ask a question,” Dr. Bornfriend says. “We tell parents that even if tears are rolling down your face while you’re having that conversation with your child, it’s better than not having that conversation.”
As for when to tell the child? “Parents should start telling a kid pretty soon after the diagnosis is known. And tell them as the process proceeds,” Dr. Bornfriend says.