Talking with a child about a parent's terminal illness

You may wonder when it is the right time to talk to your child about death. In truth, there might not be one perfect time. You can give your child time to absorb the news and ask questions by talking soon after you find out your cancer is terminal. Being included in this difficult transition can help your child feel reassured. It can help to know your family will go through this together.

Age and past experience have a lot to do with what children understand about cancer. While it may be tempting to use euphemisms like, "Mom will be going away," such vague words confuse kids. It is better to be clear about what is going to happen and address your child's fears.

• Be specific. Tell your child what kind of cancer you have. If you just say you are sick, your child might worry that anyone who gets sick will die.
• Let your child know you cannot catch cancer from someone else. Your child does not have to worry about getting it from you, or giving it to friends.
• Explain that it is not your child's fault. While this may be obvious to you, kids tend to believe they cause things to happen by what they do or say.
• If your child is too young to understand death, talk in terms of the body not working anymore. You might say, "When Dad dies, he will stop breathing. He will not eat or talk anymore."
• Tell your child what will happen next. For instance, "The treatment is not going to cure my cancer so the doctors are going to make sure I am comfortable."

Your child might ask questions right away or become quiet and want to talk later. You may need to answer the same questions many times while your child comes to terms with the loss. Kids often want to know things like:

• What will happen to me?
• Who will take care of me?
• Are you (the other parent) going to die too?

Try to reassure your child as much as you can without covering up the truth. Explain that your child will continue to live with the surviving parent after you die. The parent without cancer can say, "I do not have cancer. I plan to be around and here for you for a long time."

If your child asks questions you cannot answer, it is OK to say you do not know. If you think you can find the answer, tell your child you will try to find the answer.

As kids get older, they become more aware that death is permanent. Your child might grieve on and off into the teen years, as the loss becomes more real. Grief can involve any of these emotions:

• Guilt. Adults and kids may feel guilty after someone they love dies. Kids might think the death is a punishment for something they did.
• Anger. As hard as it is to hear anger expressed toward the dead, this is a normal part of grief.
• Regression. Kids can slip back to the behavior of a younger child. Children may resume bedwetting or need more attention from the surviving parent. Try to be patient, and remember that this is temporary.
• Depression. Sorrow is a necessary part of grief. But if the sorrow becomes so intense your child cannot cope with life, you should seek help from a mental health professional.

You may wish you could take away your child's pain but having the chance to talk through difficult feelings with you can be the best comfort. Explain that your child's feelings, whatever they are, are OK, and that you will listen any time your child wants to talk.

As much as possible, keep your child involved in normal routines. Say that it is OK to go to school, after-school activities, and out with friends.

Some children act out when faced with bad news. Your child could have trouble in school or pick fights with friends. Some kids become clingy. Talk to your child's teacher or guidance counselor and let them know what is going on.

You might talk to the parents of your child's close friends. It may help if your child has friends to talk with.

You may be tempted to have your child stay with a friend or relative to spare your child from witnessing death. Most experts say it is more upsetting for children to be sent away. Your child will likely do better being close to you at home.

If your child is unable to return to normal activities 6 months or longer after a parent dies, or is exhibiting risky behavior, call your health care provider.

American Cancer Society website. Helping children when someone they know has cancer. www.cancer.org/treatment/children-and-cancer/when-a-family-member-has-cancer/dealing-with-treatment.html. Updated September 15, 2022. Accessed October 31, 2022.

Liptak C, Zeltzer LM, Recklitis CJ. Psychosocial care of the child and family. In: Orkin SH, Fisher DE, Ginsburg D, Look AT, Lux SE, Nathan DG, eds. Nathan and Oski's Hematology and Oncology of Infancy and Childhood. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 73.

National Cancer Institute website. Coping with advanced cancer. www.cancer.gov/publications/patient-education/advancedcancer.pdf. Updated June 2020. Accessed October 31, 2022.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.