Most parents have a sense of when their child is most likely to talk openly. For younger children, it may be at bedtime when the house is quiet and they are warmly tucked under the covers. Older children may be able to toss out a question while you are involved in a routine activity or during a car ride. Especially for emotionally laden questions or discussions, your children may not want to have to look directly at you or feel like their facial expressions might be scrutinized. For example, they may bring up questions when they can turn to look out the car window, or focus on the meal you are preparing together. A question from your 10-year-old may not necessarily be an invitation to stop what you are doing and sit down in front of her—and doing so may stop the conversation in its tracks. Other times, you may need to pause, or offer a reassuring squeeze.
Some parents wonder whether their emotions or tears might worry their child or make it difficult to talk about the illness. Early in an illness, or when things are not going well, parents may hesitate to talk openly with their children for fear of making things worse or scaring them—especially if your family rarely shows strong emotions.
While it is important for you to have other adults with whom you share your biggest fears and worries, you cannot shield your children from your feelings completely. If you do get upset while talking with your kids, acknowledge that you sometimes feel scared, sad, angry, or worried, but that it won’t last forever. Let them know it is okay for them to sometimes feel those things too. In fact, sharing a few tears together can reassure children that feelings do not need to be completely overwhelming, and that you will be there to support them and to try to understand how they feel.
Deciding exactly when to talk with your children about a new diagnosis or change in medical condition may be influenced by other important events in the child or family’s life. Some parents hesitate to tell children about an illness before a big test or sports game, or when the child is facing other disappointments or challenges.
If there is more than one child in the family, it is probably best for them to receive the initial news of the diagnosis at the same time, with individual time set aside for questions or additional details later. Once everyone has basic information, the flow of ongoing news can be adjusted more individually, depending on age, temperament, and scheduled events. It is helpful to ask a child how and when she wants to receive information. Many older children will express a personal preference, and appreciate being included in these decisions. In this case, be sure that the children understand that this might result in their receiving information at different times, but that they can always ask to know more at any time.
Many parents worry about the child who has never been much of a talker—the child who says “fine” when you ask how school was, or who never seems to spontaneously ask about anything related to the illness. Some children just aren’t big talkers, and it is unlikely that they will become one during a parent’s illness. Nonetheless, these children deserve to be informed about illness-related issues. They need “news bulletins” and an invitation to ask questions, but parents may need to lower their expectations for discussion. Children, talkers and non-talkers alike, may benefit from being asked periodically if they are hearing too much about the illness, too little, or the right amount. Even children who say they don’t want to hear anything at all need to receive basic information, especially about things that will directly affect them.
For older children, sometimes writing is a useful way to communicate basic information. You want to be sure that there is still room for dialog and back-and-forth questions, but e-mail or a shared journal that gets kept in a specific place and is read regularly can be particularly helpful if your child has trouble with strong emotions or wants to receive information on her own timetable.