One challenge for parents of a child who has been diagnosed with cancer is deciding what to tell your child and how to say it. Parents want to be a source of trust and support for their child, but they may not know how or where to start explaining the disease in an age-appropriate way. Cancer.Net talked with Gregory Reaman, MD, to learn more about talking with your child about his or her cancer.

Q: How do you first approach a conversation about cancer with your child?

A: Children frequently understand a great deal more than we as parents or caretakers realize and give them credit for. Withholding information from a child who can sense the anxiety and fear in his or her parents and other family members substantially increases their own fear and anxiety. It is important to be open and honest and share as many facts as you know about the situation. Generally, your child's doctor, nurse, or social worker are available to assist with this and can guide you through the process. Some parents find it helpful to begin these discussions with a member of the clinical care team present so that one of these professionals can help contribute to the discussion.

Q: What are the most important points to discuss?

A: The most important points to discuss with a child is that he or she has a serious illness for which you, as parents, and their health-care team will do everything in their power to make better. It is important to use the word "cancer," as they may well be in a setting where they will hear this from others (other patients, other patients' families, nurses, and hospital staff) and question why they have not heard this word from their parents or doctor. This increases their level of anxiety and has the potential to create distrust. It is important to recognize the level of understanding that a given child has about the word cancer and the potential implications of their diagnosis. Emphasize that cancer in children is always treatable and, more often than not, curable. Every child's treatment for cancer begins with the intent to cure the cancer.

Q: What are the common fears that a child may have after learning about his or her diagnosis?

A: Frequently, the common fears are how the diagnosis and its treatment and management will immediately affect their lives. Typical concerns relate to attending school, competing in athletic activities, body image changes (including hair loss), and spending time in the hospital. Another significant fear is the perceived pain or discomfort associated with diagnostic procedures and therapies. It is always difficult to explain, particularly to young children, that doing something that causes pain is actually an attempt to make them get better or feel better. Another common fear is how their diagnosis will affect you as parents or other members of the family. It is important that you discuss with them, as well as their siblings, that this is a situation that requires the entire family, and possibly extended family members, to work together toward the goal of making the child better, and hopefully curing the child.

Q: How can you tell if you are sharing too much information?

A: Generally, you can never share too much information. Most children will react with fear and occasionally, anger. In these situations, it is best to not continue providing factual information, but to deal with the emotions at hand. It is important also to realize that the information is as shocking to a child as it may be to a parent and therefore, actual retention and comprehension of the information you or the doctor communicated to the child is not as much as you think. Consider repeating and reinforcing information. It is a good idea to explain to your child that you may not have all of the answers to their questions and that you are learning about this as well. It is also important for the members of your child's health-care team to understand and to help share the information as soon as possible. Obviously, the extent of information shared is highly dependent on the individual child. Also, despite individual differences, consider the relationship between age and the ability to comprehend some of the medical facts. Again, your doctor, nurse, or social worker will be able to assist you. Talk with the nurse or social worker about publications available that can help your child understand their diagnosis and the treatments that may be required. Reading these publications together demonstrates support in the sense that you are also embarking on a learning experience.

Dr. Reaman is the Chair of the Children's Oncology Group and serves as the Cancer.Net Associate Editor for childhood cancer.

Additional Resources

CureSearch: For Parents and Families

CancerCare for Kids

Candlelighters Childhood Cancer Foundation

More Information

How a Child Understands Cancer

Preparing Your Child for a Medical Procedure

Siblings and Cancer

Cancer in Children