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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communicating with Children About Their Cancer

In seriously ill adults and also in children, uncertainties about the future often provoke a profound sense of loss of control. Studies show that children wish to be informed about their illness and plans for treatment.[1] Although children's information needs may be age-dependent, most will worry about the impact of the disease and medical treatments on their daily lives and on others around them. Studies also show that when information, even if unfavorable, is withheld from children, the silence exacerbates the child's fears and fantasies.[2] While not all terminally ill children want to talk specifically about death or the dying process, when they realize that their future is limited, they adapt by shifting their focus to a more immediate future such as the next holiday or a significant event.[3] Some children also have a surprising awareness of the fact that they are going to die. Children have asked questions such as "Is it going to hurt?" or "Will I be able to breathe?" or "Will an angel come and take me away?" Sometimes children will act out their concerns with disruptive behaviors. When communication barriers are addressed, these disruptive behaviors often disappear.

What Do Children Understand About the Concept of Death?

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According to classical developmental theory, children do not fully comprehend the irreversibility of death until the approximate ages of 11 years to 16 years.[4] However, even much younger children understand the principle of cause and effect; most children with fatal illnesses—even those as young as age 3 years or 4 years—pick up cues from the physiological changes in their bodies as well as the reactions of parents and hospital staff and thus have an advanced understanding of disease and the concept of death.[5] Dying children are also aware of the short time they have left, especially adolescents who are acutely focused on the future. Thus, approaching a child with a preconceived notion of what a typical child of that age can understand about death is not always helpful in a clinical setting.[6]

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