How to Talk to Children When a Parent Is Ill

May 1, 2000 (Berkeley, Calif.) -- A serious diagnosis, hard enough to cope with in itself, creates a host of challenges for families -- how to tell the children, when to tell them, and how much.

The best approach varies according to the age of the child. Very young children may just need loving reassurance and a little more attention than usual.

Between 3 and 5 years of age, children begin to develop a sense of guilt. Combined with a growing sense that they are the center of the universe, they may feel responsible for a parent's illness. Reassure them that they are not. Be concrete and specific with your explanations, but only answer questions the child asks. Children this age do not understand the concept of death.

For that reason, if a parent dies, it's important to include the child in the funeral ceremony, says Joan Hermann, LSW, a social worker at Fox Chase Cancer Center in Philadelphia. Even so, a child this age will probably continue to ask, "When is mommy coming home?" It will take many explanations and time before he or she understands the finality of death.

Children between the ages of 6 and 9 are better able to understand abstract concepts, such as time. It will be easier to explain how long you may be in the hospital or if you will be away receiving treatment elsewhere. And while they will understand the concept of death, they are also more likely to worry about it. If your child says anything that indicates he or she is equating a parent's illness with possible death, it's important to encourage the child to talk about those fears.

As for teenagers, even though they can understand more information, they have a tendency to worry more about the information they're given. "Every child wants straightforward honesty, but with teenagers, it's like, 'Tell me, but don't tell me too much,'" says Marlene Wilson, program coordinator for Kids Can Cope, a Kaiser Permanente-sponsored program designed to support children through the "life stress" of a parent's serious illness. You can give them more, but only in limited doses. If you talk with teens about your prognosis, she suggests you say only as much as you know. "Don't get into 'what-ifs.' Generally, they can't handle all that vagueness and ambiguity."

Above all, say people involved in children's programs, it's important to be truthful, and to be available for questions and discussion.

Christine Cosgrove is a writer based in Berkeley, Calif., whose work has appeared in WebMD, Parenting magazine, and other publications.