Many families have close relatives, or even members of the nuclear family who are dealing with cancer. We have responded to a question from a parent - that particular situation involved a child's mother. Every situation has its own many individual features, but we hope that the advice that we offered in this situation will have some general applicability for other families as well.

Q. My 6-year-old niece has a friend whose mother is battling breast cancer. After months of chemo and treatments, my niece still asks, "What is cancer?" Do you have any suggestions for how to talk to her?

A. Explaining cancer to children is certainly not an easy task.  When explaining cancer or any other serious illness to a child, parents should offer an explanation of the facts of the illness itself, keeping in mind that the child's questions and concerns are influenced by the meaning of that particular person to the child. Explaining a neighbor's cancer is a different task than explaining a family member's cancer. Furthermore, parents can be most helpful when they understand how to help children to feel able to voice their questions.

Explaining cancer: With the kind permission of the author, we would like to share some excellent explanations for children about cancer that are contained in the book, Barklay and Eve: What is Cancer Anyway, authored by Karen L. Carney, RN, LCSW and available at dragonflypublishing.net. (The full text in the book is probably more suitable for a child older than your niece, but her parents can modify the text.) Some of the explanations offered in Barklay and Eve are: "The body is made of lots of cells...  Cells are so small that you can only see them under a microscope... Normal cells are the kinds of cells that we need.  Normal cells keep the body working well... Cancer cells do not look like normal cells, and they don't work like normal cells... Cancer cells grow very fast. They crowd out the normal cells. When cancer cells grow, they get in the way of the normal cells. A group of cells that keeps growing and crowding out normal cells is called a tumor. Sometimes the part of the body where the cancer cells are growing does not work right, so the doctor may operate to remove as much of the cancer as possible... Sometimes people with cancer are given radiation therapy to help get rid of cancer cells. Radiation therapy is treatment of cancer with radioactive rays. This is done with a very special machine that is made just for cancer treatment. It's not the same as an ordinary x-ray... Sometimes people with cancer are given chemotherapy. Chemotherapy is a kind of cancer treatment that uses special kinds of chemicals that destroy cancer cells... Chemotherapy kills fast growing cells like cancer cells. Some healthy cells that normally grow quickly may be harmed, too. Hair is made of fast growing cells. That's why hair falls out from certain kinds of chemotherapy. The hair will grow back after chemotherapy treatment ends."  

It might be helpful if your niece is also told that cancer cannot be caught. Whether she asks or not, it is safe to assume that she is wondering whether anyone in her family has cancer, or will get cancer. Her parents can consider bringing this up directly. They can tell her that although some people get cancer, usually it happens to older people, although their neighbor is someone who got cancer at a younger age (if this is the case!) If she asks whether her neighbor will die, her parents can say, "It's important to understand that everyone's cancer is different. Some people get better, and some people do not get better." She can also be told that her neighbor is very hopeful that she will be fine, as are her doctors (if true); or even that everyone thinks she will be fine (if true).

Responding to questions: We have some further suggestions that will assist children to ask their questions about their curiosities and concerns - about cancer, and other matters as well. Questions about sensitive subjects such as robbers, divorce, illness, or a tragedy on the news, can be challenging because a full answer is beyond children's cognitive ability and capacity to process emotionally. Parents need to provide enough honest information that helps children understand to their satisfaction, but not so much information that children are confused or frightened. Finding this balance can be quite a task!

Parents should also keep in mind that children might not ask questions that are on their mind. Your niece is repeatedly asking about cancer, but even in her case, we do not know if she had to work up her courage each time.  Children, like adults, find it difficult to ask questions when worried about the possible answer.  

Parents are sometimes advised to simply wait for children to ask their questions on the presumption that children always ask what they want to know. We believe that children don't always spontaneously ask their questions, and may hold questions inside causing themselves needless worry. Therefore, we advise parents to facilitate questions by providing a welcoming and encouraging atmosphere for them. For example, your niece's parents could have asked her if she had any questions about cancer. Furthermore, just as adults may be satisfied at the moment with an answer, but at a later date either need to repeat the question or discuss follow-up questions - so children need repeated opportunities to discuss emotional concerns. Your niece's parents could ask, from time to time, if she has any further questions or wants her parents to explain their answers again.

Finally, children's comfort with their parent's good answers about any of life's difficult topics will be influenced by their parents' level of comfort. Children's factual questions may be fueled by their reactions to parental feelings. For example, your niece's parents are undoubtedly upset about their neighbor's malignancy, and may have their own specific anxieties. Children usually benefit when parents share and explain their own emotional reactions in appropriately discreet ways.

Your niece's parents have an opportunity not only to help her understand cancer, but also to discuss a sensitive topic with their tactful awareness of her feelings and cognitive and emotional capacities. They have the opportunity to show that they are open to her concerns and model communication that keeps another's needs clearly in mind. In so doing, they will be helping to build a foundation for successful life-long parent-child communication.

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