Delivering difficult news to children

By Dr. Batya L. Ludman, Psy.D., FT · Published January 10, 2014

About six months ago I had a chat with my dear friend Sarah, who had recently been told that her sister was found to have a genetic predisposition to breast cancer, and was about to have her ovaries removed as well as a bilateral preventive mastectomy.

After conferring with my husband, a cancer genetics specialist, and especially after hearing about Angelina Jolie’s double mastectomy, Sarah thought she too ought to get tested.

Well, it turns out that Sarah also carries the genetic change in the BRCA1 gene, and she too was advised by her doctor to have her ovaries removed – given that she is 40 and has completed her family.

Yesterday, I called Sarah to find out when she was scheduled for her surgery. Suddenly she began whispering to me on the phone.

“Sarah,” I realized, “you haven’t told your kids yet, have you?” “No, even though I have already known for half a year,” she replied, with heaviness in her voice. “My appointment hasn’t yet been scheduled and I haven’t wanted to check to see why it was delayed.”

More than a decade earlier, another friend of mine died before her 39th birthday, leaving behind three children under the age of 12. Sadly, she had never really been able to tell her children that she was dying, in part because she had such difficulty in acknowledging it herself. As her friend, I helped her make a recording for each child and write letters to each of them just weeks before she passed away, so that they would have a small but very special part of her when they were older. While it was difficult for her to do this, she was comforted by the fact that at least in some small way, she could let her children know just how proud she was of them and how much she loved them.

Let’s face it: No one likes to hear bad news. Even waiting to receive what we presume will be good test results can cause tremendous anxiety, as was demonstrated by a study that I once conducted with a group of obstetricians, who wanted to assess the impact of waiting for prenatal screening results.

Children, both young and grown-up, may not want to know about parental or other illnesses, and we may not want to talk to our children about things like divorce, war, earthquakes, Grandma’s developing Alzheimer’s or even the need for a medical procedure. Who wouldn’t want to lovingly envelop their children in their arms and protect them at all costs from anything bad? We may even think, like Sarah, that we will tell our children bad news only if and when we absolutely must.

As I have written so many times in this column, and I do believe this sincerely – you can say anything to anyone. It is how you choose to say it that will determine how it gets heard.

This is a column that you may hope you can file away and never use, but I am a firm believer that it’s always easier to deal with what you know about than fear the worst because of ignorance or secrecy. You may think of your child – be they three or 33 – as young, but I promise you, they are likely to be much more aware of what is happening than you think.

So, how do you deliver difficult news to your children? Here are a few thoughts:

  1. While you may still be in shock due to unanticipated and upsetting news, make sure that you are calm and “in a good place” before talking to your children. You need to proceed slowly, as you need time to absorb the information – and so will they.

    If you feel you can’t talk with your children, find someone who can, or get help and advice as to how to best relay the information they need.

  2. Pick the right time and place to talk to your child. Let him know that you have something difficult you would like to discuss. Do not talk to your child when he is tired, hungry or unwell, and definitely not right before bed.

  3. Keep the discussion age appropriate. Be clear, honest, empathetic and as positive as possible. Use simple language and give as much information as you need, but don’t overwhelm your child with more details than he needs. Prepare your child as best as possible for what they will hear, what may happen and what they may see. Focus on facts more than predictions, and remember that you will revisit the topic and provide more detail as needed.

  4. Be aware of your choice of words and ask your child to paraphrase what he thinks you said. This way, you can clarify any misunderstandings.

  5. Ask your child if he has any questions and tell him you’ll follow up on the conversation at a later time, rechecking for questions, concerns or thoughts. Some children may prefer art to conversation. That too is okay.

  6. The greatest fears of children and adults alike are those related to pain and abandonment. Reassure your child that they will be okay, and let them know what plans you have to ensure this and provide additional support. Is there an adult available to help when you can’t, a plan and meeting place for emergency evacuation, a time to visit an aging grandmother? Preparation decreases anxiety and will give your child a sense of control.

  7. Help your child put the situation in perspective, prioritize what he will need or find most helpful, and maintain normal routine as much as possible.

  8. Remain hopeful and optimistic. Be a good role model and show your child things to be grateful for. Monitor your child’s feelings and turn something bad into good as much as possible. Find ways for him to help out and to contribute. If aging or illness is involved, help your child visit, make a card or bake a cake.

  9. Teach your child how to calm his body, breathe properly for maximum stress reduction and give him tools for relaxation. Make sure to always take breaks from a difficult situation.

  10. If you or your child needs help, get professional support as soon as possible. You never have to carry this burden alone.