Talking To a Child About Cancer Healthy & Natural Journal, Feb, 2001 by Lynnette Wilhardt By discussing cancer, children

can get a more accurate picture of the problem and perhaps resolve many of their imagined fears. According to the American Cancer Society, half of all men and one-third of all women will develop cancer during their lifetimes. Today, millions of people are living with cancer or have been cured of the disease. Therefore, it is highly probable that cancer will affect your family in some way. Would you know how to explain such a disease to your child? Some parents and caregivers try to avoid topics like cancer for fear they will only scare their children. The problem with this approach is that children are very smart and intuitive. If someone in the family is dealing with cancer and it's not being discussed openly, your child's fear and sadness will only increase. Knowledge is power How do you start this essential conversation? In my experience, a short science lesson about healthy cells and cancer cells is an important first step. The following information is accurate, non-threatening, and can be understood by children of all ages. Our bodies are made up of millions of cells. As the healthy cells grow, they multiply and divide in a somewhat uniform pattern. Some of these cells may be cancerous cells and may begin to grow in an abnormal way. When this cancer cell divides, it mutates and doesn't form this uniform pattern but instead grows into a blob, a mass, or a tumor, as it is sometimes called. Since they grow from our bodies, tumors are not always recognized as foreign and escape detection by our bodies' defense systems. When someone has a tumor growing inside of him or her and the tumor is cancerous, it needs to be removed. Sometimes, because of its location, it can't be cut out, so doctors use chemotherapy and/or radiation therapy to destroy it. Cancer tumors are made up of fastgrowing cells, and chemotherapy was made to kill all fast-growing cells. But we have other fastgrowing cells in our bodies that aren't cancer cells, such as our hair, fingernails and linings of our mouths and stomachs. When chemotherapy is used to kill the fast-growing cancer cells, it also kills the good fast-growing cells as well. Fortunately, the other fast-growing cells are smarter than the cancer cells, and even though they get damaged from the chemotherapy, they are able to repair themselves. That is why some people lose their hair during chemotherapy. Hair does grow back when the chemotherapy treatments are finished. Because chemotherapy is strong medicine, many people get very tired and sometimes become sick to their stomachs while taking it. They often need lots of rest.

Radiation therapy works differently. Radiation uses a very strong X-ray that helps destroy the cancer cells. Doctors target the X-ray beam so it only hits the cancer and won't hurt other parts of your body. Most people don't feel sick after having a radiation treatment, but they do feel tired. Talking about prevention Once you have explained the science of cancer, many children may ask: "But how did the person get cancer in the first place?" Although no one really knows how or why some people get cancer, researchers have found that there are some things you can do to help prevent getting cancer in the first place. Offer some healthy tips: * Don't ever smoke cigarettes. * Eat lots of fruits and vegetables. * Get regular exercise. Feelings about cancer Once you have addressed the science of the disease, it is equally important to help your children explore their feelings about cancer. Cancer is a scary word for most children. When a parent has cancer, children usually sense that something is wrong. They assume the condition is really bad when the adults won't talk about it. Their imagination is often worse than reality. If cancer is not explained to them, children may begin to believe that perhaps they caused the disease, it's contagious, or the person with the disease will die. By discussing cancer, children can get a more accurate picture of the problem and perhaps resolve many of their imagined fears. Young children Most children have many misconceptions regarding cancer and the treatment for this disease. Children of ages 4 to 7 will sense that something is wrong. However, they cannot cognitively express their feelings. They are more likely to act out these feelings through tantrums and tears. At this age, children often act as the barometer in the family. If they are dealing with sadness or anger, chances are the parents are too, but perhaps not as expressively. Since the children sense a problem and are acting out, avoiding the issue can make matters worse. When children of this age are given some knowledge regarding the situation, their feelings can be validated. They are often best at seeing the "silver lining" of such situations and will focus on how great it is to have mom or dad home more. A young child is very malleable and is not bothered by loss of hair and other physical changes. It is important to try to keep the daily routine as similar as possible, as this will assist young children in dealing with the stress that cancer puts on the entire family.

Older children Children of ages 8 to 12 are usually more cognitively aware of what cancer is and what may happen to their parent or family member. At this age, children are often dealing with feelings of sadness, fear and confusion that may cause them to become very clingy to the sick parent. They may feel that as long as they are near, the parent will be OK. They may experience intense anxiety over a day at school or a slumber party at a friend's house. At this age, children need more detailed information regarding a cancer diagnosis. They also need their feelings discussed thoroughly and repeatedly. It may be difficult for a child of this age to understand what he or she is feeling. Parents should help interpret the child's actions. A reassuring phrase often helps: "I understand that going to school is difficult because you worry something might happen to me. You can call me at your recess and check in with me." In this way, the child's feelings are validated. Angry adolescents Adolescents of ages 13 to 18 usually have a great sense of anger regarding a cancer diagnosis. They are often angry and embarrassed about the entire situation. It is imperative that children of this age are given accurate information regarding the diagnosis and prognosis. Adolescents often need their feelings interpreted as well. A parent should sit with the child and empathetically validate his or her feelings of anger. Discuss how the disease has changed your lives. The parents must be careful to not put too many extra responsibilities on the adolescent and appreciate that older children need time with their peers. Open communication If a cancer diagnosis is affecting your family, it is imperative that parents thoroughly explore their own feelings and seek therapeutic help if necessary. Feelings that are not worked out within the parent will bubble up in the children, and they will act them out for the parent. If parents have dealt with their issues and feelings, they can more easily recognize and help their children with similar feelings. Lynnette Wilthardt, L.C.S.W., M.S.W, is a licensed clinical social worker in private practice in Costa Mesa, Calif. She specializes in working with adults, children and families who are dealing with the psychosocial issues regarding cancer and its treatment.