When a serious medical diagnosis comes into a family, children deserve to know. Silence is not golden. Discussing illness candidly and openly, in developmentally appropriate ways, teaches children that parents are trustworthy and that honesty is a family priority.

Parents diagnosed with serious health issues often put off sharing the news with their children because they think that keeping their kids in the dark will protect them. However, children will almost certainly figure out on their own that something is very wrong. In truth, this tends to increase their fear and anxiety.

When children are not told what’s happening, they are left alone with their fear and confusion. When this happens, children often imagine that things are far worse than reality or that they are somehow responsible.

Sharing news of a medical diagnosis is emotionally difficult. Despite the fact that I am a nurse, social worker and child development specialist, talking with our children was the hardest part of my cancer experience. But it needs to be done, and it can be done.

Here’s how to tackle this very difficult conversation, plus specific tips for helping children of different ages through this challenging time…


    • Bring notes. Prior to the conversation, jot down the key points you want to mention. Depending on the child’s age, these points might include the specific type of illness you have and the treatment you will be pursuing. Without notes, you might forget something important or give your child the impression that things are worse than they really are. This conversation could become emotional, and that’s OK.
    • Choose a time for the conversation that makes sense for your child. This timing needs to be when children are most awake and alert. Weekends are optimal because they give the child some time to process the news before going back to school.
    • Have the conversation at the child’s eye level, literally. This encourages conversation and engagement. It also is respectful. With a young child, it might mean sitting the child on your lap.
    • Open with a “warning shot.” This introductory sentence prepares the listener for the gravity of the conversation ahead.

Example: “I have some important news to tell you…”

  • Speak clearly, calmly and confidently. Our kids hear our mood as much as our words. If you are calm and confident during this conversation, it will help your kids feel calm and confident, too. Pause a few seconds between sentences to let important information sink in.
  • Be honest if the child asks if you’re going to die. If your ­illness is very treatable, you might respond by saying, “I don’t think so, and my doctors and I will do everything we can to prevent that from happening.” If the diagnosis is potentially life-­threatening, you might respond with, “I don’t know, but my doctors and I will do everything we can to prevent that.”
  • Do not promise that you won’t die. That sows doubt in the child’s mind about whether he/she is being told the whole truth and robs the child of his chance to come to terms with the possibility of your death.
  • Share your emotions with the child. If you’re sad, worried or angry, say so—it encourages your kids to be open about their feelings, too. Reassure your children that the family will get through this challenge together and that they will be kept informed.
  • Maintain a consistent schedule and normal discipline with your kids. Kids draw a sense of security and normalcy from consistency.
  • Head off kids’ common misunderstandings and fears. If your kids are younger than age 12, stress that they did not do anything to cause your illness and that there always will be family members to take care of them no matter what. Repeat these points during future conversations.
  • Encourage questions. Tell your child that he can ask questions or express his feelings about your illness at any time.


    • Toddlers (ages one to two): Toddlers cannot fully understand what it means to have a serious illness, but they are able to sense when something is wrong and deeply fear being separated from their parents.

What to do: Maintain a consistent environment with predictable ­caregivers. Provide comfort through touch, rocking and routine.

    • Preschool and kindergarten (ages three to six): Preschoolers can understand the seriousness of an illness, but they often engage in magical thinking and associative logic. They can imagine that waving a toy wand will cure their parent or that the disease was caused by something that they did or thought.

What to do: Use simple terms to explain that you are sick, but provide more detail than you would with a toddler. These details might include the specific name of the illness and where it is in your body. Stress that the illness is not a result of anything he did, nor is it a punishment for anything he might have done wrong. Ask the child to explain back to you the important points to make sure that he understands. Continue to maintain a consistent schedule with predictable caregivers.

    • Middle childhood (ages seven to 12): These children have the capacity for a deeper understanding of your illness, but they still might become confused by big words and complicated topics. They also might not admit when they don’t fully understand something you have told them.

What to do: The advice for ages three to six still applies, but add even more specifics—kids this age derive security from concrete facts. Provide details about your illness and treatments. Carefully explain all difficult words and concepts.

Write out schedules for upcoming days and weeks so that the child knows what to expect. You even might want to ask the child if he would like to meet your doctor, assuming that is OK with the doctor.

    • Adolescents (ages 13 to 18): Teenagers can understand the biological and psychological implications of a serious illness. They often are self-centered and might voice concerns or complaints about how the parent’s illness affects them rather than about the parent’s welfare. This could result in the teenager feeling guilty.

What to do: Provide the basics about your diagnosis and treatment, then ask the teen what he already knows about your illness and what he would like to know. Don’t force the conversation if the teen resists. Let him know that you are available to talk whenever he likes, but don’t be surprised if he prefers to talk with another adult, such as a trusted coach, teacher or relative.

If your teen wants to learn more about your disease, encourage him to do the research with you. There tends to be a great deal of inaccurate information on the Internet, and even accurate information might not apply to your specific situation. It is very important that your teen has accurate information.

Talking to Adult Kids

The news that a parent has a serious illness is likely to come as a huge emotional blow even to adult children. The adult child might want to drop everything and rush to the parent’s side—and might feel helpless or guilty if this is not feasible.

What to do: Consider waiting until you have details about your diagnosis, treatment plan and prognosis before sharing the news. That way, you can give the adult child a more complete picture of the situation, minimizing his fears as much as possible.

If an adult child who lives far away offers to drop everything to come help you, consider suggesting that he postpone such drastic action (unless your prognosis is extremely dire). Better that he save his vacation days and travel budget for times when you might need his help more, such as immediately following surgery.

If the child insists on helping, suggest specific forms of support that can be provided from afar, such as calling or Skyping you often or researching doctors or caregivers on your behalf.

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