Children are in an innocent period of their lives. For most people, having to tell their child they have cancer is not an issue. Approximately 1 in 330 Americans will be diagnosed with cancer by the age of twenty. For many of these, it falls to the child's parents to explain what cancer is and help them know what to expect.
Disclaimer: I am not a medical doctor. I have my Bachelor of Science degree in Psychology but it is not enough for me to practice in the field. I have faced a cancer diagnosis and being told as a child. However, do not take my experience as if I were a doctor. This is written in part based on my own ideas and I am sharing my experience to hopefully help others.
My parents were one of the couples who had to tell their child she had cancer in 1986. I was nine years old and believed old men who smoke were exclusively the ones to be diagnosed with cancer-as my grandfather died seven months before I was born due to colon cancer and he was a smoker.
The way I learned I had cancer was rather brutal. My parents planned to wait until we went to St. Jude Children's Research Hospital and seek help from professionals there to tell me I had cancer. One night, while I remained in the hospital, my best friend from the fourth grade called and asked me if I had cancer.
The reason she knew is my reading teacher at school decided to tell the entire class about my cancer before my parents could tell me. I grew angry with my friend and claimed I did not have it. She believed I was telling the truth and at the time I believed it as well. I asked my mom and grew slightly more confused.
For my mom's benefit, she did an amazing job trying to explain the cancer to me. I had a tumor so she said I did have cancer but it was gone and I no longer had it. The word tumor and cancer were separate in my opinion. When I returned to the fourth grade after a month's absence from school, one boy in the reading class asked if I had cancer. I said I didn't even though I knew the removed tumor was related to cancer. We went to St. Jude Children's Research hospital within a week of my diagnosis. I saw children all over the hospital with bald heads and in wheelchairs. I asked my mom and she said they had cancer. I was at the same hospital and it clicked-I did have it or something close to it.
It took until I reached Piaget's formal operational period of developmentto fully connect the word tumor to cancer. When someone is in the formal operational period he or she can understand the abstract thought it takes to understand cancer. This stage usually begins about the time a person is 12 years old.
I was in the concrete operational periodof development(ages 7-11) when diagnosed and knew I had a tumor (concrete evidence) but cancer was abstract and something I could not understand. My parents did an amazing job but the complete link to what happened did not click with me until ninth grade health class when we learned what benign and malignant meant. Between the ages of 9 and 14, I became aware of abstractions such as cancer. It is my opinion a child in that period should have more revealed as they grow better able to understand what happened.
Working backward, children who are in Piaget's preoperational period of development (ages 2-7 years)present a difficult challenge when it comes to explaining cancer. Children in this stage of development absolutely need psychological help in understanding what is happening to them. Most hospitals will show the child doctor masks and other things that will be used in medical procedures to try to reduce fear but children of this age have their own thoughts. A little girl I knew during my recurrence was seven years old and she ceased speaking while going through therapy. The best option is to seek psychological help for the child, be open to talk about what the child is going through. As difficult as it is, do not show too much sad emotion. Emotion is a delicate balance in these cases. While working at the St. Jude professional oncology education program, we were finding childhood cancer survivors diagnosed in this age period were especially prone to repressing their feelings. Much of this repression comes from wanting to be a "big girl" or a "big boy." Make sure your child knows they are a big boy or big girl whether they cry or not. Tell your child grownups cry while going through cancer. As difficult as it may be, you have to be their rock.
Piaget's sensorimotor period of development occurs when a child is a newborn until about the age of two years. When facing cancer with a child of this age, it is important to verbally tell them what is happening (they understand more than you think) but the nonverbal actions are most important. Nonverbal actions, such as plain old love and comfort, are the only ways available to comfort a preverbal child. Rest in the assurance of knowing if your child has cancer and is in this age group, he or she will not remember the experience.