Sharing Difficult News with Children HF#7280

No matter how much you want to protect your child, sometimes he needs to hear difficult news.  News like this can be life changing.  The way your child learns this kind of news affects how he learns to adjust and cope with it.  There is no one way to share this kind of news with a child.  You know your child best.  With this handout and our support you will be gently guided to share this news.

 

This handout offers ideas about how to share difficult news with children based on age.  The younger your child is the fewer the details you need to share.  You may find it helpful to read this and think about what you might want to share before you talk to your child.

 

Common Questions

 

Am I the best person to share difficult news with my child?

You have a role in helping your child cope with hard times in his life.  You are the expert on your child.  Members of your child’s health care team will work with you and support you as difficult news is shared with him. 

 

Isn’t it better to protect my child by not sharing difficult news?  Why should I make my child feel sad?

A parent’s first instinct is to protect the child’s feelings.  We feel it is best to be open and honest with your child about the news.  Here are some ideas that might help you.

 

Children. . .

• Are strong and resilient.  
• Want you to be honest and direct; honesty and directness form the basis of hope.
• Want to know how the news affects them.  
• Don’t want you to downplay the news.

 

Isn’t it best to hold off sharing difficult news? 

• It is best not to try to keep the news a secret.  
• Your child may worry more about what is not being said than about the truth.  
• If you wait too long to share the news, your child might hear it from someone else first.  
• Waiting to share difficult news until your child asks can be a problem.  Some children may never bring it up.

 
But won’t waiting help me hide my sad feelings from my child?

• Most children cope best if they learn difficult news close to the same time as the rest of the family.  
• If you are worried that your sadness will scare your child, explain that feelings and tears are a normal part of talking about this kind of news. 
• Let your child know you will be ok.  
• Letting your child see your sad feelings will not harm him.  
• Sharing feelings can bring you closer.  
• You can model sharing feelings in a healthy way.  This can help your child feel safe doing the same with you.  
• Teach your child to find words for his feelings.  This will help him learn to describe these feelings to others.
• If you are too upset to keep talking, take a break and let your child know you will talk more later.

 

What might my child ask me?

This is a list of some of the more common questions children ask.  If you don’t know the answer to a question, it is ok to say “I don’t know.” 

 

• Can I catch it?
• Will someone die?
• Does it run in our family?
• What is going to happen to me?
• Is it going to hurt?
• Did someone do something bad to cause this?
• Is the sick person being punished?
• Am I being punished?

 

Some things to think about as you get ready to share difficult news

• Who else do I want with me?  Examples are:  other family, family friend, doctors, nurses, psychologists, social workers, chaplains, and child life specialists.
• Where do I want to share the news?  Examples are: a quiet place where your child feels safe and has favorite things nearby.
• When do I share the news?  Choose a time when you won’t be disturbed and there won’t be a major event later that day.

How do I prepare my child to hear difficult news?

• Start by saying to your child in a calm voice “I have some difficult news to share with you.”  This will avoid catching him off guard.
• Ask your child what he knows already.  He might have some ideas that are not correct or he may know more than you think.
• Pace the news by making a few key points and then check to see if your child understands or has questions.

 

Some things to keep in mind as you share difficult news

• Be loving and give comfort.
• Be honest and share your feelings.
• Share the news with your child in as much detail as you think he can take in.
• Make eye contact. 
• Explain that it’s not your child’s fault.
• Listen to your child and accept his feelings no matter what they are.
• Give your child a chance to ask questions any time.
• Help your child think of other trusted adults he can talk to.
• Praise your child for having the talk with you.

 

Be ready for any response.  There is no right or wrong way for your child to behave.

Your child may react to difficult news with 

• Anger
• Frustration
• Fear of the future
• Helplessness
• Confusion
• Tantrums
• Acting younger than his age
• Changes in eating or sleeping habits
• Bad dreams
• Physical complaints (stomach ache etc.)
• Shock
• Denial
• Sadness
• Embarrassment
• Guilt

 

Does my child’s age matter?

How you share the news depends a lot on your child’s age and her own needs.

Here are some ideas based on age.

 

For Children 0 to 18 months

While a baby doesn’t understand news the way an older child does, you can still help her when her routine is changed by sickness or being away from her parents.

• Keep the number of caregivers small so they get to know your baby and she feels safe with them.
• Stay in touch with caregivers so they know of day to day changes.
• Try to keep your baby’s routine and surroundings from changing.  If you need to be away from her, leaving a recording of your voice, a picture or other object may comfort her. 

 

For Children 18 months to 3 years

• Explain the news so your child learns how it will affect her.
• Keep the number of caregivers small and known to your child.  It will help when you can’t be with her.
• Give your child choices when possible.  
• Keep your child’s routine the same.  If it needs to change, tell her in a way she can understand.
• Give your child lots of time to play and practice new skills such as medical play.

 

For Children 3 to 6 years

• Explain the news in an honest and simple way.
• Have your child tell you what she knows.
• Stay with your child as much as you can. 
• Keep your child’s routine the same from day to day.
• Give your child lots of time to play.
• When you can, tell your child about treatments and changes ahead of time. 
• A toy, blanket, pillow or picture may help when you need to be away from your child.
• It helps your child when you stick with the limits and rules you used before. 
• Share the news with teachers and other adults in your child’s life and tell her that these adults know.

 

For Children 7 to 12 years

• Be honest and give your child concrete details.
• Keep your child’s life as normal as you can.
• Give your child praise and support.
• Help your child stay in touch with friends and things she likes to do.
• Share your feelings with your child and talk about her feelings.
• Demonstrate and share ideas for helping your child cope with stress (music, quiet time, breathing, etc.)
• If it is a sibling who is sick, give your healthy child a few extra tasks, but not too many.  Thank her for helping and tell her you are proud that she cares.
• Offer to talk with your child’s friends and their parents.  
• Tell your child the difficult news is not her fault.  
• Explain what will happen in treatments and how they might make your child feel.
• Share the news with teachers and other adults in your child’s life and tell her that these adults know.

 

For Children 12 to 18 years

• Show respect and give your child space and privacy.
• Give your child as much control as you can.
• If it is a sibling who is sick, help your healthy child balance time with her sibling and time with her friends.  Give her some extra tasks at home, but not too many.
• Try to talk when you won’t be disturbed and when there is not a major event coming later that day.
• Involve your child in making choices.
• Find ways to let your child be herself.
• Share the news with teachers and other adults in your child’s life and let her know that they know.

 

For Children of all ages

• Children might react to difficult news in ways that don’t make sense to adults.
• Children need to deal with the news at their own pace.
• Watch for cues that your child may be ready to talk some more.  At first, she may act like nothing happened and go back to playing.  This is common and normal.  
• Your child is watching you for cues, too.  Let her know you are there to help any time she is ready to talk or has a question.

 

What Should I Keep in Mind After I’ve shared the News?

• Expect questions as your child re-thinks the news.  New questions can come up as she grows and matures.
• Be there for your child.  Give her lots of love and support.
• Your child may worry that talking about the news makes you sad.  Help her to see it is healthy to talk about feelings and ask questions.
• A healthy sibling may feel guilty or like she did something to cause the sickness.  Your child may act out if she has trouble talking about it, or is too young to know how to share those feelings.
• Be open to asking for help.  There are many people who can support you and your child in the hospital or at home.  Examples are: Psychologists, therapists, social workers, chaplains, nurses, doctors, child life specialists, teachers and counselors.  There are also many books and other resources that can help you and your child.
• Keep life as normal as you can.  
• Let your child have fun without feeling guilty.
• Help your child figure out people she can turn to for support.
• Be ready to repeat things you have talked about as your child takes the news in and works through her feelings. 
• Tell your child when things change.  Keep her up to date.  
• Ask your child often if there is anything she wants to talk about or to ask you.

 

How Can I Tell if My Child Needs More Help?

Sometime it’s hard to know what is normal and what is not.  Every family and every child is different.  Here are some signs that your child may need some extra help from you or a professional.

• The normal ways you support your child aren’t working.
• Your child’s mood or actions are getting in the way of life at school, home or with friends.
• You see changes in your child’s sleep or eating habits.
• Your child’s grades are slipping. 
• Your child avoids school.
• Your child doesn’t want to do things she used to enjoy.
• Your child stays quieter, sadder, more anxious, or fearful.
• Your child keeps complaining of sickness or pain (examples are:  stomach aches, headaches, tiredness).
• Your child begins making choices that reflect poor judgment (examples are: not following typical rules, significant negative changes in behavior, using drugs or alcohol).
• You are worried your child will hurt herself.
  

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 11/02/2011

Copyright © 11/02/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7280

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