When should children be told that a parent might die?

Many factors influence when a child needs to be told that his parent is probably going to die. The first depends on what a child has been told over time about the situation. Hopefully, the child has been given truthful information from the start about the nature of the parent's cancer and how it affects the family. Children need to be told the truth in manageable doses and given a chance to adjust to what they can understand while still going about their everyday lives. If you have now reached the point that you know you are going to die soon and your doctor has confirmed this, your children need to be told.

A good way to begin this discussion might be to ask your children what they understand about your illness and how they think things are going. Your children might already have an idea that things are worse than before. Children react to what they experience and see. If your condition has worsened, you are probably less able to take part in their normal activities, are more tired, depressed, or anxious, so they might sense that the treatment is not working well. But given the advances in managing the side effects of treatment, in some cases patients may not look as if they are dying. Children are also very concrete. One little boy, when asked if he worried about his dad dying, said that he knew this wouldn't happen because his dad's feeding tube was helping him eat. So don't assume that you know what is going on in your child's mind. You must ask.

Because a child's concept of time is so different from an adult's, your children may not cope well with many months of waiting for a parent to die. So talk to them gradually and only when you are certain that this will happen in the near future, as in days or weeks. Wait until you have the emotional energy to address the issue. If this seems impossible for you, talk to your spouse or other family members about who can best handle these discussions. Ideally your spouse or someone your children are close to and trust should have these discussions. If you cannot count on family members to help you with this, talk to your heath care team and ask for their help. Cancer care professionals have experience with families in all kinds of situations and are usually very willing to help or refer you to the outside help your family needs.