How to Talk to Kids About Your (or Another Loved One’s) Serious Illness

There’s no easy way to tell anyone that you or a loved one is dealing with a serious illness — but especially not your kids. Breaking the news can be an emotional roller coaster, and there are no absolute right or wrong ways to do it. Like so much of life and parenting, you just do the best you can.

“Illnesses like cancer are scary, and it’s scary to talk about bad things, especially when there are so many unknowns about it,” recognizes child psychologist Kate Eshleman, PsyD. “As an adult, you don’t always know what you’re dealing with, which can make it more difficult to speak to children about it.”

Dr. Eshleman shares some strategies that can help you explain this tough topic — and keep the lines of communication open.

Plan the first conversation

First, it’s important to give yourself some time between learning the news yourself and sharing it with your kids. Allow yourself to process the news and get a handle on it before talking to your children.

Other things to consider:

• Seek moral and emotional support. Ask your spouse, partner or another trusted family member to be part of the first conversation.
• Get on the same page as your partner, if you have one. Make sure you both agree about how much you’ll reveal in this first conversation. Go over the topics you’ll cover, like how treatment will affect you physically and how it may change what you’ll be able to do day to day.
• Take your time. You might feel tempted to get the initial conversation out of the way quickly, but be sure to leave ample time for it — and for your kids’ questions. Don’t break the news right before rushing to another commitment or bedtime.

How to break the news of your diagnosis

There’s no correct way to tell your children that you or someone else in their life has a serious illness, but try to trust yourself. You know your kids best and what they can handle, so let your instincts be your main guide.

So, where should you begin?

“In general, it’s always important to give information truthfully and in a developmentally appropriate way,” Dr. Eshleman says.

• Ask kids what they know about the illness. This will give you a baseline of their knowledge level and any misconceptions.
• Be honest. “Kids can often tell when adults are lying or withholding, which can make their fears worse,” Dr. Eshleman warns.
• Give age-appropriate explanations. Use straightforward language that your kids can understand.
• Consider your child’s personality. Tailor the discussion to their temperament and conversational style.
• Talk about expectations. Tell kids what may happen, both in terms of how their loved one looks and acts (“Mommy will lose her hair”) and how it will affect their life and routine (“Grandma won’t be able to pick you up from school anymore.”)
• Answer their questions. Give kids a chance to ask questions. If they ask something you’re not sure about, it’s OK to say that you don’t know — and that you’ll find out.
• Show that you’re coping. When you demonstrate your own coping skills, you reassure kids that they can cope, too.
• Share your own emotions. Don’t feel like you have to hide your own fear or sadness. Displaying your own coping mechanisms helps model healthy emotional regulation skills for kids.

Dr. Eshleman delves deeper into each of these tips for talking to your kids about a loved one’s serious health diagnosis.

Ask them what they know

This might seem like an unexpected first step, but before you break the news about a serious illness, ask kids what they know about that illness, in general — even if you expect them not to know anything about it.

“As adults, a lot of times, we under-assume what children are aware of,” Dr. Eshleman says, “but kids often know more than we expect.”

She suggests asking them what they know about the illness, which can help provide a starting point for the conversation and clues you in to any understanding and misconceptions they may have.

You can simply start with, “Have you ever heard of cancer?” If they say yes, ask what they know. If they say no, then you can start explaining.

Be honest

When you’re talking to your kids about anything, but especially something as weighty as being diagnosed with a serious illness, one of your main goals should be to maintain their trust.

“In order to do that, you have to be able to tell them the truth,” Dr. Eshleman states. “Kids are smarter and pick up on more than we sometimes assume.”

No matter their age, kids can sense when something’s wrong and when you’re not telling them the truth, which can make their fears worse. So when you tell your children that you or another loved one is dealing with a serious illness, it’s important to be honest and direct — even when you wish you could shield them from the truth.

Give age-appropriate explanations

Children of different ages react differently to the news of a serious health diagnosis. And being honest with them doesn’t necessarily mean giving them every single painful detail.

“When you’re communicating with your kids, it’s important to be mindful of the language you use,” Dr. Eshleman encourages.

• Keep your explanations simple, short and honest. “You want to give them the information they need to know in a way that they can understand, depending on their age and functioning,” she says.
• Don’t be afraid to use the name of the illness. “We tend to describe illness as ‘being sick,’ but then kids worry that they could get sick, too,” Dr. Eshleman notes. “I encourage naming the specific illness, whether that’s a specific term or a broad one — for example, leukemia or osteosarcoma specifically, or cancer more generally. Then, provide reassurance that the child cannot catch it.”
• Use accurate words. Start introducing terms related to the illness (e.g., surgery, chemotherapy, dialysis) so that they become a part of your kids’ overall understanding of their loved one’s illness and treatment.

Consider your child’s personality

Age isn’t the only factor when determining how you have this important discussion. Their temperament and general personality play a role, too.

“Some kids will want a lot of information, while other kids will be very uncomfortable and just need to know the basics,” Dr. Eshleman says. “Think about who your child is and how they typically cope best. Then use that information to frame your conversation.”

Different kids, of course, have very different personalities — and very different coping skills. You may need to have separate conversations with your kids, each targeted to individual needs and levels of understanding.

Talk about expectations

As you share the news, begin to discuss the changes to come.

“Start telling them what they can expect and what plans are in place for coping with that,” Dr. Eshleman advises. “Explain, for example, that Mommy is going to lose her hair, then problem-solve around that: She will start wearing a wig, or We’re going to go buy some new hats.”

You might want to explain changes, too, like that their loved one might:

• Look or sound different (like after a stroke)
• Be extra tired while they’re going through treatment or dealing with side effects of their illness
• Not be able to go places or play with them as much
• Need to use medical equipment that they’re not used to seeing, like a wheelchair or an oxygen tank
• Have scars or bandages

Talk, too, about some of the ways their loved one’s illness may impact their life. Kids thrive on routine, and nothing upends everyday routines like a serious health diagnosis can.

“It’s possible that each and every aspect of a child’s day-to-day life could shift,” Dr. Eshleman says. “Explain that there will be appointments that might affect them — that sometimes, Grandma will pick them up from school instead of Daddy, or that they might spend the night with their cousins more often.”

Answer their questions, if you can

Not all kids will have questions, at least not right away. But depending on your child’s personality and coping style, they may want to know more about your illness and what comes next.

“By answering their questions, you make them feel safe and comfortable to continue asking questions,” Dr. Eshleman explains. “This helps maintain open lines of communication.”

Common questions a child might have

You child might have questions like:

• “Can I catch it?” Kids may need assurance that serious illnesses aren't contagious, the way that colds and the flu are.
• “Did I cause it?” Young children may blur the boundary between imagination and reality, leading them to believe they’re somehow responsible for a loved one’s illness. Reassure them that nothing they did played a part.
• “Who will take care of me?” Kids want to know that they’ll be safe. When one of their primary caregivers is sick, they may worry that no one will be available to care for them. “Provide reassurance that there are a lot of people here to help as your family goes through this process,” Dr. Eshleman suggests.

If your child asks questions that you don’t have the answer to, it’s OK to say so.

“You don’t have to have all the answers at the start of the conversation,” Dr. Eshleman says. “You can say that you’ll talk to your doctor and find out for both of you.”

Show them how you’re coping

Guide the conversation as much as you can. When you present the news in a calm, reassuring voice, you show your children that you’re coping — which helps them do the same.

“What impacts you is going to impact your child,” Dr. Eshleman says. Try to be mindful of your own reactions to this new diagnosis and the stress it’s putting on you. You’re there to inform and support your children, so you want to do your best to stay in control.

Share your own emotions

Staying in control doesn’t mean that you have to suppress all of your feelings. Dr. Eshleman encourages you to be yourself — and that may mean showing your emotions.

“Expressing emotion and modeling how to cope with those emotions gives children permission and space to do the same,” she continues. “It tells them it’s OK to be angry, sad or worried, and it opens up conversations about how to deal with that.”

Sharing your own feelings can reinforce that you’re all in this together. Plus, Dr. Eshleman says that trying to hide your emotions will only make you feel — and appear — more stressed, which can make the conversation more difficult.

How to help your child cope

You’ve had the initial conversation. Now what? Dr. Eshleman shares additional tips about how to be there for your child afterward and in an ongoing way.

Keep communicating about it

Kids might have a hard time processing or understanding the news the first time they hear it. They may also need to ask the same questions over and over again.

“Think of your first conversation as one in a series,” Dr. Eshleman recommends. “Learning together as you go creates continued space for discussion.

On the other hand, don’t force conversations that your child doesn’t seem to want to have.

“It’s important to remember that each person, children and adults included, copes differently,” she adds. “Some people benefit from talking, but not everyone wants that. Look for other opportunities to promote the act of coping that don’t involve conversation.”

Explain any changes in their routine

During your first conversation with your child, you set expectations about possible changes in their routine. But when their routines are actually about to change, be sure to discuss the details so kids know what to expect in real time.

Explicitly explain, for example, “Starting next week, you’re going to take the bus home after school.” Or “You and your sister are going to go to the neighbors’ house for a playdate tomorrow so your dad and I can go to his doctor’s appointment.”

Try to maintain kids’ routines as much as possible. But also help your child develop flexibility and coping skills by communicating on an ongoing basis.

Involve your child in the process

Kids don’t know what’s happening when you’re at appointments or in the hospital. All they know is that you’re not there to pick them up from school or tuck them into bed.

“Helping them understand what’s going on during these periods of time can make it feel less mysterious to them,” Dr. Eshleman says.

With your provider’s permission, she suggests considering sharing photos of clinic visits or doing a video chat from the waiting room. It may also be appropriate for your child to visit their loved one in the hospital or be involved in other aspects of treatment.

“This helps them to better understand what’s going on when their loved one isn’t at home,” Dr. Eshleman says.

Provide opportunities for play

Just like adults, children need breaks from stress and other painful emotions. Play can be a wonderful opportunity for this type of pause.

It can also be a chance to better understand how they’re coping. Many children express and work through their feelings while playing. This means that oftentimes, their play can reveal their fears or misconceptions about what’s going on.

It’s important for caregivers to watch and listen for issues or feelings that appear during play so you can help address them.

Seek support from others

Your family doesn’t have to go through this experience alone. Other adults who play important roles in your children’s lives can also help them cope.

“Oftentimes, parents feel like this is a private issue that the family needs to address independently,” Dr. Eshleman understands, “but there are a lot of people who can help support your child through this experience.”

She recommends communicating with teachers and other school personnel, like coaches or tutors. “When they know what’s going on, they can keep an eye on how your child is coping and continue to support them.”

Consider sharing the news with the parents of your child’s friends, too. They may be willing to add your child to their afterschool pickup route, squeeze in an extra playdate or host an occasional sleepover to help give you the time you need to cope, as well.

Remember: You don’t have to be perfect

“There’s no handbook for how to communicate with your kids in this type of unknown situation,” Dr. Eshleman stresses, “so try to reduce the pressure to do it perfectly.”

You’re going through something big and scary. It’s understandable that you don’t know exactly how to talk to your kids about it. But give yourself — and them — some credit.

“Children tend to be very resilient, especially if we can support their coping along the way,” she encourages. “They may do much better with it than you think.”