Click here to watch the accompanying video clip of Dr. Cline using these tips to talk with a teenager who is discouraged about living with cystic fibrosis.   

What Should I Say?! How to Talk with Your Kids about Difficult Issues

by Lisa Greene and Foster Cline, MD

I asked the doctors, “So how do I talk to my children about their illness? What do I tell them when they ask questions about how long they’ll live?” And they said, “Treat it just like when kids ask questions about sex- answer them on a ‘need-to-know basis’.” “Okay,” I thought, “I can do that.” I figured that my kids are young so I’ll have plenty of time to figure it out.

But then, as we were driving down the road one day, a question came out of the blue: “Mommy, how does the daddy seed get into the mommy’s tummy to make the baby?” I stuttered and swerved and mumbled something about needing to pay attention to the road so I’d have to get back to them on that. I thought, “A need to know basis??! What does a four- and six-year-old need to know about that?” And that’s when I realized I didn’t know how to talk to them about sex anymore than I knew how to tell them that the disease they were born with, cystic fibrosis, has a life expectancy of 37 years of age.

Parenting is tough enough at times for just about every parent. Parents sometimes need to talk with children, or answer their questions, about difficult issues like divorce, the death of a loved one or the loss of a parent's job and lifestyle change. But the situation can be even more difficult when a child has a serious health issue. What do you say to a child who struggles with life-threatening allergies, cancer, cystic fibrosis or diabetes? What do you do when parenting is truly a matter of life and death? 

Parents must navigate a complex maze of medical information and cope with children who may be resistant, confused, or frightened. There are many difficult-to-answer questions that a child may ask: “Will my disease kill me?” or “Will it hurt when I go to the doctor?” or “What will happen if I don’t take my medication?” Unprepared parents may find themselves at a complete loss. Here are some tips to help you become more prepared for these challenging moments.  

Teach your children early on about their medical condition and be honest about the consequences of non-adherence. One of the most challenging things for parents is to have a difficult discussion about life-threatening content in a matter-of-fact manner.

The key is to show curiosity and interest while outlining the consequences (of non-adherence). Do your best not to show fear and angst about the issue. Generally speaking, if parents don’t show fear and angst, then the child is less likely to become fearful. Children pick up on our cues and young children tend to mirror them almost exactly. If you are having trouble controlling your own emotions about these tough issues, grief counseling might be helpful.   

Oftentimes, we just don't know how to handle these issues with our kids. So when you don't know what to say, do what therapists do: be curious and ask questions. Then your kids end up guiding you!  If that method is good enough for therapists, it's good enough for parents! Some good questions to ask are: 

      - “How much do you know about your illness?” 

     - “How worried are you?” 

     - “How are you handling it?”

     - “What can I do to make things easier?”

     - “Is there anything more you need to know?” 

Obviously, we would explain things differently to a three-year-old than to a seven-year-old. Concrete examples, word pictures and drawings are important communication tools for explaining things to young children. Condition-specific children’s books that are geared to your child's age can be very helpful. 

Ideally, children should be fully aware of the details of his or her illness by around the age of eight. This might sound a little young to some of you, but when children go to school, we lose control of the information they will be getting. It is not uncommon for a child to come home from school upset saying, "Susie said I'm gonna die from CF. Is that true?" It's better that parents "break the news" about these types of issues than children hearing it from their insensitive peers.   

Here are some guidelines to follow when discussing difficult issues with your children: 

- Before you give answers, ask yourself whose needs are you addressing - yours or your child’s?
- Consider whether you are giving more information than the child wants or needs to hear.  
- Be open to your children talking with you about anything and everything.  
- When you are not sure how to give the answer, ask more questions.  
- Recognize that sometimes your child is trying to protect you.
- Show acceptance even when you can’t show approval. 
- Every answer dealing with life-and-death issues should leave room for hope. 

An example of a discussion using some of these guidelines might be something along the lines of:

“Darling, God gives us a gift by not letting us know exactly how long our life on earth is. But one thing is for sure: some people pack years of experience into a shorter life, and some have a pretty vacant and hollow longer life. I guess what is important is not how big the bowl is but how much ice cream is in it! Your years could be shortened some because of your illness. On the other hand, lots of folks with illness live a nearly normal life span. But how important is that really? The thing that makes my heart sing is knowing that however long our lives are, our family packs it full of good experiences and gifts to others.” 

Set the example for healthy habits and a positive attitude. Kids learn from our modeling. It’s never too early to start teaching good health habits. Wise parents cheerfully model the behavior they want their child to learn: “Here’s some cereal for you. Let’s check if there are any peanuts in it. Nope! That’s good. Peanuts can make you very, very sick. This is a no-peanut zone!” Remember, toddlers can understand what you say long before they can talk clearly. And when we model a positive, hopeful, can-do attitude even in the face of the challenges we face, then it's more likely our kids will grow up with the same attitude.

In summary, what we say depends on the age of the child, the ease of the parent in dealing in a matter-of-fact way with reality laced with hope, and upon the parent’s religious beliefs.  

Dr. Cline answered my questions about talking with my kids about their illness so well that I figured maybe he had some ideas about how to talk with them about sex, too. And here’s what he said…

“When your kids ask how the daddy seed gets into mommy’s tummy, try answering with something like this: ‘It's a special thing that they need to help each other with because the seeds are really small so it's hard to get them inside.’”  

Dr. Cline said that the key is to be really general and see how specific the kid is. Does he keep asking for clarification or will the above (or something like it) do the trick? As children get older (but aren’t quite yet ready for The Talk), you can fill in the details by saying something like: ‘He uses the part of his body where the pee comes out. The seeds come out of that and then they spill into the mom. But that can't happen until a person is a lot older than you so don't spend your time looking for seeds!’” 

Dr. Cline adds this thought: "And if we’re really lucky, Mother Nature will help us along and we can say: ‘Oh, look at those dogs! The seeds are being popped out of the boy dog and into the girl dog. Pretty slick the way that works..."  

Of course, that might start up a whole new round of tricky questions. Isn’t parenting fun?    
 
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From the book “Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Special Healthcare Needs” by Foster W. Cline, M.D and Lisa C. Greene.

Dr. Cline is a child psychiatrist, author, and co-founder of Love and Logic. Lisa is the mother of two children with cystic fibrosis and a parent coach. For free audio, articles and other resources, visit www.ParentingChildrenWithHealthIssues.com.
 
Copyright 2008 by Foster Cline MD and Lisa Greene. All rights reserved. 

The information published on this website or in any connected material is the opinion of Lisa C. Greene dba Happy Heart Families only and is not meant to replace professional medical or mental health care. Persons should always seek the advice of a medical professional when making decisions about personal healthcare or treatment.