When a Child Is Diagnosed: A Psychologist's Advice

GOODHEART: It's helpful if the parents can keep their own fear under control and not speculate wildly. It's important to break it down into manageable moments and manageable pieces of information; "X-rays don't hurt, but you have to lie very still. Mommy will stay with you and hold your hand."

ABC NEWS: Cancer is a fatal illness. At what level does a child understand that, and how directly should that be addressed?

GOODHEART: Cancer is not always a fatal illness. It used to be two generations ago, but cancer is treated as a chronic disease now. And people, including children, can often live for very many years with cancer. The cure rates for some kinds of childhood cancer are now very high. So it's important not to assume it's a fatal disease.

ABC NEWS: But sometimes it is. How do you approach the subject of death with a child in those cases?

GOODHEART: There is a study which found parents have no regrets if they talk to their child about death ahead of time. But they did feel some regret if they did not talk to their dying child about death.

I think the main thing is to tell a child that there will be no more pain or fear or worry. Some parents feel like they cannot tell a child, and they will ask a doctor to do it. Sometimes, children understand that animals, plants, people, all are born, all die and the living is in between. The main thing is to comfort the child because there is a lot of fear of the unknown: that they will have no more pain, no more worry and the parents and the family will be with them.

What you can promise a child is that they'll be comfortable. It's important not to promise what you can't deliver. And it's also very important to allow the child to express his or her fears, because sometimes it's a very small concrete thing that you can do something about.

Some children as young as 9 make plans. They make a little will, or they want to give certain favored possessions to a brother or sister or friend. Sometimes children worry, what will happen to my family afterward? And one of the things a family can do is to say, you will always be part of our family. We will always be a family together.

I know one family that lost a child that celebrates that child's birthday every year. They always do a special event that's fun. And the family talked about this together and made those plans with the child, because that's what the child wanted.

ABC NEWS: How should the family handle the other children?

GOODHEART: When a child is dying, depending on the age of the other children, you want to include those children in any memorial planning. The siblings also need an opportunity to express their feelings and fear. The siblings will sometimes get angry that the sick child is getting attention and then they sometimes feel guilty about it. Depending on their temperament, different siblings will have different reactions. So you might have the child who feels he or she has to be very, very good all the time. Or you might have a child who seems quite callous. And that's because they can't bear to think about it.

It's also important to remember that there's no time limit to grief when a sibling is lost. And oftentimes people process it many years later. They process it over and over again, so the way they process it at 8 or 10 or 12 may not be the way they process it when they're 25.

ABC NEWS: Are there any mistakes a family in this situation can make?

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