Leslie Cannold: Writer, Commentator, Ethicist, Researcher
ARTICLES

There is an art to breaking bad news to children

Last year, a girl at my son’s school primary school – let’s call her Susan – had a headache. The next day she collapsed and since then has been in a wheelchair from spinal damage caused by a benign tumour.

Susan and the other children were told that that she might not walk again. Not that she would not, but that she might not. Only gradually did it became clear to everyone – the little girl, her friends and the parent community – that walking was not on the cards.

Susan’s parents were clear and open about their family’s crisis. They posted a child-friendly explanation of what had happened to Susan, and follow up “chapters” of her story, in the school newsletter. They authorised teachers to talk about Susan in class. This gave permission for the children and everyone else to talk about what happened, express grief, ask questions and make plans to help.

But in couching Susan’s prognosis in possibilities rather than certainties, were the parents guilty of telling a white lie, or even a bald-faced one?

Absolutely not. The reality is that adults have trouble levelling with kids even – or perhaps especially – when the issue matters. A majority of parents of donor-conceived children never tell their children the truth about their conception As well, experts report chronic difficulties in convincing parents of children facing catastrophic illness – those who’ve been born with AIDS, or diagnosed with life-threatening cancer – to tell their children the truth about their condition and prognosis.

The reasons why include parents being in denial themselves, feeling guilty or ashamed, or simply being unsure what to say. But whatever the cause, parents put their children at risk by withholding such critical information because if the secret gets out – and most secrets do – the child may struggle to trust her parents or anyone else again. Parents also have no right to deny children critical information about their health and lives. They hold such information in trust, but it is the moral property of the child.

Of course telling, like lying, can be done badly or well. To tell well, parents must be sensitive to the child’s age, temperament and resilience.

By presenting their daughter’s diagnosis as a possibility instead of a certainty, Susan’s parents offered her and the rest of us the chance to explore the scariest of outcomes in a context that offered an emotional “out”. This “out” was one I saw my own son take a number of times. Briefly contemplating the wheelchair as a permanent fixture in Susan’s life, he would suddenly switch off, telling me that we didn’t have to think about this too much, because it might not happen. But as the months passed, I noticed he could meditate on the idea that Susan might not recover for longer and longer periods. This meant that when the final prognosis was laid bare, he and the other children were quick to accept it and to move on to discussions about helping Susan to return to school full-time.

So while it is true that honesty is the best policy, there is an art to breaking bad news. What Susan’s parents taught me is this when kids need to be told difficult things, adults need to speak plainly and openly, and to stage disclosures in ways that give the children time to process the information and move through the pain.

Publication History

There is an art to breaking bad news to children, Sunday Sun-Herald (Sydney)
20 Apr 2008

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