Talking to Kids About Cancer: Tips from Dr. Kate Eshleman

Podcast Transcript

Intro:
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Molly Shroades:
Hi, and thanks for joining us for this episode of The Health Essentials Podcast. My name is Molly Shroades and I'll be your host. When a friend or family member is diagnosed with cancer it can be a lot to process. Many thoughts and feelings will be going through your head and your heart. But how do you talk about this with kids? Child psychologist, Kate Eshleman is joining us today to help give us some good tips and ways to have this conversation about cancer with kids. Thank you so much for joining us today, Dr. Eshleman.

Dr. Eshleman:
Thank you for having me.

Molly Shroades:
So starting off, can you just tell us the types of patients you see and what brings them in your door?

Dr. Eshleman:
Sure. So I'm a pediatric psychologist, which means I primarily work with children, adolescents, young adults and their families that have a medical diagnosis. And I'm the psychologist for our peds hematology, oncology, and BMT department.

Molly Shroades:
So diving right into this topic, why is it so hard to talk about cancer and especially why is it so hard to have this conversation with kids?

Dr. Eshleman:
I think there are a couple of reasons that make it so difficult. Cancer's a scary word. And historically cancer often had bad outcomes. And so it's scary to talk about bad things. I think a lot of times too, there's a lot of unknowns about it. You know, the adults don't know what we're dealing with and when we don't know that makes it more difficult to speak the children about it.

Molly Shroades:
Absolutely. Absolutely. So can you suggest a few ways that someone can start this conversation with kids?

Dr. Eshleman:
Yeah. I think it's always good to ask the kids what they know. I think a lot of times as adults, we kind of under assume what children may be aware of. So asking them what they know about cancer, if they've ever known anyone with cancer and kind of starting the conversation with where they're at.

In general, it's always important to give information truthfully and in a developmentally appropriate way. So when we have these conversations, one of the main goals is to be able to maintain the children's trust. And so in order to do that, you have to be able to tell them the truth. Now developmentally appropriate way will depend based on the child's age and or functioning. So giving them the information that they need to know in a way that they can understand.

Molly Shroades:
Now does the way you talk to a child about this diagnosis change depending on who is dealing with the diagnosis?

Dr. Eshleman:
Sure. I think we definitely, again, want to take the kids age into consideration, but also their temperament style. So some kids like a lot of information. Some kids are very uncomfortable and just need to know the basics. And so part of that'll be knowing your child and how he or she copes best. And then being able to kind of frame your conversation with that information. It's also important to know that different kids in the same family cope differently. So you may have one conversation with one child and a very different conversation with another child.

Molly Shroades:
You know, that leads me into wondering about detail. How detailed should you be? And I have a feeling this might vary depending on the kid you're talking to.

Dr. Eshleman:
It does. It varies very much depending on the child. So again, if it's a child that seeks a lot of information or asks a lot of questions, we certainly want to ask any questions that they pose. Because we want to maintain those open lines of communication. And so by answering those questions, we make them feel safe and comfortable to continue asking questions. I would read your child's cues if you're giving them information and they're starting to kind of phase out, they're more interested in video games or getting back to their homework, then it's time to stop. So I'd watch the child and his cues that will lead you in terms of how much detail to give.

Molly Shroades:
Wonderful. So I'm wondering about how much emotion you should show during this conversation. It's obviously a very hard thing to talk about for many people. Should you cry? Should you show emotion or should you try to keep a calm exterior? What's kind of a suggested idea there?

Dr. Eshleman:
Sure. I think in general you should cope with it in the way that you would otherwise. I think it's very appropriate to show kids expression of emotion and then ideally we're modeling good coping with that emotion. I think by showing our own emotion it gives the children permission and space. It tells them it's okay to feel angry or to feel sad or to feel worried. And then kind of open that conversation about how we're going to deal with that. So it is appropriate. I think the idea too, of trying to contain yourself increases the parent's stress, which is going to make that conversation even more difficult.

Molly Shroades:
Can we talk for a moment about how to have the conversation if it's your child that has been diagnosed with cancer? How is that conversation different? What should you work into that?

Dr. Eshleman:
Sure. And in reality, it's actually not that different. Again, we want to be, you know, the main point here is to be truthful. Kids are smarter and know more and pick up on more than we sometimes assume. And if a child has had symptoms or has been ill, if he or she's been taken to the doctor for multiple appointments, or if they're going to be missing school, they pick up on those things and they know that something is wrong. So we want to be truthful with them about what's going on.

So again, giving that information in a truthful and developmentally appropriate way, asking what questions they have and being able to seek out that information together is a great approach for talking with a child who's been diagnosed with cancer.

Molly Shroades:
How else can this diagnosis impact a child?

Dr. Eshleman:
Sure. I think it's important for parents to remember that what is going on is going to impact the parent as well and what impacts the parent impacts the child. So I think being mindful of the parent's own reaction to this new cancer diagnosis and the stress or the impact it's having on the parent so that they can then communicate this to the child and look for other ways to help support themselves, which is also going to help support the child as well.

Molly Shroades:
Let's talk a little bit about speed bumps. What are some common speed bumps that parents run into during this conversation?

Dr. Eshleman:
I think just as you've kind of noted a parent's own emotions can sometimes feel overwhelming. And so just recognizing that you don't necessarily have to have your own emotions under control or in check to be able to have this conversation. And I think from an emotion standpoint you can say, "I'm sad because you have to go through this." Or, "I'm sad you have to go to the hospital." It doesn't necessarily imply something terrible happening.

So I think a parent's own emotions. I think a parents lack of knowledge or understanding, again. Fortunately, most of us have not had an experience with cancer. And so it's difficult to talk about things that we don't know about. And it's okay to tell your kids that you don't know. You don't have to have all the answers when entering these conversations. You can get that information along the way. And finally, it's important parents recognize they do not have to go through this alone. There are a lot of resources likely within your cancer center, but also in the community that can help parents and help children as they go through this process. So you don't have to know it all or have all the answers to enter the conversation.

Molly Shroades:
I think that's a really great point to say, to be comfortable saying, "I don't know" in front of your kids. And it's kind of a good thing to have them go through that education process with you, correct?

Dr. Eshleman:
That's right. I think learning things together, and again, it creates that space to talk about things. It's important to remember that each person, children and adults included, cope differently. And so some people do benefit from talking and that creates that space to talk through these things together. And not everyone wants to talk. And so looking for other opportunities to promote that act of coping that might not involve conversation.

Molly Shroades:
It sounds like it's a very unique case by case scenario here?

Dr. Eshleman:
It absolutely is. Yes.

Molly Shroades:
So speaking of shifting and changing here on the family dynamic, I'd like to talk a little bit about when there is a cancer diagnosis in a family, how does that family dynamic shift and change?

Dr. Eshleman:
Sure. I think there can be lots of ways. And just as you've already mentioned it tends to be on a case by case basis. And in part it depends on who's diagnosed. Oftentimes there are shifts in work routines. A parent, one or both parents, may no longer be able to work or their work schedule may look different. Often times a parent is having to help transport to appointments, whether that's a spouse or a child, or even a friend that they're stepping up and helping out in different ways. That may then look different. The child might start taking the bus home from school or going to aftercare. Maybe a grandparent or a neighbor picks the child up. Or dinner or bedtime routines look different. It's really possible that each and every aspect of a child's day to day could be shifted based on a new diagnosis.

Molly Shroades:
Yes. And I was wondering about routines. So I'm glad you mentioned that. For a lot of kids, routines are very important in early childhood, kind of how do you work around that shift with those routines?

Dr. Eshleman:
Sure. I think the goal is still to maintain it as much as possible, but to be able to also help a child develop that flexibility, and really an adult too. I think we all have a little bit of trouble shifting when something that we expect to happen doesn't. Of course when something that we don't expect to happen does. So we want to maintain that routine as much as possible, but again, opening the communication about, "I might not be able to pick you up from school today. It might be grandma." And so just kind of giving some advanced warning if things may be different. Again, in part that depends on the child, because some kids do better with more advanced notice while other kids would have more difficulty with that. And so letting them know closer to time would be more helpful.

Molly Shroades:
Okay, awesome. So should you try, as a parent, should you try to work in special activities to kind of add some levity to the situation? Or should you try to stick very strictly with the routine?

Dr. Eshleman:
I think that the simple answer here is yes to both. I think ultimately we try and stick with routine, but I think when someone and care about has been diagnosed with cancer, it provides some different perspective. And so all of a sudden things like getting the homework done right away or doing dishes after dinner may feel a little less important. So you might want to shift some of that time to things that are more enjoyable.

The other thing is is that when you're caring for somebody with cancer, there isn't as much time available. And so it is okay to try and promote some really positive and enjoyable family time and interactions to kind of replace that or make up for it. That said you don't want to create kind of undo stress or pressure on parents to do that. So if it's not possible, that's okay too.

Molly Shroades:
So you don't need to try to plan the perfect day every day?

Dr. Eshleman:
That's right. And in fact, a goal of anything being perfect is probably unrealistic and unattainable, right? And so stepping back and recognizing that. That we might try and make things fun, but you look at the situation and maybe a child has not slept as well or missed breakfast. And so those are things that set some of those extra fun activities up for failure or being a little less than expected. And so just keeping that in mind as well when you're trying to plan those fun activities.

Molly Shroades:
How has the pandemic changed the way we communicate with children about cancer and treatments?

Dr. Eshleman:
Sure. I think because of the pandemic and the limit on visitation to the hospital, when somebody's diagnosed with cancer, it becomes kind of mystical to the kids. They know that their parent is gone all day at appointments. That oftentimes there's extra food or gifts that come home with the identified patient. And sometimes that can be, it can create a little discomfort or even jealousy in the child. And so there are ways to cope with that.

Helping the child understand what might be going on during this kind of mystical time or this period of absence. So things like, with provider's permission, taking pictures of clinic visits. Maybe doing a video chat while the sibling or the parent is at their appointment. Getting some pictures or videos of what happens while they're there to help the child better understand what's going on when the patient is outside of the home.

Molly Shroades:
Absolutely. That isolation and separation of what's going on versus home life is probably a big factor here?

Dr. Eshleman:
That's right.

Molly Shroades:
So what are some of the biggest concerns that you hear from parents when they're trying to start this conversation? What do they come to you saying, "I don't know how to deal with this?"

Dr. Eshleman:
Sure. I think the parents are just scared in talking with kids kind of about the diagnosis and about potential side effects. But, again, I think that the kids often know more than we expect. And so just reassuring parents of that and trying to educate them on the value of being truthful in these conversations. Again, in terms of maintaining that trust and allowing a child to know what to expect so they can better cope with it. And then I think also, again, providing that reassurance that there are a lot of people here to help as your family goes through this process.

Molly Shroades:
Great. So are there ways we can integrate community members like teachers and coaches and others that impact the child's life in this conversation to help the children cope with everything?

Dr. Eshleman:
Absolutely. I think oftentimes parents tend to feel like this is a private issue that families address independently. But it really is important to remember there are a lot of people that can help support your child through an experience like this. It's probably a really good idea to communicate with a child's teacher and school personnel, coaches, or parents of friends what's going on so that they can keep an eye on the child and watch for his or her coping and continue to support the child through this as well.

Molly Shroades:
That's what that old phrase of, It takes a village," right? That's right.

Dr. Eshleman:
That's right. Absolutely.

Molly Shroades:
As we wrap up, can you suggest a few key talking points that parents really need to make sure they cover during this conversation? What are kind of the main points they want to make sure they hit during this conversation with their kids about cancer?

Dr. Eshleman:
So I think things that are important to keep in mind when communicating with your kids is the language that we use. So oftentimes I think we tend to describe illness as being sick, but especially during times like a pandemic, but even otherwise. Kids worry that they could get sick too. So I think giving the kids a name, so whether it's specifically like leukemia or osteosarcoma or more broadly describing it as cancer, and then providing reassurance that the child cannot catch it. It is not contagious.

And so kind of talking about some of the expectations. That there are going to be appointments. That daddy or your brother may lose their hair. And so giving them some information about what to expect. And then the plan you guys have in place for coping with that. So we're going to get a wig or we're going to go buy a new hat. And kind of talking and problem solving around that.

I think it's very important. It's very important for parents to remember that there's no right or wrong way to do this. There's really no handbook about how to communicate with your kids. And this is an unknown situation, an uncharted territory for many parents and families. So trying to reduce the pressure on parents to kind of do it perfectly is important as well.

Molly Shroades:
In the worst case scenario where something has a bad outcome how do you broach that conversation and talk about things like death with kids?

Dr. Eshleman:
I think this tends to be a very personal family conversation. A lot of families rely on kind of their faith and spirituality about kind of what death means and what happens after. Again, I think it's important to be honest with the children and that the patient had this diagnosis, we did this treatment, and it just didn't work for their body. And so sometimes when treatments don't work, the people cannot live in these bodies any longer.

And again, this will kind of vary based on the child that you're communicating with, his or her age, probably the details related to the patient who's diagnosed in his or her treatment. A lot of times kids, they kind of watch this process along the way. And so they have some sense of kind of the changes this person has gone through and the impact of this illness on the person.

And so asking them, if they have questions, what they think is going on, what they think is going to happen. And I think it's important for parents to kind of not superimpose their own reactions or their own expectations on the child. Children tend to be very resilient. Especially if we can support their coping along the way. And they may do much better with it than you think. And there are plenty of kids and, and families that continue have difficulty coping with that. And we have resources available for them as well.

Molly Shroades:
It sounds like there's open conversation and open communication is a very big and important part of all of this?

Dr. Eshleman:
That's absolutely right. And that applies to this situation but every situation. If you want to know what's going on with your child's day at school, how it's going with their friends, we always want to open lines of communication. So that if things come up the child feels more comfortable and open and willing to talk to the parents about things happening in their life.

Molly Shroades:
Great. Well, thank you so much for joining us today and sharing your insights, Dr. Eshleman.

Dr. Eshleman:
It's my pleasure. Thank you for having me.

Molly Shroades:
To learn more visit clevelandclinicchildren.org/behavioralhealth.

Outro:
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