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Delivering difficult news: From adults to future adults

By Kelsey Mora February 10, 2021

As a dual certified child life specialist and licensed professional counselor, the questions I most often get from parents and caregivers are “What will I tell the children?” and “How will I tell the children?” These questions come up when facing a new diagnosis, a loss of a pregnancy or loved one, a traumatic injury, or a suicide attempt.

Although I work in a setting and with a population where I am prepared to assist families and parents through such life-altering events, many clinicians are not. To support other providers when faced with similar questions from their clients, I have developed three key tips for delivering difficult news to young children. These tips can be applied not only to medical events and loss, but also to divorce, an upcoming move, a local tragedy, and other life-altering events.

1) Honesty really is the best policy.

Being honest with children builds and maintains their trust. By not telling children about an event, we risk the likelihood of them hearing false information from someone else or finding out about it in an uncontrolled way. This may involve an overheard phone call, a read text message or an encounter with a neighbor, friend or relative. As counselors, we can empower our clients by explaining to them that they, as trusted adults, have the ability to control the delivery of this information to their children and create an environment where it is OK for them to talk about the event.

When children are forced to come to their own conclusions about what is happening, their imaginations may create something far worse than the reality. The caregiver should follow the child’s lead by assessing what they already know before providing or correcting the information. It is important for parents/caregivers to use simple, clear and honest language with their children and to understand that this may need to be repeated over and over again.

Avoid euphemisms. Even though terms such as “cancer,” “dying” and “divorce” may seem harsh or scary for children, these terms are less likely to lead to misconceptions later. Adults can always clarify terms along the way, but starting with the real words is recommended. For example: “Dying means he will not come home; his body no longer works” and “Divorce means we couldn’t get along anymore. We have decided to live in different houses, but we both love you very much.”

Find an appropriate setting. Encourage the adult to identify a private, quiet and comfortable setting, preferably outside of the child’s safest place (which, for most children, is their bedroom). Consider the living room or dining table. Practice starting by giving a warning shot. For example: “I have something sad or difficult to tell you.” Help parents/caregivers to think about the best timing of the conversation. Who should be there?

Finally, it’s OK for adults not to know what to say or how to answer their child’s questions. They can say, “I don’t have all of the answers, but as soon as I do, I will tell you.” This builds trust and is still honest. Help the child to at least know what will happen next and what they can expect. Once the discussion has taken place, give the child or adolescent time to adjust. Rehearse by acknowledging, “I know this was not what you expected to hear,” and practice providing empathy and reassurance that they (the adult) will be there if the child or adolescent has more questions, concerns or feelings. Young children may need time to play, whereas older children may prefer being with their peers. Both responses are developmentally appropriate.

 

2) When in doubt, keep things normal.

Children benefit from structure and clear expectations. However, it can be very hard to maintain routine for children when disruption is taking place. When this is the case, encourage your adults clients to prepare their children for anticipated changes. For example, if the children are able to attend their extracurricular activities or playdates but will be picked up by a friend or relative instead of their parent, make sure this is communicated to them. Similarly, if the bedtime routine or school drop-off will look different, parents/caregivers should ensure their children know who and what to expect. Children are resilient, but they do best when prepared for change.

Help your adult clients consider ways to include the child. Children may benefit from having a role or purpose. For example, they could be responsible for packing a bag or making a card. When possible, parents/caregivers should identify choices to offer to give children a sense of control and mastery during a time that feels out of their control. The child should not be forced to do something such as say goodbye to their loved one, but they should be given the option and presented with different ways to do so.

Caregivers may think they know what is best for their child and then be surprised by the child’s decision. I have worked with children who have persistent regret over not participating in their parent’s funeral but were denied the opportunity because the surviving parent was trying to protect their child. Often, parents will ask, “What if they [the child] regret their decision?” I reassure parents that they can remind their child that they were given a choice and that they made the choice that was best for them in that moment.

 

3) Expressing feelings is healthy.

When your adult client says, “I have to be strong for them [the children]” or “I can’t let them see me cry,” ask the parent/caregiver: “What does being strong really mean?”

Children who grow up in a home where they are shielded from feelings may inadvertently learn to internalize their feelings. Parents, caregivers and other adults possess the potential to teach children about the healthy expression of all emotions — the good, the bad and the ugly. It is inevitable that children will experience heartbreak, disappointment and upset throughout their life trajectory. When they are faced with these circumstances, it is imperative that they have learned how to identify their feelings and express them safely and effectively. Being strong can mean demonstrating appropriate reactions to situations.

Help your adult clients name their own feelings. Have them practice “I feel” statements such as “I feel sad because your grandpa is in the hospital” or “I feel worried about everyone’s safety.” Then, encourage them to follow these statements with plans that can be shared with their children, such as “But I am going to do everything I can to help you feel safe and cared for during this difficult time.” This encourages children to express their own feelings safely and effectively and to feel comfortable asking questions when they have them because they know it is OK to talk about the situation. Furthermore, practicing this gives the adult client an opportunity to process their own thoughts and feelings about the event before being in front of their child.

 

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These three tips can be applied to and modified for children of any age facing nearly any difficult event. I have used these principles to provide guidance for parents and caregivers on explaining recent events, including the pandemic and social unrest, to their children.

Developmental reactions to difficult circumstances will vary by age. Infants may demonstrate increased crying, clinginess or fussiness. Toddlers and preschoolers may regress or display a fear of separation. School-age children may exhibit irritability, confusion and distractibility. Adolescents may display anger, take on new roles and express criticism. But when parents and caregivers provide honest information, present clear expectations and encourage healthy discussions, children and adolescents are more likely to experience a positive adjustment both during and beyond the situation.

 

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Kelsey Mora is a dual certified child life specialist and licensed professional counselor who works both in a hospital setting and for a private practice in the Chicagoland area. She specializes in helping children and adolescents cope with illness- and grief-related challenges and is specifically trained to coach caregivers on language and techniques to use when parenting their child through medical conditions, family life transitions and traumatic loss. Contact her at kmora@illnessnavigation.com or through her website at illnessnavigation.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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