How should a Child Life Specialist handle truth-telling and assent with school-age children facing serious illness?

• A. Provide dishonest information to avoid distress.
• B. Provide honest, developmentally appropriate information; solicit questions; involve parents; obtain assent when possible.
• C. Withhold information until the patient asks.
• D. Ignore assent and proceed.

Answer: (B)

Truth-telling and assent for school-age children facing serious illness centers on giving honest information in language they can understand, inviting their questions, and honoring their voice alongside parental involvement. At this developmental stage, children grasp concrete details about illness and treatment, notice when information is vague or inconsistent, and benefit from explanations that are paced to their level. Sharing honest, developmentally appropriate information helps reduce fear born from uncertainty, builds trust with the care team, and supports the child’s ability to participate in care decisions.

Involving parents is essential, but the child’s assent should be sought when feasible. Assent means the child agrees to participate in aspects of their care, reflecting growing autonomy and giving them a sense of control. The process includes checking understanding by asking the child to summarize what they’ve heard, inviting questions, offering choices when possible, and slowing down if the child becomes overwhelmed. If the child cannot express themselves, the team uses family insights and observable cues while continuing to provide truthful information appropriate to the situation.

Withholding information or proceeding without the child’s input can undermine trust and hinder coping and cooperation. Providing honest information, soliciting questions, and obtaining assent when possible supports ethical practice, aligns with the child’s developmental needs, and helps the child navigate what’s happening with a sense of agency.