Month: July 2023

The news these days is overwhelming in its awfulness. Acts of terrorism, wars, and heated conflicts constantly erupt throughout the world. Climate change looms, contributing to wildfires and flooding. Incomprehensible shootings occur with numbing regularity. The pandemic seems to be shifting from an immediate threat to health to an endemic illness — yet it’s still affecting us. The news has been so horrible, and so unrelenting, that it is hard to even process it.

Imagine processing it as a child?

Our first instinct is usually to shelter our children from the news and not say anything about it to them at all. That’s completely understandable, and if your child is very young or you are certain for some other reason that they aren’t going to hear about it, then not saying anything is a viable option.

But if they aren’t very young, or if you ever have the news on where they can see, or if they are ever in settings where people might have the news on or talk about it, it might not be so viable. If children are going to hear about something, they really should hear about it from you.

Also, as parents it’s important that we give our children the perspective and skills they need to navigate this scary world where, let’s be honest, bad things happen. The way you talk to children about tragedies in the news can help them cope not just now, but in the future.

The American Academy of Pediatrics has all sorts of resources to help parents talk with children about tragedies. Here are four simple things all parents can and should do:

1. Tell them what happened, in simple terms. Be honest, but skip the gory details. Answer their questions just as simply and honestly. If you think — or know — that your child has already heard something, ask them what they’ve heard. That way you can correct any misinformation, and know not only what you need to explain but also what you may need to reassure them about.

2. Be mindful of the media that your child sees. The news can be very graphic, and because the media are as much in the business of gaining viewers as of delivering news, they tend to make things as dramatic as possible and play footage over and over again. When the planes flew into the Twin Towers on 9/11, my husband and I were glued to the television, not realizing that one of our daughters, who was 3 years old at the time, thought that planes were literally flying into buildings again and again. It wasn’t until she said, “Are those planes going to come here too?” that we shut off the TV and didn’t turn it back on again until all the children were in bed.

3. Make sure your child knows that you and others are always doing everything you can to keep them safe. Talk about some of the ways you keep them safe, ways that are relevant to the tragedy you are talking about. Make a safety plan as a family for things like extreme weather or getting separated. Help them think about what they might do if they are ever in a scary situation, and who they could turn to for help. Which leads me to the most important thing to do…

4. Look for the helpers. The wonderful Fred Rogers often talked about how when he saw scary things on the news, his mother would tell him to look for the helpers, because there are always people who are helping. That may be the best thing we can do as parents: help our children look for the helpers. In all of the recent tragedies, as in all tragedies, there were so many helpers and heroes. When we concentrate on those people, not only do we give our children hope, but we may empower them to one day be helpers too.

The world can be a scary place, yet there is much we can do — from a very young age — to help children build strengths and nurture resilience, even in the face of tragedy.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

First, some good news: Merkel cell cancer is exceptionally uncommon. Roughly 1,600 cases occur in the US annually. But this rare skin cancer sometimes goes unnoticed initially. That's worrisome because it often metastasizes early — that is, spreads to other parts of the body such as the lungs and bones.

Here's what to know about Merkel cell skin cancer: where and how it starts, what it looks like, who is more likely to get it, how it's diagnosed and treated — and most importantly, steps you can take to help prevent it.

Where and how does Merkel cell cancer start?

Merkel cells are tiny oval-shaped cells found in the outermost layer of skin. Seen close to nerve endings, they help with the perception of touch.

Rarely, these cells begin to multiply uncontrollably, creating clusters of cancerous cells. Typically the tumors occur in regions that receive greater sun exposure, such as the face, neck, and back of the hand.

Sun exposure isn't the only factor, though. A virus called MCV, or Merkel cell polyomavirus, is thought to trigger development of this cancer in about 80% of all cases. Aging increases the risk of this cancer, and plays a role, too.

What does Merkel cell cancer look like?

It appears as a reddish or purplish bump on the skin and often grows rapidly. Most people don't experience any pain or itching.

Unfortunately, the tumor cells may spread to different parts of the body, including the brain, lungs, bones, and other areas of the skin. This may occur early: nearly half of people with Merkel cell cancer have metastases when first diagnosed.

Who is most likely to develop Merkel cell cancer?

Certain factors increase risk for developing Merkel cell cancer:

• age older than 65
• high exposure to ultraviolet light from sunlight or tanning beds
• fair skin
• family or personal history of skin cancers
• gender (men are more than twice as likely to be affected as women).

People are also more likely to get this cancer if their immune systems aren't strong because they

• take drugs that lower their immune response such as high doses of steroids
• have certain health problems such as blood disorders or HIV
• have had organ transplants and need to take immunosuppressive drugs.

What steps can you take to prevent Merkel cell cancer?

Protect your skin from the sun. Wear UV-protective clothing that covers your trunk, arms, and legs. Wide-brim hats can protect your scalp, face, and part of the neck. Regularly apply broad-spectrum sunscreen on all uncovered skin.

Do not use tanning beds. They increase your chance of developing skin cancers.

Visit your dermatologist regularly for a total skin check if you have had skin cancer, or if a family member (parent, sibling, or child) has had it.

Tell your dermatologist or medical team if you notice any skin changes. Any new mole, bump, or lump should be checked.

How do I find out if I have Merkel cell carcinoma?

If a dermatologist suspects you have Merkel cell cancer or another skin cancer, they will remove a small piece of the skin lesion to look at it under a microscope. This procedure will confirm if the lesion is skin cancer.

How is Merkel cell cancer treated?

Treatment depends on where the tumor is, its size, and whether it has spread. That can be determined by removing lymph nodes near the tumor and through scans.

• If the tumor has not spread: Surgical removal can be done to remove the tumor and a margin of normal skin around it.
• If cancer cells have spread to other parts of the body: Radiation treatment is an option. Chemotherapy, a treatment with medications, may be recommended, though it is not as effective as radiation. Immunotherapy, which can help the immune system recognize and kill cancer cells, is also an option in some cases.

There is a high risk that this cancer will come back after treatment. So people who have had it should regularly see a dermatologist or their cancer team for surveillance.

About the Authors

Lais Lopes Almeida Gomes, Contributor

Dr. Lais Lopes Almeida Gomes is a dermatology research fellow at Massachusetts General Hospital, and a pediatric dermatologist in Brazil. Her clinical and research interests include atopic dermatitis and global health. She is part of the … See Full Bio View all posts by Lais Lopes Almeida Gomes

Neera Nathan, MD, MSHS, Contributor

Dr. Neera Nathan is a dermatologist and researcher at Massachusetts General Hospital and Lahey Hospital and Medical Center. Her clinical and research interests include dermatologic surgery, cosmetic dermatology, and laser medicine. She is part of the … See Full Bio View all posts by Neera Nathan, MD, MSHS