Talking to Your Child about Cancer

When talking your child about cancer, keep 3 principles in mind:

• Be honest and open
• Explain cancer and treatment using words your child can understand
• Share details appropriate to your child’s age and developmental level

Importance of Honesty and Openness

Honesty and openness with your child will build trust and strengthen your relationship. It might be tempting not to tell your child that he or she has cancer or to try to shield him or her from negative information. It is natural to want to protect children from anything unpleasant.

But children are very observant. Even if it looks like they are not paying attention, they watch their parents, care team members, and other family members or adults to figure out what is going on. It is very likely that during some point in your child’s treatment, he or she will hear the word cancer (from staff, another hospital peer, or even family and friends visiting) even if you warn people not to use it. Many parents report that explaining cancer instead of trying to prevent people from talking about it takes less energy and can remove the strain of always trying to maintain defense.

• Keeping the lines of communication open is important for a number of reasons: Even young children can sense when something is wrong. If you don’t tell your child what is going on, they will likely make assumptions or use their imagination. Often what they imagine can be worse than the truth.
• Children tend to blame themselves when something difficult happens to them. They need to know cancer is not their fault.
• The more your child understands, the less scary things are. Children tend to be cooperative with treatment if they know how it may help them.
• Being honest will lessen a child’s worry, confusion, and misconception of guilt.

Plan What to Say and How to Say It

Practice what you are going to say. Ask for advice from your child's care team or another parent who has been in a similar position.

The way you share information is also important. Your child will learn a lot from your tone of voice and facial expressions. Stay calm when you talk with your child. Tears are OK, but if they happen explain why you are crying. You might tell children that it is natural for parents to be sad when their child is sick or that it is normal for people to feel upset when there are so many changes. Tears are a way of expressing emotions. It is important that children are reassured that they didn’t cause cancer and it is not their fault that people feel sad.

Decide Who Will Tell Your Child and When

Many parents receive their child’s diagnosis from the doctor at the same time that their child learns of it. But if you want to be the one to tell your child, your child’s care team can help you decide what to say and how to answer your child’s questions.

Tell children as early as possible. It will help build trust.

When you first talk with your child, consider asking another person to be with you. This person might be another family member or trusted friend who can provide support. It could also be a doctor, nurse, child life specialist, or social worker who can help describe cancer in more detail.

What to Tell Your Child about Cancer

Most children and teens have the same basic questions:

• What is cancer?
• Why did I get it?
• Will I get better?
• What’s going to happen?
• When can we go home?
• What about school?

Children need information to manage treatments or procedures, cope with feelings, and have some control over their situation. Most of all, they need to know they are loved, supported, and surrounded by people who care about them.

Trust your instincts. You know your child better than anyone else. You know the best way to tell them. Here are some helpful tips.

• Give age-appropriate information. Consider talking with a child life specialist at the cancer center. They are experts in child development. They can help you explain cancer using age-appropriate terms and help children cope based on their developmental stage. They can explain concepts using therapeutic medical play and visual aids. Social workers, psychologists, and chaplains can also provide support.
• Consider carefully how much information to share at one time. It is usually a good rule of thumb to start with general “big picture” information. Try not to overload your child with too many details at once. Have several short conversations. It may be hard for many children to process too many details. You can share more information over time. Watch your child for cues. If they change the subject or start looking for distraction, they have probably received enough information at that time. Allow opportunities for their questions to also lead the conversation. Feeling safe to ask questions is a great way for them to communicate they want more information and for you to learn specifically about what.
• Help your child to understand the basic facts about the illness, the treatment, and what to expect.
• Explain common terms the child will hear regularly such as cancer, tumor, chemotherapy, and side effects.
• Encourage your child to share feelings and ask questions. Answering your child’s questions and having honest, ongoing conversations can help your child cope.
• Know that children are sometimes afraid to ask questions. Watch their reactions to different situations. For example, if children seem upset when they see a child without hair, use that as an opportunity to ask them about their feelings or if they have any questions.
• Affirm truths and correct misinformation. Your child may have already formed ideas about cancer based on situations seen on TV or information heard from family or friends prior to their own diagnosis. Ask your child what he or she already knows about cancer.
• Offer hope. The care team is there to help them face cancer. There are many treatments available to try and make the cancer go away.
• Don’t forget siblings. Remember that brothers and sisters need explanations, too.

Common Reactions of Children to Cancer

Each child is different. Their reactions and how they deal with a cancer diagnosis will vary depending on their age, level of development, and personality.

• Some may have a visible, obvious reaction such as crying or angry outbursts.
• Others may become quiet.
• Some express their feelings in words, others in actions.
• Some children regress to behaviors they had when they were younger.
• Every day is different. Children’s schedules, the way they look and feel, and their friendships may all go through changes.
• Some days will be rough. Others will be smoother.

Children will follow your lead. Try to be calm and reassuring. Find ways to tell and show your children, (including siblings) that you will always be there for them.

Common Fears and Misconceptions about Cancer

There are some common fears that many children have when they learn about cancer. Your child may be scared to talk about these concerns. You may want to bring them up yourself. Use sentence starters such as: Some children think..., Have you heard... ?

• Misconception — Cancer is their fault. It is common for younger children to think that they caused the cancer by doing, saying, or thinking something “bad.” Let your child know that nothing he or she did, said, or thought caused the cancer. Cancer is not a punishment.
• Misconception — Cancer is contagious. Explain to your child that people cannot "catch" cancer from someone else. Give children age-appropriate facts about cancer.
• Misconception — Everyone dies from cancer. You can explain that cancer is a serious illness, but millions of people survive cancer. If children know someone who has died of cancer, let them know that there are many kinds of cancer. Everyone's cancer is different and has different names and needs different kinds of medicine. You may need to repeat these points many times during your child's treatment.

As you encourage your child to share his or her feelings and questions, be open and honest about your own feelings and questions.

You can be your child's most important source of information and support.