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Age-appropriate Information

The information you share with your child about cancer depends on his or her age and developmental level.

All children need simple, clear explanations. They need to know they are loved and supported.

  1. Infants

    Common reactions of infants and young children

    Infants may:

    • Be upset by medical procedures
    • Withdraw and avoid interacting with staff
    • Cling to parents
    • May take some time in reaching milestones such as talking, walking, or feeding themselves because of all the changes they are experiencing

    What to say and do

    • Talk or sing to your child because the sound of your voice is soothing.
    • Comfort your baby by holding and gently touching him or her. Skin-to-skin contact is ideal. Ask your care team questions if there is medical equipment that is making you feel nervous about coming in contact with when you hold your child.
    • They want you to feel at ease.
    • Help your child feel secure by continuing feeding, bedtime, and other routines as much as possible. However, cancer treatment often creates a “new normal.” Think about developing new routines and structure for this phase of your family’s life.
    • Bring familiar items from home, such as toys or a blanket. Familiar sights and smells can help your baby feel more secure. Make time for play such as reading books, singing, and tummy time just as you would at home. Talk to your care team if you are worried about your child’s safety or physical comfort during these activities.
    • Try to limit the number of care team members present at one time to help with stranger anxiety. (This can sometimes be difficult.)
  2. Toddlers to Age 3

    Common reactions of toddlers

    Toddlers may:

    • Do well with consistent routines for medical procedures, such as blood draws, taking medicine, and going to the hospital or clinic. This can include how they are positioned and what they may like to look at or do. Talk to your care team if you would like help coming up with coping plans.
    • Have fears that they will live in the hospital away from parents forever
    • Regress to younger behaviors
    • Be afraid of and upset by medical procedures

    What to say and do

    • Use simple, clear descriptions of what will happen. Children in this age group cannot understand what the word cancer means. Use words like sick and boo-boo. Point to the area of the body that is affected.
    • Prepare your child right before a procedure if it is something that will hurt. (Ask your care provider if you are not sure if it will.) Not preparing your child may cause your child to become concerned that simple things like taking vital signs or a physical exam may also hurt.
    • Provide choices whenever you can. For instance, let them choose which arm to take their vital signs.
    • Give your child opportunities to play with children their age. Visit play rooms at the hospital. Check to see if the hospital has organized play groups.
    • If your child has to stay in the hospital, share these details, too. Children need reassurance they won’t be left at the hospital. It can also be helpful to tell them what they can do including play or activities that are important to them.
    • Make time for play and incorporate it into their day even when at the hospital. Play can bring comfort and familiarity to a new place.
  3. Ages 3 to 7

    Common reactions

    Children may:

    • Regress to younger behaviors
    • Be afraid of and upset by medical procedures
    • Ask a lot of questions
    • Think cancer is a punishment for something they said, did, or thought
    • Fear that parents will leave them at the hospital
    • Have difficulty with taking oral medications

    What to say and do

    • Children can understand cancer explained in simple terms. They can learn the name of their cancer, understand simple facts about treatments, and hear basic information about how day-to-day life may change.
    • They need parents to reassure them that they did not cause their cancer through something they did, said, or thought.
    • They need assurance that parents will not abandon them at the hospital. Preschool-aged children may fear that they will end up living at the hospital. Also, if there are times you will be away from your child because of work or siblings at home, it is important that you tell your child when you will be back. Since their sense of time is not fully developed at this age, equate the time to something they know.
    • Be honest with your child about tests and treatments that may hurt. Explain that they are having the treatment to try and make the cancer go away or show the doctors what is happening inside their body. Investigate if there are resources available to help make things like needles less painful. You can also distract your child and try to have them focus on something other than the pain by reading a story, giving him or her a comfort item to hold, or something else to look at. Ask your care team if you would like help coming up with routines and coping plans that could help bring comfort, predictability, and control (including for oral medicine).
    • Ask the doctor if your child can see or touch unfamiliar machines or supplies (tubes, bandages, or ports) ahead of time to help with preparation.
    • Children might like to learn what is happening through therapeutic medical play with special dolls or activities designed to teach children about their treatment. Ask if there is a child life specialist available at your hospital to facilitate.
  4. Ages 7 to 12

    Common reactions of school-aged children

    Children may:

    • Have questions and concerns about changes in appearance
    • Might worry that all new procedures will be painful
    • Will want to know when they can return home
    • Have a greater understanding of time
    • Might ask if they are going to die
    • Be upset by disruption of school
    • Miss seeing classmates and friends
    • Show anger and sadness over the change of health, extracurricular activities and daily routines
    • Look for more emotional and social support from family and friends

    What to say

    • Children at this age are capable of understanding a more detailed explanation of cancer.
    • They are more likely to understand that they will need to take medicine and undergo other treatments.
    • They are afraid of pain. Be honest with them about likely pain from some tests and treatments. Ask the care team how other patients describe how these procedures feel. Discuss what doctors and nurses can do to help lessen pain.
    • Kids this age will likely hear messages about cancer from other sources, including school, television, and the internet. Encourage your child to share details he or she learns with you. Talk about it together. You can correct any misinformation and remind them that there are many different kinds of cancer and everyone’s experience is unique.
    • Children this age can be prepared for new experiences the day before to a week before depending on the significance of the experience and how anxious your child is when hearing new information. Ask yourself, “Do they benefit from more time to get used to an idea and have time for questions?” or “Do they seem preoccupied with worry until the event happens?” These can guide your decision about when to tell them.
    • Try to connect with other families who have children of similar ages. Provide opportunities for kids to play together.
    • Children need information about what happens with school and other activities during treatment.
  5. Teenagers

    Common reactions of teenagers

    Teens may:

    • Feel that cancer has taken a lot of their freedom and privacy away
    • Will want to know when they can go home for breaks or when treatment will be over. Teens may need the support of you and the care team when there aren’t answers with certainty. They may grow frustrated when predicted schedules change especially if it interferes with them participating in an event they were looking forward to.
    • Need to depend on parents at a time when they are trying to become independent. It will likely help to give your teen some of the space and freedom she had before treatment and encourage independence.
    • Feel as if nothing bad could ever happen to them. They may take risks that could cause problems or rebel against parents, doctors, and treatments.
    • Have fears about death
    • Try to protect parents and others they love by holding in their feelings
    • Might find it helpful to connect with people their age who have cancer. Teens with cancer may feel isolated.
    • Experience changes in friendships, feeling loss when they cannot participate in the same activities as peers
    • Might have concerns about changes in appearance, including changes in weight, hair loss, and scars
    • Show intense emotional responses
    • Focus on the meaning of life and the cancer’s effect on their identity
    • Have the ability to think about their future and how cancer could impact their future plans

    What to say and do

    • Teens can understand a complex explanation of the cancer and may have many detailed questions. They may be interested in learning more about their diagnosis. Direct them to trusted online sources if you sense they are using the internet to seek information. Remind them everyone’s cancer is different and that this is not a result of any risky behavior.
    • They should hear diagnosis and treatment information directly from the care team, as much as possible. Teens may want to play a role in making decisions about their treatment.
    • They are most likely to think about their cancer in terms of its symptoms and effect on daily life, such as school, sports, and friends.
    • Teens are capable of understanding the relationship between their symptoms, cancer, and the role of treatment.
    • Be open and ready. Encourage, but don’t push, your child to share his or her feelings. Be there when your child comes to you even if you are unsure of what to say. 
    • Teens will likely hear messages about cancer from many sources. Ask your teen to share details. Also, learn about your teen’s specific fears so that you can discuss it together and with the care team.
    • Teens often have a unique set of concerns about their physical appearance. They may worry about losing their hair and large weight changes. Talk honestly with your teen about other possible side effects with emphasis about things that are only temporary. It can be normal for teens to initially experience anxiety about social settings. Talk with them about possible scenarios or questions they might be asked and possible ways to handle them. For example, being stared at (because of hair loss, physical differences resulting from surgical procedures, or other changes in appearance) can be a challenge for teens with cancer. Ask the care team to help your teen with positive messages to remember when these situations occur and for suggestions of how to handle situations.
    • Friendships and fitting in socially are of primary importance to teens. They may be scared and angry about how cancer has changed their life and isolated them from their friends. Look for ways to help your teen stay connected to friends through texting, e-mails, online video chats, letters, pictures, and visits. Some teens use social media sites to stay connected to friends or even meet other teen oncology patients who have had similar experiences.
    • Teens usually want to know if they can still do things "normal" teens do such as parties, school activities, and hanging out with friends.
    • Don’t assume you know what your teen is thinking. Take time to observe and listen. Many people, teens included, have trouble sharing their thoughts and feelings. Sometimes it may be easier for your teen to confide in a friend or a member of the care team instead.
    • Teens might benefit from talking with social workers, psychologists, and child life specialists at the hospital or cancer clinic to talk about feelings without their primary caregivers being present.
    • You may want to encourage your teen to keep a running list of questions, fears, and other thoughts to write down and share. If your teen is too shy to say them out loud to the care team, check to see if it is OK if you share them with the care team.

Reviewed: June 2018