How to talk to kids about cancer

Newswise — Knowing how to talk to kids about cancer when a parent or someone else close to them has been diagnosed is important for children. They often sense something is going on, so it is better to talk and explain what is going on.

Danae Lund, a Sanford Health pediatric psychologist, helps parents understand how to tell their children they have cancer.

Setting up the conversation

When looking for time to confront the situation, choose a time when you and your child are both well-rested, and you will have enough time to focus on your child and talk for as long as your child would like. It’s ideal to let your child know that you have important information about your health that you’d like to talk with them about.

It can also be helpful to remember that the initial conversation with your child may be short, as your child likely needs time to take in and process what you have shared. Not having questions or discussion right away doesn’t mean your child doesn’t care or is minimizing the situation, but rather means that your child needs time to take it all in.

Offer your child a chance to ask any questions he or she may may have, and reassure your child that you will make sure that his or her needs will still be met, and that you are thinking about how they will be affected by your cancer treatment.

Make sure you let your child know that you are available discuss things in more detail later, and that they can come to you at any time with questions they may have.

How to explain to different ages

Each age understands information differently. If you have more than one child, you could choose to sit down and talk to them separately or all at once. If you choose to explain to your children at different times, telling each child close in timing to prevent one from overhearing or not hearing it directly from their parent.

Here is some advice on approaching different age groups of children:

Babies or toddlers (0-2 years):

• At this age, there is little awareness of an illness, but children may react to the separation and changes in their normal routine.
• Though they cannot talk much about how they are feeling, their reactions speak much louder than words and may include: Changes in their breastfeeding routine, fussy, cranky or clingy, changes in sleeping or eating habits, tantrums, and sucking their thumb or wetting the bed.
• Following regular schedules and creating a familiar environment is important when supporting your child’s reactions to your illness.
• Make sure to give extra hugs and cuddles to make your child feel secure and keep an eye on clues to how he/she is adjusting while they play.
• Say things to help a child understand: “Mommy is sick and needs to go to the hospital to get better.”

Preschool and kindergarten (3 to 5 years):

• At this age, there is a basic understanding of what it means to be sick, so it is important to explain, on their level of terms or through drawing a picture, what the situation is and how your treatment works.
• Pre-K aged children think everything is related to them, so they may do “magical thinking,” which is thinking they caused the illness by being naughty or thinking bad thoughts.
• Their world view is based on their own experiences. Kids do not mean to be self-centered, but they may initially focus more on what it will mean for them, such as will they still be able to play with friends, participate in activities, or worry about who will take care of them.
• Your child’s reactions could include difficulties at bedtime, scared of monsters or the dark, wetting the bed, stuttering or using baby talk, either overly active or uninterested in things, separation anxiety, aggressiveness or repeatedly asking the same questions.
• To help support your child, address the misunderstandings, remind them they didn’t cause the cancer and it is not contagious.
• Stick to your child’s routine, day and night, and make sure they are active each day to bring out positive energy. If things do need to be changed, make sure to explain to them why and how.
• Help your child feel important through this process by paying attention to their feelings, compliment and comment on things they are doing well, even ask them to do basic things around the house to allow them to feel their purpose.
• Things you can say: “I am sick with something called cancer. The best doctors are giving me medicine to help me feel better. Some days I will be tired and not feel great, but that doesn’t mean I am getting sicker. Some days I will feel good and we can play together.”

Elementary and middle school (6-12 years):

• At this age, your child can understand more complex explanations of cancer but will often fill gaps of the unknown with their own theories. These theories could be told to them by their peers, such as how cancer is contagious or that all people with cancer die.
• Explain that there are different kinds of cancer, and not all people with cancer die, but that you will be getting the best treatment available. You could ask what they know about cancer or if they know anyone who had cancer.
• It is a good idea to explain the treatment being used, so kids can understand the symptoms and know they don’t need to worry.
• Death is something children at this age understand, so it is important to explain the reality of the illness and talk about how it will impact the family.
• They have short attention spans and may move on pretty quickly from the discussion; that is normal and doesn’t mean they don’t care or aren’t interested.
• They may feel guilty and believe they caused the cancer by misbehaving; it is important to reassure them they did not cause the cancer.
• Your child’s reactions could include: Sadness, anxiety or guilt, separation issues, could feel embarrassed or ashamed, afraid of performance, punishment or new situations, and worrying about the health of others in their family. They may complain about headaches or stomach aches, have issues at bedtime like wetting the bed, turn aggressive, have trouble concentrating in school causing poor grades, withdraw from their peers, or try to hide their feelings by being extra good.
• To support your child through this process, make sure to stay open and truthful while explaining the illness, treatment, and what could happen, address the issue of dying even if the child does not ask about it themselves. Allow the child to feel involved by giving simple tasks around the house or even asking them to get you a glass of water.
• Reassure the child by reminding them it is not selfish to still have fun and be a kid, that their other relatives are healthy and are there to help them with anything they need as well.
• It is important to watch for clues on the child’s behavior and notify the school or anyone else about the situation.
• Things to say: “Cancer cells are different than healthy cells, and they grow faster, and lump together to form tumors. They can either take them out through surgery, or medication or radiation. The medicine is so powerful so it might make them feel more tired or sicker. That doesn’t mean cancer is getting worse.” OR “You don’t need to worry about me because I have great doctors that are helping me get better.”

Teenagers (13 to 18 years):

• At this age, teens have a deeper understanding of cancer and the impact of situations that they haven’t experienced themselves.
• Since this is a period of becoming more independent, this situation may be more difficult for them and they may become overwhelmed with the responsibility of helping out at home, causing them to feel frustrated or guilty.
• Make sure teens talk about their emotions with someone, even if it is not you, their parents. Suggest that they talk to or confide in a teacher, friend or a friend’s parent.
• Your child’s reactions could include: Rebelliousness and acting out; depression, anxiety or insecure; critique how their parents and others are handling the situation; hide their feelings; worried about how others will treat them because of their sick parent; have poor judgment on their decisions such as drinking alcohol, smoking, staying out late or having unsafe sex; withdraw from family and friends; show symptoms of stress or worry them or other family members will get cancer, too.
• To support your teen, make sure to encourage them to talk about their feelings, check in and remember they may not volunteer their feelings, give privacy when needed, provide opportunities for counseling, and continue finding balance between supporting the family and being a teenager.
• Reassure your teen and encourage them to still hang with friends and do activities that they enjoy while continuing to discipline and set appropriate limits.
• Remember that even if your teen’s “normal behavior” upsets you, it is not a reflections of how much they care about you.
• Things to say: “We have some news to share with you. I have cancer. We don’t know what we’re dealing with yet, but I’m going to have surgery so the doctors can find out.” AND “If you think of any questions or have any worries, please don’t keep them to yourself. Come and talk to me. It’s okay if you talk to someone else, too.”

When is it time to seek outside help for your child?

If your child’s behavior and reactions to the illness start to concern you, don’t be afraid to reach out for help from counselors or support groups. Sometimes children and teens have an easier time talking to others who understand what they are going through so they aren’t embarrassed to talk about their feelings.

Some concerning behaviors could be:

• Show extreme changes in behavior (eating or sleeping habits, severe mood changes, acting out)
• Isolating themselves at home or in school
• Having difficulty at school (grades are dropping, misbehaving, teachers report changes in personality)
• Losing interest in activities they used to enjoy
• Expressing desire to hurt themselves or others (in this case, find support immediately)