Tools for Helping Children:

How should I tell my children I have cancer?

Talking to your children is one of the most difficult things to do. Of course, you will want to protect them from pain, but children need to know the truth. All research shows that keeping information from them about your cancer does more harm than good, can damage their trust in you, and fuels their imaginations with fears that may be worse than the current situation. Children have an amazing capacity to cope when they have clear and honest information about your cancer.

What and how you tell your children depends upon their age and level of development. Telling your children about your cancer is best done with a gentle, open, and honest approach. Informing and discussing your cancer with your child is not a one-time event. You do not need to tell your children everything at once. Throughout treatment and follow-up care, continue talking with your children.

Some suggestions for children of different ages:

• Under Two years of age: Children this young are unable to understand what cancer is as an illness. This age is most concerned with what is happening with them. Separation and strangers are a major area of anxiety. Children of this age need to be assured that they will be well taken care of and by whom.
• Two to five years of age: Children are still in need of reassurance about what is happening with them. Giving them a transitional special toy or blanket that your child can carry with her to the hospital, or friends’ homes, or get comfortable with at night is helpful and can be used as a reminder that you are thinking of them when you are gone or too tired. At this age children also want simple explanations about what is cancer and how it is affecting you. Relating cancer and treatment to familiar ideas can be helpful. For instance, one might explain cancer treatment as a contest between the “helpful cells” and “the not helpful cells.” There are several story books that both you and your child might find supportive and effective.
• Six to eleven years of age: Children at this stage can understand more detailed explanations, though it is helpful to include familiar scenarios. Many children of this age have a basic knowledge of body parts and their functions, and can understand simple explanations about the cancer and its effects on the body. Cancer treatment could be explained as “pearl like drops or light rays that are helping your body to build more normal cells and eliminate those cells that have gone out of control and formed a tumor.” They will want to know in what part of your body is the cancer. They will want to know about how treatment works and what side effects they might see, such as hair loss, a parent’s nausea, or fatigue. Let the children's teachers and school nurse/counselor know about your condition, as their suggestions and understanding will help if there are any problems. You might ask your child if there are other people that they want you to inform them of your cancer, such as their brownie or scout leader, coach, or their friends' parents. As best as possible, maintain your child’s normal routine. Let them know when there will be changes to activities, family time, or temporary caretakers.
• Twelve years and older: Children of this age are able to understand more complex relationships between events Though teenagers may want either more detailed information or to not talk about your cancer and their feelings, preferring to keep things inside or to talk with their friends rather than with you, check in with them regularly. If they are helping out, acknowledge their extra efforts and make sure that they have time to spend with their friends. Being a teenager is a time of emotional ups and downs when they can feel confused and unsure about themselves. This can make the way they deal with a parent’s cancer very different from that of a younger child. Their reactions are likely to be more intense than an adult's. It is very important that they have the time to grieve about the illness and be included in what is happening.


Some overall suggestions for talking with your children include:

• Explaining that cancer is not contagious and that there is nothing they have done, thought or said to cause you to have cancer. Clear up any misconceptions.
• Tell your child what has happened and what you expect to happen next. Be prepared to share both the good and bad news. Your child might ask if you are going to die. Without promising your child anything, inform her that not everyone dies when they get cancer and that right now, you are getting treatment and hoping for the best outcome.
• Reassure your child that she will still be well cared for and loved and by whom. Let them know of other adults that they can lean on for support and/or talk with.
• As you offer your children information, it is okay to talk about your feelings. You do not need to go into great detail about the medical terminology or financial concerns, but do let them know how you feel and what changes to their routines they can expect.
• Most importantly, listen to your children. Encourage your child to tell you what they have noticed. Let them ask questions. Listen for what they are really asking and answer them as simply and completely as you can.


Some don'ts:
• Avoid using jargon such as the “Big C,” “a boo boo,” ‘an owie,” “a nasty seed,” or “something I ate” as these can give children the wrong ideas and be very frightening. Just say “cancer.”
• Don’t lie and don’t make promises you may not be able to keep. Instead of saying, “I promise to take you…” try saying, “I will try to…” Don’t promise that you will not die, that you will be there forever, as this cannot be true as everyone at sometime leaves (even if temporarily), and every plant, animal and human dies at some time.
• Don’t be afraid to say, “I don’t know” or “That’s a good question. I’ll need to think more on that and get back to you.”
• Give children “news bulletins” about the ‘need to know information- both good and bad news,’ and don’t push children into talking if they don’t want to. Leave the door open for future times to communicate.
• Establish a support system of extended family, friends, community members and/or contact a professional for additional help. Don’t let your child worry alone.
• Don't expect to be perfect. Talking to your kids about cancer can be challenging. If the conversation did not go as planned, learn for the next time and plan what to do differently. Anticipate what might happen. Be kind to yourself, you are human and some days will be good parent days and others not so good just like before you had a cancer diagnosis.

What signs or symptoms in my children do I need to worry about?
It is normal for children to be upset, or distressed when a parent has cancer. Your child may:
• Have nightmares or difficulty sleeping
• Be clingy, and not want to leave you
• Eat more or less than usual
• Younger children may have toileting accidents, bedwetting, and thumb sucking
• Act out at school or at home
• Complain of physical symptoms such as stomachaches or headaches
• Express feeling worried, sad or angry
• Withdraw from friends or not want to do their normal activities
After a few weeks, if your children are continuing to have problems, they might be telling you they need some help coping. To sort out if the concerns are a temporary adjustment or something that needs more attention, you may want to contact a professional counselor.


What if I am not going to recover?

A time may come when the reality is that you will not recover. It is very difficult to face the knowledge that you are going to die and to talk openly about death and dying to your family. It will also be difficult for you family and especially children. Yet, talking about your situation together and allowing your children to be a part of that process will likely help them prepare for the future and will most likely help them with their recovery from grief.

Children are often more knowledgeable than we think and need to be given permission to talk about what is happening. Speaking in a language they will understand, using open, honest and direct communication while avoiding jargon or complex clinical terminology, helps children of all ages navigate this difficult reality. Even though it is difficult, using precise words, such as “when I die…” is far less confusing for children. A child can become very frightened when euphemisms are used to explain death. For example, if you were to say that death is “just going to sleep,” your child might not want to go to sleep after you die, terrified that they too might die in their sleep at night.

Talking to your children may occur over many short conversations, as they may need information repeated many times, and in small doses in order to make sense of such challenging and profound loss.


What should I say if I am not going to recover?

Some suggestions for talking with your children:

• Explain death using real words rather than euphemisms.
• Share family traditions, religious or spiritual beliefs around death.
• Provide an abundance of verbal and physical affection to assure children that they will continue to be cared for and loved.
• Encourage your child to talk about their emotions and suggest ways for them to express their thoughts and feelings, and to ask questions. Books, journaling, drawing, role-play, and/or music, are some ways that can enhance both a child’s understanding and with their expression of emotions and thoughts.
• Explain that normal grief involves a wide range of emotions that the pain of grief will come and go over time, with some of those times being more intense than other times, and that their reactions may differ from those of an adult.
• Let children know that they need not feel guilty or feel that they are betraying the loved one who has died if they are having fun or feel happy. Protect family time and support your children in spending time with their friends and involvement in activities.
After the death of a loved one:
• Let children know that they are not to blame for the death and that the person who has died will not return.
• Children from the age of three years, understand the concept of saying “goodbye.” It is beneficial for the child to have a choice in how they want to say goodbye to a loved one.
• Pre-school and older children can be given the choice of attending a memorial service, but not forced to attend.
• Some children will want to attend the service but not the burial.
• Older children may want to help plan the memorial service.
• Let your child know what will happen at the service and if possible, ask if they would like to visit the place in which the service is to be held or the cemetery beforehand.
• Encourage a trusted adult to help care for a young child at the service or accompany her if she wants to leave early.
• Encourage children to speak with trusted others outside the family to enlarge their support network and give them additional opportunities to cope with their loss.


Children at different ages have different understandings of death and may experience different temporary reactions at different developmental stages:

• Birth to two years: Have no understanding of death. They will be aware of separation and will grieve the absence of a parent. At this age, a child may continue to ask for the missing parent and wait for her to return. This is the age when a child is most affected by the surviving parent’s sadness.
• Three to six years of age: Children of this age are curious about death and believe death to be temporary or reversible. This is an age of “magical thinking” and their understanding is a mixture of reality and fantasy and belief in “magical powers.” Preschool age children are most concerned with what is happening to them and often see themselves as the cause of events around them. It is common for this age group to feel guilty and believe that what they thought, said, or did made the loved one die. They might also believe that they can make the deceased person come back to life if they are “good enough.” They may be anxious about who will take care of them, about affected by the sadness around them. Children this age may have difficulty verbalizing and often react to the loss through irritable behaviors, aggression, physical symptoms, sleep difficulties, or regression such as thumb sucking, or bed-wetting.
• Six to twelve years of age: School age children can understand the finality of death. Up until the age of ten years old, death is seen as something that happens only to other people. By age ten, children can understand that death is universal, inevitable, and could happen to them and they may still worry that they are to blame. Many children this age want details about death and what specifically happens to the body after one dies. A range of emotions may be experienced: anger, shame, guilt, anxiety, sadness, fear of being abandoned, and worry about their own death. In this experience, children may have difficulty expressing their feelings and instead, react with a broad range of behaviors: school difficulties, physical symptoms, withdrawal, regression, and/or clinginess.
• Teenagers: Thirteen to eighteen year olds have the same understanding of death as an adult though lack the experience or coping tools of an adult. Teenage years are a time of intense emotions. In experiencing a wide range of emotions, a teenager may be uncomfortable expressing them and feel overwhelmed by the intensity. Having difficulty with expressing their feelings could lead to some teenagers developing behaviors such as directing anger at family members, irresponsibility with completing school work, or reckless with substances, withdrawal or regression. Struggling with independence from parents can cause some teenagers to hinder their ability to receive adult family support, creating greater tension. Teenagers cope with this tension by wanting to spend more time with their peers or alone.

If these symptoms become severe or persist, you may want to seek a professional counselor who can assist you and your child through the mourning process.

For a list of books that can help you and your child cope with a cancer diagnosis, please see our list of books.