Age is an important factor in deciding what and how much you should tell a child about a cancer diagnosis. The guiding principle should be to tell the truth in a way that children are able to understand and prepare themselves for the changes that will happen in the family. Kids thrive on routine—it helps them feel safe. When life becomes unpredictable, they will need help adjusting to the changes.
Young children (up to 8 years old) will not need a lot of detailed information, while older children (8 to 12 years) and teens will need to know more. Teens, who are testing their independence and limits, will have very different concerns from a 5-year-old who needs parents for basic caregiving.
All children need the following basic information:
- The name of the cancer, such as breast cancer or lymphoma
- The part of the body where the cancer is
- How it will be treated
- How their own lives will be affected
First, set up a quiet time when you won’t be disturbed. You may wish to talk to each child alone so that information can be tailored to each child’s age and understanding. This can also help the parent pay closer attention to how each child responds. The child may also be more willing to ask questions when away from the other children and possible distractions. Be sure you have time to answer questions and a plan to manage interruptions before you start. If you stop to answer the phone, turn off the stove, or let the dog out when your child is opening up to you, the child may find it more painful to try again.
It helps to plan how you will talk with each child. Think about what you want to say and how to answer questions on a level each child can understand, but in a serious and thoughtful way. You are trying to lay the groundwork for an open line of communication with the child—a way for the child to come to you with their concerns, needs, and fears. If you can start this and keep it going by regularly checking in with each child during and after the cancer treatment, it can be a great comfort to them.
Young children (up to age 8) can be told that the body is made up of lots of different parts. When someone has cancer, it means that something has gone wrong with one of these parts and it’s stopped doing what it’s supposed to do. Part of the body is no longer normal. Over time, a tumor or lump has developed, or a bunch of bad cells started to grow (in the case of leukemia and lymphomas). The tumor (or the bad cells) should not be there.
Cancer can spread and grow into other parts of a person’s body, so the person needs treatment to either take out the tumor or stop the bad cells from spreading to other places. Some kids may not have any questions at first, but invite them to ask you later if they think of any. Older children (in general, ages 8 and up) may be able to understand a more complex discussion. They may want to see pictures of cancer cells or read about cancer treatment. Again, encourage them to ask questions that they may think of later.
Besides the illness itself, children have other worries about the cancer. The most common of these is that something they did or didn’t do might have caused the parent’s illness. We know this isn’t true, but most children believe this at some point during the cancer experience. Parents know that children engage in “magical thinking.” They believe they are the center of the world and that they can make all kinds of things happen. Children can also believe that bad things happen because they have been angry with their mom or dad. So when a parent gets sick, children often feel guilty and think they are to blame for the cancer. Kids usually won’t tell you this, so it’s a good idea to reassure them about it. Parents can say something like, “The doctors have told us that no one can cause someone else to get cancer—it’s nothing that any of us made happen.” It’s better not to wait to see if children bring this up because they could be feeling guilty without saying so.
Children may also worry that cancer is contagious and they can catch it, or that everyone dies from it, or that the other parent will get it, too. It’s a good idea to correct these ideas before the child has a chance to worry. Kids can become confused about how people get sick. A common worry is that cancer can be passed from one person to another, like a cold. Parents can explain that cancer is a different kind of illness and the child doesn’t have to worry that someone passed it on to Mom or Dad or that they will get it.
Parents should also say that it would be very unusual for the other parent to get sick. They may want to tell their children something like this: “Years ago, people often died from cancer because doctors didn’t know much about how to treat it. Doctors have learned a lot more about it since then, and there are treatments that can cure many cancers. Now, people can live with cancer instead of dying from it.”
So along with the basics about the parent’s cancer as noted above, be sure to stress these facts:
No one caused the parent to get cancer. (It’s not the child’s fault.)
You can’t catch cancer like a cold or the flu—it’s OK to hug or kiss the person with cancer.
The family will work together to cope with cancer and its treatment.
Even though the sick parent may not have as much time with them, the children are loved and will be taken care of while the parent is sick.
You may need to make these points more than once. More importantly, the parent and other adults in the child’s life can serve as examples and remind the child of these things too. Children pick up on small cues in how you and others act around them, so if they notice adults don’t hug the sick parent like they used to, a child may worry. Or if adults are in a hurry and don’t speak as kindly to the children as they once did, the children may think the adults are mad at them or blame them in some way for their parent’s illness.
