Children and teenagers often respond to news of a cancer diagnosis with a range of emotions which reflect those of their parents. Their feelings vary with what each child goes through as a result of the diagnosis. Patients may become ill very quickly, have a lot of pain, or have many diagnostic tests. Or they may not feel sick at all. Some may need to travel far from home to see the doctors. Others may wait days or weeks to learn what is actually wrong with them. Some may miss school for a long time, or have to give up sports or other activities. Brothers and sisters may face sudden long separations from parents and each other. The family's usual life and daily routines are changed.

The child's age, development, and personality also affect their responses. For example, a toddler with cancer may fear being away from parents for scans and tests. School age children may understand what's going on, but still be angry and sad over what they've lost. Some teens may notice how the cancer affects their identity or sense of self. Others may be angry and rebel during diagnosis and treatment.

Each child is different, though there are a few common themes based on the age of the child. Keep in mind that the lists below are just some of the more common ways that children respond. There are many others. All responses call for patience and creative work with the cancer team to help the child through it.

Infants and very young children with cancer might

• fear being separated from parents
• be afraid of and upset by painful medical procedures
• yell, scream, throw tantrums, refuse to cooperate, or withdraw
• cling to parents
• become aggressive
• be angry or sad that they are restricted in their normal play and exploration

School age children with cancer might

• be upset by disruption of school
• miss seeing classmates and friends
• show anger and sadness over the loss of health, school, and normal life
• look for more emotional and social support from family and friends

Teens with cancer might

• be upset by the disruption of school and their activities with friends
• feel their independence is threatened
• show intense emotional responses
• need support from friends, school contacts, and others who are important to them
• focus on the meaning of life and the cancer's effect on their identity
• joke around about their cancer, distract from it, or try to "think positively"
• take risks that could cause problems
• rebel against parents, doctors, and treatments

Siblings of children with cancer have their own burdens

Siblings may feel shock, sadness, fear, and confusion over what to expect and what is expected of them during the illness. It is common for them to feel they somehow caused the cancer with angry thoughts or by wishing the child ill. While their brother or sister is in treatment, they often feel lonely, less valued, and jealous of the attention the sick child is getting. They may resent the changes in their lives, and then feel guilty about that as well. Siblings may have trouble with memory and concentration, which can cause school problems. Sometimes they deny or minimize these responses because they don't want to add to their parents' distress. Ways to help the child cope with these and other problems are discussed in the section "What helps kids with cancer and their brothers and sisters?"

Fear and anxiety

The child with cancer

Children with cancer are often as stunned as their parents by the sudden move from health to illness and the unwelcome tests and procedures needed to get a diagnosis. If the child needs to go into the hospital, it may be a new experience. It could be scary and overwhelming. Fear and anxiety are also the main emotions that both patients and siblings face after diagnosis.

It is very frightening to be told your body isn't working right, and that you have cancer. It is normal for the child or teen to be afraid of new and often painful experiences. It is hard to face having blood drawn, biopsies, bone marrow aspirations, lumbar punctures, scans, or other tests. Some kids fear they will not be able to handle the treatment. It is also upsetting to see your parents and relatives worried by all that is happening. It is disturbing to have to deal with a strange place and many new people. It is worrisome to think about what the treatment will do to your body, how you will look and feel, and how your friends will react. It is often terrifying to think that you might die.

Siblings of the child with cancer

Brothers and sisters have their own fears. Sometimes they are afraid that they also might get cancer. They may pick up on parents' anxiety and not understand what's going on -- they may not be sure what cancer is but they know it is bad news. They may be afraid to visit the hospital or see their brother or sister sick or in pain. They worry that they do not have the whole the truth about what is happening. They are concerned when they see their parents distressed and fearful. They are upset at being separated from mom or dad and being in the care of relatives or friends. They worry about going to school and maybe facing questions they cannot answer about their sick brother or sister. They are afraid their sibling will die.

Anger and guilt

The child with cancer

Anger and guilt are normal reactions of both the patient and his or her siblings. Patients question why this has happened to them. It is not fair! They are angry at all the things they have to do -- be poked and prodded, swallow nasty-tasting liquids, take big pills, talk to lots of strangers, lie in scary-looking machines, have their privacy invaded, and be kept in a hospital.

Feelings of guilt are also common. Children often worry that maybe they have cancer because they were bad in some way. Maybe something they did caused the cancer -- telling lies, smoking, trying drugs, having sex, or even having bad thoughts. They also may feel guilty that they are responsible for this family crisis and may be concerned about their parents. They feel guilty that they are causing all this worry and trouble that is painful for the adults who are important to them. This may be especially tough when parents are in conflict, divorced, or have other serious problems or stresses.

Siblings of the child with cancer

Siblings may also be angry that this has happened to their brother or sister. They are angry that life for them is disrupted and that things are never going to be the same. They are angry that their parents may not seem to have time for them, or don't seem to care about how unhappy they are. They may be angry that their brother or sister is getting all the attention. They may feel angry with their sibling for being ill and causing so much worry and trouble for everyone in the family.

They often feel guilty about their anger when their sibling is going through so much and their parents are so stressed. They may feel guilt about things that they did or said to the child with cancer. Some may feel guilt just because they are healthy and their brother or sister is sick. They may also worry that something they thought or did might have caused the cancer. It is rare that the child is able to say these kinds of things to the parents, but some may act it out by rebelling or being the "bad child"-- in contrast to the "good child" who has cancer.

Sadness and feelings of depression

The child with cancer

Feelings of sadness and depression are also common in children with cancer. They may realize that they will not be able to do some things that are important to them, such as dancing or sports, for a long time -- if ever. They feel sad when they realize they are now different from their peers. They may feel depressed when they think about the months of treatment facing them and how it might interfere with their life. They think about the changes in their body that will result from cancer and its treatment, and feel depressed about how they will look and how their friends may see them. They may also feel hopeless, and be afraid that the treatment will not work.

Siblings of the child with cancer

Siblings are also sad as they begin to realize that their brother or sister is really very sick and will need serious treatment. They feel sad as they witness their parents' distress, too. Younger children miss the parent who usually provides most day-to-day care when that parent is unable to return home for days or weeks after the diagnosis. Adolescents understand the risk to their sibling's life and may be depressed by a new awareness that life and health can be fragile. All young people are saddened by the changes in family life that often occur.

Both patients and siblings express these normal feelings based on age, their nature, level of intelligence, maturity, and coping style. Most young people are still learning to name their feelings and talk about these feelings to others. They are alert to the moods and expression of feelings of those around them, particularly parents. They are not always able or willing to talk about their fear, anxiety, guilt, or sadness, but may show their feelings through body language or behavior. Sometimes they look to parents and other key family members for cues about how to deal with their troubled feelings.

Although most children with cancer and their siblings seem able to cope, there are times when it gets to be too much. If a child in the family seems to be having trouble, it may mean a more serious problem than a normal, sad response to cancer. Extra help is needed if a child:

• is unable to handle the feelings of sadness
• feels sad all the time
• cannot be comforted
• admits to thinking of suicide
• feels extra irritable
• becomes very angry very quickly
• has changing grades
• withdraws or goes into isolation
• acts very differently from the usual
• has appetite changes (only count those that are not due to cancer treatment)
• has low energy
• shows less interest in activities
• has trouble concentrating
• cries a lot
• has trouble sleeping

These are signs that should be discussed with the youngster's doctor. You will want to talk with a mental health counselor or social worker at the cancer center who can evaluate the child and make sure that the child gets the kind of help he or she needs. Rarely, a child may need to see a psychiatrist for medicines or counseling.

Go back to Children Diagnosed with Cancer: Dealing with Diagnosis.

Last Medical Review: 06/02/2009
Last Revised: 06/02/2009