Infants and very young children (birth to age 3)

Here are some ideas for helping infants and very young children with cancer. In the second part, there are ideas for infants or very young siblings of the child with cancer.

The infant or very young child with cancer

• Soothe and comfort by being with the child, holding, touching, rocking, and singing or playing music.
• Cuddle and hug toddlers often.
• Be with baby or child during tests and procedures.
• Distract with toys and colorful things.
• Keep favorite stuffed animal, blanket, or other objects that are special to the child near by.
• Use a stuffed animal to let the baby know when a staff member or visitor entering the room is safe (isn't going to do anything that causes pain) to help the infant stay calm.
• Try to establish the crib as a safe, treatment-free area.
• Limit the number of visitors.
• Have siblings visit as often as feels comfortable for the situation (based on the health and the need of each child to socialize).
• Create a cheerful hospital room with good lighting, art, and bright colors.
• Maintain as much of a schedule as possible, including nap times and meals.
• Set aside time for play.
• Record lullabies, stories, or messages when a parent cannot be with baby or child.
• Seek advice from recreation therapist or child life worker on other ways to help.
• Talk with other parents of very young children with cancer to see what works for them.
• Talk with team social worker or nurse about your own emotions in dealing with baby's distress.

Infants or very young siblings of a child with cancer

• Keep the baby or child near the parents, if possible.
• Get relatives, nanny, or day care providers to help maintain baby's or child's routine.
• Have a parent or trusted adult who is a consistent part of the child's life see the baby or child daily.
• Record lullabies, stories, and messages when a parent cannot be at home.
• Offer frequent reassurance to toddlers that mommy or daddy will be back soon.
• Cuddle and hug often.
• Arrange visits to ill brother or sister.

Toddlers or pre-schoolers (ages 3 to 5)

Here are some suggestions to help toddlers up through age 5 cope with cancer.

The toddler or pre-school child with cancer

• Give very simple explanations of what is happening and repeat them often.
• Comfort your child when he or she is upset or fearful.
• Check on your child's understanding of what is happening.
• Do not try to persuade the child through reasoning.
• Offer choices when possible.
• Do not tolerate biting, hitting, kicking, or other aggressive behavior.
• Teach acceptable expression of angry feelings such as talking, drawing, pounding a pillow.
• Encourage doll play and other play to rehearse or repeat worrisome or painful experiences.
• Discourage whining and tantrums.
• Create opportunities for physical activities.
• Maintain a schedule for meals, naps, and play.
• Teach staff about what works to get child's cooperation.
• Talk with the child life expert or social worker about how to reward good behavior when the child cooperates with tests and procedures.
• Make use of experts on the cancer team to help you with your child or teach you useful strategies.
• Give simple explanations for a parent's crying and sadness. For example, "I just feel a little sad and a little tired today. It makes me feel better to cry and get it all out of my system. Now I feel better."
• Don't forget humor -- laugh together when possible.

Toddler and pre-school siblings of a child with cancer

• Give a simple explanation that brother or sister is sick and that the doctors are helping.
• Offer comfort and reassurance about the parent's absence.
• Arrange for reliable daily care, and maintain usual routines.
• Keep caregivers informed about family situation.
• Have a parent or trusted adult who is a consistent part of the child's life see the child daily, if possible.
• Have sibling nearby (for example, use a local Ronald McDonald House during hospitalization or treatment).
• Be alert to changes in behavior.
• Reassure sibling about parent's distress and sadness.
• Consult with cancer team professionals about any concerns.
• Talk with the child life expert or social worker about ways to provide positive reinforcement for newfound independence and supportive role in the family.

School-age children (ages 6 to 12)

School-age children are especially sensitive to parental feedback during the time of illness.

The school-age child with cancer

• Explain diagnosis and treatment plan in terms the child can understand.
• Include the child as much as possible in talks about diagnosis and treatment.
• Answer all questions honestly and in understandable language, including "Am I going to die?" (talk with cancer care team about how to answer these difficult questions).
• Listen for unasked questions, and pay attention when the child talks about fears and concerns.
• Offer repeated reassurance that the child did not cause his or her cancer.
• Encourage and help youngsters to identify feelings.
• Teach that sadness, anger, and guilt are normal feelings and that it's OK to talk about them.
• Teach about feeling and managing anxiety.
• Relieve anxiety about missing school by supporting as many connections to the child's teacher and classmates as possible.
• Console the child over missed sports events and other activities.
• Encourage expressing feelings, especially anger, and safe ways how to do that.
• Use team professionals to intervene or suggest strategies for parents to use.
• Allow the child to keep feelings private, if that is preferred.
• Suggest personal recording of thoughts and feelings through writing or drawing.
• Make sure there is fun and pleasure in each day.
• Arrange for daily physical activity, if possible.
• Help the child stay in touch with siblings, friends, and classmates by using cards, phone calls, e-mail, and other methods.
• Make plans with team members and teacher to keep up with schoolwork, which may include classes on speakerphone or internet, recordings of class discussion, and visits from classmates (if possible).
• Plan the child's return to school when the cancer care team can estimate a date.
• Use humor to distract.
• Arrange contact with other patients to see how they have dealt with cancer.

School-age siblings of a child with cancer

• Let the sibling tour the clinic, meet the medical team, and ask questions if possible. Provide understandable information about diagnosis and treatment, and keep the sibling up to date with what's happening. Find out if the cancer center has special group for siblings.
• Answer all questions honestly, including, "Will he (or she) die?" Get help from the social worker and cancer care team if needed.
• Listen for unasked questions, especially about personal health.
• Tell the sibling's teachers, coaches, and other school staff about the family's cancer situation.
• Offer repeated reassurance that the sibling did not cause the cancer.
• Arrange for the child to stay in school and do other activities on schedule as much as possible.
• Support the sibling's having fun, despite brother or sister's illness—make sure they don't feel guilty about it.
• Arrange for good child care; if possible, let the sibling help choose where to go after school, and whose care they prefer when a parent can't be there.
• Plan for the daily availability of a parent or trusted adult who is a consistent part of the child's life.
• Teach about normal feelings, such as fear, anxiety, sadness, guilt, and anger.
• Encourage the sibling to share their feelings, taking the time to attend to emotional concerns as well as physical needs.
• Accept the sibling's unwillingness to talk about feelings if they don't want to talk.
• Explain that even though the parents have less time for the siblings during the treatment period, they are still loved and valued just as much as the sick child.
• Suggest siblings write, telephone, send drawings, text or voice messages to patient.
• Offer reassurance that the family will be OK.
• Explain that the parents' distress, sadness, or crying is OK.
• Arrange for one family member or friend to take a special interest in each sibling.

Adolescents (ages 13 to 18)

The teenage years are challenging as teens are learning to separate from their parents and be more independent. Illness forces some of the task of separation to be put on hold.

The teen with cancer

• Offer comfort and empathy.
• Include the teen in all discussions with the parents and medical care team about diagnosis and treatment planning.
• Encourage the teen to ask questions (parents should listen for unasked questions).
• Give information on normal emotional reactions to a cancer diagnosis.
• Provide repeated reassurance that they did not cause their cancer.
• Address spiritual concerns or questions such as "Why me?" (or encourage others to address them).
• Encourage the teen to share feelings with someone: parents, family, friends, or staff.
• Be willing to tolerate some reluctance to communicate thoughts and feelings.
• Encourage the teen to keep a journal or log.
• Allow private time for the teen to talk with team professionals.
• Offer assurance that the patient, parents, and family members will be able to manage the crisis.
• Address feelings of anger and frustration (even if they are unspoken).
• Use team professionals to teach new coping strategies.
• Encourage the teen to share news of diagnosis with friends and classmates, and stay in touch with them.
• Arrange for visits of siblings and friends.
• Plan with team members and teachers at school for keeping up with classes, as well as the return to school and any restrictions that might apply.
• Make sure there is some fun and pleasure in each day.
• Use humor to deal with frustration.
• Help the teen make contact with other adolescent patients, if desired.

Teen aged siblings of a child with cancer

• Arrange for the teen sibling to tour the clinic and ask questions of the cancer team if they wish.
• Keep the sibling up to date with what's happening during treatment.
• Find out if the cancer center has special group for siblings.
• Answer all questions honestly.
• Reassure all that cancer is not contagious.
• Offer assurance that nothing they did or said caused the cancer.
• Inform the teen sibling's teachers, coaches, and other school staff about the family situation.
• Discuss spiritual concerns related to diagnosis.
• Encourage sharing of feelings and talk about what is normal.
• Explain that even though the parents have less time for the siblings during the treatment period, they are still loved and valued just as much as the sick child.
• Arrange for the management of daily life at home.
• When possible, let the sibling help choose where to go after school and have a voice in whose care they prefer when a parent can't be there.
• Provide assurance that the family will be able to handle the crisis.
• Encourage teens to keep up their usual involvement in school and other activities.
• Don't expect the teen to take on caregiving and other difficult tasks. Talk with the cancer care team about your family situation and see if you can get other help.
• Ask a relative or friend to take a special interest in each teen sibling.

Like parents, patients and their siblings will find that with the help and support of those who love them they will be able to handle this cancer crisis. Cancer care teams can refer you to skilled experts to help your family as needed, offering teaching, counseling, support, information, and other resources to make the task easier.

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

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