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Introduction
It is normal for families facing a new diagnosis of cancer to be upset and worried about this crisis. For families of young children or teenagers, there is more concern as they wonder how children will react to a diagnosis of cancer in a family member. Here we discuss how to help children understand and deal with a parent’s or close family member’s cancer experience.
Often, to a large degree, how a child reacts to a cancer diagnosis will depend on how their parents or other close adults handle the crisis. Children learn through their parents’ behavior. While parents know this, they are still under a great deal of stress and they have their own intense feelings of fear and uncertainty. Sometimes, with the right kind of help, parents and their children can and do learn to cope with cancer and its treatments.
Why Do We Need to Tell Children About a Parent's Cancer Diagnosis?
Some parents fear their children will worry more if they are told the facts about the situation. It is important to realize that parents and children have very different life experiences. So it is unlikely that a child will react to a problem as an adult would.
Cancer is an impossible secret to keep. Ever heard the expression, “Little pitchers have big ears”? It means children tend to eavesdrop on adult conversations. When children hear conversations they aren’t meant to hear, they may pick up on the anxiety and worry of their parents. Often, they will tend to be afraid and believe the worst if they haven’t been given complete information. The effort it takes to keep such secrets may rob the parent of precious energy, too.
If children hear about their parent's cancer from someone else, such as a curious neighbor or a classmate, it can destroy the trust that parents have worked so hard to put in place. If children think their parents are being vague on purpose or are trying to hide something from them, they find it hard to believe they are being told the truth. So it is better that parents learn how to share this information truthfully, but in a way that allows the child to understand and take part in the discussion. The other problem in keeping the cancer a secret is that the child may incorrectly assume that whatever is happening is too terrible to be discussed. This may lead the child to feel isolated from the family, so the natural desire parents have to protect their children sometimes only makes things harder. Parents know that it is impossible to shield children from all of the stressful parts of life, and that their job is to teach their children how to manage these challenges.
How Should Children Be Told That a Parent Has Cancer?
Age is an important factor in deciding what and how much you should tell a child about a new diagnosis. The guiding principle should be to tell the truth in such a way that children are able to understand and prepare themselves for the changes that will happen in the family. Children thrive on routine – it helps them feel safe. When life becomes unpredictable, they will need help in adjusting to the changes.
Young children (up to 8 years old) will not need a great deal of detailed information, while older children (8 - 12 years) and adolescents will need to know more. Adolescent daughters of women with breast cancer will have different concerns than a 5-year-old who needs a parent 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, and how their own lives will be affected.
Young children (up to age 8) may need an explanation and 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 these parts and they’ve stopped doing what they're supposed to do. Part of the body is no longer normal. Over time, a tumor or lump develops. A tumor should not be there. Because tumors can continue to grow in other parts of a person's body, the person will need treatment to either take out the tumor or stop it from spreading to other places.
(See discussion of Treatment in next section). Older children (ages 8 through adolescence) may be able to understand a more complex discussion. They may be interested in seeing pictures of cancer cells or reading about the disease in the library.
In addition to the illness itself, there are other worries children have about cancer. The most common of these is that something they did or didn't do may have caused the parent's illness. While we know this isn’t true, 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 express 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 may be feeling guilty without saying so.
Other things children worry about are that cancer is contagious or that they can catch it, that everyone dies from it, or that they or the other parent will get it. It’s a good idea to correct these ideas before the child has a chance to worry. Children can become confused about how people get sick. A common worry is that cancer can be passed from one person to another. 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 that, years ago, people often died from cancer because doctors didn't know much about how to treat it. Many advances have now been made and the outlook for many cancers is much more hopeful. Now, people live with cancer instead of always dying from it.
Should I Expect My Child to Be Upset?
Some children may become very upset when learning about a new cancer diagnosis, while others may act as if nothing is wrong. The goal is to give the child a balanced point of view. The child should realize that cancer is a serious – but not a hopeless – illness.
A child's emotional reaction to this news will depend on many things, including how the information is presented and the child's experience with illness. It is important for parents to choose a time when they are feeling fairly calm to talk to their children. In a two-parent household, it’s a good idea for parents to talk to their children together. For single parents, it may help to ask a relative or friend to be with them if they're feeling a bit shaky about the conversation. If people are feeling distraught or uncertain about what to say, it might be better to wait until their emotions are a bit more under control. That is not to say that parents need to pretend that there is nothing to worry about. It is okay if their children see them crying on occasion. Parents can admit that this is an upsetting time, that cancer is a scary disease and that it’s okay to have strong feelings about it. That doesn't mean, however, that the family won't be able to find ways to deal with it.
Sometimes parents worry about showing any negative emotion in front of their children. They worry this will scare the children or that being negative will somehow affect their ability to cope with the illness. In the media, you see advice about developing a "positive attitude." In general, feeling positive is a good way to approach life. However, when people try to deny the very real feelings of fear and sadness, which are a part of any new diagnosis, the effort often just doesn’t work. The energy it takes to stifle negative emotions can sometimes make coping much harder. Many people feel that a grieving process occurs with a new cancer diagnosis. It is normal to be sad and upset after being diagnosed with cancer. It feels like nothing will ever be the same. Patients grieve for the loss of certainty and predictability in their lives. When these feelings are faced, it is much easier to work on having a positive mindset about the challenges ahead.
Obviously, no one wants to alarm his or her children by being hysterical. However, there is absolutely nothing wrong with shedding a few tears when a family has a crisis. Parents can tell their children that there will be times when they will need to cry about the situation, as that helps them to feel better. Parents can assure them that at some point they won’t need to cry, but that they are encouraged to express all of their feelings, angry or sad. Everyone deals with problems in a different way and it is important for parents to give themselves permission and time to figure out what is best for them and each family member.
If other family members have died from cancer in the past, children may assume history will repeat itself. It is important for parents to explain that there are more than 100 different kinds of cancer, there are several different kinds of treatments, and that all patients respond differently to treatment and have different outcomes for the future. Make sure children understand that each situation is different in its own way and that just because grandpa died 5 years ago doesn't mean the same thing will happen now. Everyone responds differently to treatment. Cancer treatment changes from year to year and better treatments are being developed all the time. No one can predict the future and people are approaching cancer treatment with new hope.
Are There Certain Reactions That I Should Look For?
Each child responds in his or her own way to the news of a parent’s cancer diagnosis. The age of the child, his personality, his relationship to the parent, and the way information is presented are just a few factors that can influence how a child will behave. Parents know their children better than anyone else and can expect their children to react in ways that are typical of their personalities. For instance, a child who is very dependent may become even more so during that crisis of a new cancer diagnosis. A child who always imagines the worst may do so now. A child who plays rough with his toys when upset may get even rougher. Children are often unable to express how they are feeling in words. Most parents get an idea about what is going on with their kids by watching their behavior. So, a parent who is observing their children fighting with each other more now can probably assume that this is their way of showing they’re upset. Parents put this into words by saying something like, "I know everybody is more worried right now, but let's talk about this instead of fighting."
In general, parents can expect that the stage of a child’s development determines his or her ability to understand what is going on. Children tend to regress or act younger when they are under stress. (Adults often do the same.) A child who has just become toilet trained may start having accidents. A child who has gone off to kindergarten quite happily may become upset at the prospect of separating from the parent. Children who have problems paying attention in school may have even more trouble concentrating than before. Usually these changes in behavior disappear after the situation returns to normal.
It is well known that children blame themselves when something goes wrong. This is because children see themselves as the center of the universe. We see this in children of divorcing parents. Kids assume they must have done something to cause the breakup of their parents' marriage. The same thing happens with illness. Children wonder if they are to blame. It is best to address this before the child asks about it, because children usually don't ask.
Trust is another issue that impacts a child’s behavior during this time. Generally, children who are included in this experience from the beginning with truthful information in small doses will have less anxiety than children whose parents are more evasive.
What if My Child Asks if I'm Going to Die?
The question, “Are you going to die?” causes the most distress for families. It is a good idea to rehearse how you are going to respond to this, either with someone else or just to yourself. There are some things you should know before you decide how to answer this question. First, allow yourself to admit that this is a scary question for you as well as your family. It is a difficult question for a child to ask and he or she may never have the courage to ask it directly. The issue, however, does need to be addressed. Whether you openly talk about it or not, you can be sure that your family members are worrying and thinking about death. There is usually no way to know at the beginning of the cancer experience if a person will die. The answer to the question depends on the patient's response to treatment. Even for cancers with a very poor outlook, a person's response to treatment can vary. Cancer is a chronic disease, not necessarily a terminal one. Even for cancers which may over time cause death, people can live for many years. For most people, this means they will deal with the real chance of death at some time in the future. In the meantime, the family's focus must be on how to live with cancer. For cancers that have already spread to other parts of the body (metastasized) at diagnosis, parents will need to be direct and give children different information, based on their children's ages and stages of development.
So, if a child asks if the parent will die from the cancer, there are a number of different ways to answer. Here are some examples of what other parents have said:
- Sometimes people do die from cancer. I'm not expecting that to happen because the doctors have told me they have very good treatments these days, and my type of cancer usually does go away with treatment.
- The doctors have told me that my chances of being cured are very good. I'm going to believe that until I have reason to believe something else. I hope you can believe that too. I'll tell you if I get new or different information.
- There is no way to know right now what's going to happen. I'll know more after the first treatments are finished. When I know more, I’ll be sure to tell you.
- There is not a lot known right now about the kind of cancer I have. But I’m going to give it my best shot and do everything I can to get well.
- My cancer is a hard one to treat but I'm going to do everything I can to get better. It's impossible to know right now what will happen down the road. What you can be sure of is that I'll be honest with you about what is going on. If you can't stop worrying, please tell me so I can make it better.
Obviously, what people tell their children depends on how they understand their particular cancer and its potential outcome. Even with an uncertain future, patients still need to work on what they must do to live with their illness. Children need to do the same. Regardless of the words that are used, one of the most important things for parents to communicate is their desire to tell the truth. This does not mean that parents should tell their children all they know as soon as they know it. It means that children should be given truthful information when they need to have it in order to cope well. A parent might say, for example, "I don't want you to worry about the future at this point. Let's think about what’s going on right now. If that should change, I promise you I will tell you. I will always try to tell you the truth. I want you to ask me any questions you have and I'll do my best to answer them."
How Can I Reassure My Child That Everything Will Be Fine?
Unfortunately, parents probably cannot offer the kind of blanket reassurance they would like to at the beginning of their experience with cancer. This is because no one really knows at that point how they will respond to treatment and that everything will be okay. In spite of this, there are things that parents can do to help their children cope. Parents can reassure children that no matter what, they will always be cared for. If the parent is feeling sick, they will arrange for someone else to fill in. The most important issue for children is their own sense of security and safety. Children depend on their parents for their basic physical and emotional needs. A parent's cancer can make families feel that their lives are totally out of control.
During this time it is important to realize that the entire family is likely to feel anxious and unsettled. The person with cancer will make trips to the hospital, their partner may take time off from work and, in general, family members will feel – and show – all kinds of emotions. In spite of all this, parents should try to keep as much of their children’s lives the same as possible. This may sound like a tall order, but it is usually possible to reorganize family routines at least for a short period of time.
In talking about your diagnosis and treatment, it is a good idea to prepare children for the fact that certain changes will need to be made in the family routine. Parents will need to call on others to fill in for them during periods of active treatment. Perhaps a relative will be moving in for a while to help out if a parent needs to be in the hospital. Perhaps the sick parent has friends who have volunteered to take turns in preparing meals for the family. A relative or friend may volunteer to pick a child up from school and take him to special activities. When these changes in family routines are explained to children, they offer a powerful message that Mom or Dad is still in charge and the child's needs will be met. Life will go on as normally as possible given the crisis the family is facing. The child will not be left on his own. Parents should confirm that no one is happy that life seems turned upside down right now, but it will not last forever. In the meantime, tell children over and over again you love them and that their needs will be met.
Sometimes children react strongly to changes in routine and parents feel frustrated and even angry as they try to meet everyone's needs. Keep in mind that it is no one's fault when parents get cancer and there is nothing they can do to change that fact. People have choices about how to handle the situation. Find something in the situation that the child has a choice about like whom they would like to meet at the school bus, or what they would like to wear when they go to a neighbor's after school. Don't spend endless time discussing issues back and forth – sometimes that's just the way things have to be at the moment. Children are not expected to like it when their routines are disrupted – adults don't like it either. Parents can admit this to their children along with the fact that they have a right to feel angry and upset right now. Although parents can't fix the situation, they should be interested in how their children are feeling.
Obviously, whatever needs to be done to care for the children will vary depending on the age of the child and how available others are to help. Young children have basic survival needs and are more dependent on parents to feel secure and safe. Teenagers present special challenges because they tend to test their need for independence. But it is logical to ask them to be there to fill in more for an absent or ill parent. Sometimes there may be a fine line between asking for help from a teenager and giving them too much responsibility for the household. Parents may need to recognize their teenager's normal desire for independence and assure them that you know they need their own time and space in spite of the fact that a parent is ill. Establishing a time for a "family meeting" in which parents and children can review how things are going in the family and make decisions about what should be different or stay the same may also be helpful.
Some families may find it difficult to ask for help. Families may not be living together or there may be a history of family tension. We know from experience that people who try to manage the problems that cancer can cause alone will have a hard time. Try to remember that usually people really do want to help, and if you allow them to help, they will feel useful and needed. If there is no one available to help, patients or their families should ask to talk with the hospital social worker or the nurse in the doctor's office about any community agencies that can help.
How Will I Know if My Child Needs Help?
Deciding if your child needs help can be confusing as parents try to sort out what is a "normal" response to a new cancer diagnosis and what is not. This is new territory and it will take some time to figure out what works best for you and your family. So while you are learning for the first time how your children react to cancer, you already have experience with how your children deal with other stressful events. Most parents can tell exactly how each of their children behaves when they are upset. Because children, especially young ones, are often unable to talk about how they feel, they show us by their behavior. Some children will become withdrawn, while others may fight, whine and complain. The most important thing to look for is how extreme the change is and how long it has been going on. A child who has usually gone to bed by him or herself may need more supervision with that routine for a period of time. One of the most common signs of depression in a child is a change in behavior like suddenly getting poor grades in school or losing friends.
If the usual methods of handling this are not working and the child is unable to accept extra support, professional help may be the answer. It may be useful to talk with the child's pediatrician, school counselor, or with the counseling staff at the hospital where the parent is receiving treatment. Since these experts have experience with how other children have reacted to illness in the family, they may be able to offer a useful way of looking at the problem. They should also be able to refer parents to others professionals who have experience with children whose parents have a chronic illness.
Additional Resources
More Information from Your American Cancer Society
We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345.
- After Diagnosis: A Guide for Patients and Families (also available in Spanish)
- It Helps To Have Friends When Mom or Dad Has Cancer
- When Your Brother or Sister Has Cancer
The following books are available from the American Cancer Society. Call us at 1-800-ACS-2345 to ask about costs or to place your order.
Other Publications*
Books for Adults
Can I Still Kiss You? Answering Your Children’s Questions About Cancer by Neil Russell. Published by HCI, 2001
Helping Your Children Cope With Your Cancer: A Guide for Parents by Peter Van Dernoot and Madelyn Case. Published by Hatherleigh Press, 2002
How to Help Children Through a Parent’s Serious Illness by Kathleen McCue and Ron Bonn. Published by St. Martin’s Press, 1996
Life and Loss: A Guide to Help Grieving Children by Linda Goldman. Published by Taylor and Francis Group, 2nd Edition, 1999
When a Parent Has Cancer: A Guide to Caring for Your Children by Wendy S. Harpham. Published by HarperCollins,Publishers, 2001
When Someone in Your Family Has Cancer. National Cancer Institute, 1-800-4-CANCER or www.cancer.gov
Books for Children
Lost and Found: A Kid’s Book for Living Through Loss by Marc Gellman and Debbie Tilley. Published by HarperCollins, 1999; Ages 9-12.
My Mommy Has Cancer by Carolyn S. Parkinson. Published by Solace Publishers, 1991
Sammy’s Mommy Has Cancer (Books to Help Children) by Sherry Kohlenberg, Published by Gareth Stevens Publishers, 1994
The Year My Mother Was Bald by Ann Speltz and Kate Sternberg. Published by American Psychological Association, 2002; Ages 9-12
Vanishing Cookies: Doing Ok When a Parent Has Cancer by Michelle B. Goodman, Published by Michelle B. Goodman,1991
*Inclusion on this list does not imply endorsement by the American Cancer Society.
The American Cancer Society is happy to address almost any cancer-related topic. If you have any more questions, please call us at 1-800 ACS 2345 at any time, 24 hours a day.
Revised: 09/07/2005
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