Helping Children When a Family Member has Cancer: Understanding Psychosocial Support Services

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When to get help

How will I know if I need counseling or other support?

When first diagnosed with cancer, most people go through a period of emotional turmoil, which includes feelings of anxiety, sadness, grief, and fear for the future. You may have questions about why this has happened to you; what does your life really mean; what about a higher power; as well as worries about your job, money, insurance, and other practical matters. Over time, as you move through cancer treatment, you will begin to figure out how to address these concerns.

If you have close relationships with other family members or friends, they will play a part in helping you cope with cancer and its problems. If things stay unsettled or you find yourself feeling sad much of the time, or if you feel unable to make even small decisions, it may help to talk with a counselor. The normal process is to feel more capable of meeting the challenges of the cancer diagnosis and treatment as you go along. Typically, you will begin to feel you can handle your treatment as well as the issues of other family members. But if you have constant feelings of hopelessness, anxiety, and fear you may need outside help. Trying to tough it out can waste time and energy. Getting the help you need can put you back on course much more quickly.

Family members may have their own issues as a result of your illness. In a marriage or long-term relationship, cancer happens to the couple, not just the patient. Sometimes couples have trouble talking about cancer and its many issues. Often this is because couples tend to protect each other, but in the long run, this can become a communication barrier. Even with the best intentions, each person can feel alone or abandoned instead of supported. Family members are often angry about the cancer. But they find it hard to talk about that to the person with cancer because they don’t want to seem to blame an innocent victim. With help, couples learn how to talk about their feelings without hurting each other.

If you seem to be talking about the same issue over and over again, you may be stuck. It might be helpful to talk with a professional to get another view on how you can move forward and support each other.

Single parents or couples with problems that started before the cancer may be even more stressed by the demands of the illness. Single people will need even more support from friends or extended family members. A single parent may want to talk with a cancer counselor or join a support group to meet others who are dealing with the same issues.

With troubled marriages or other relationships, you are often forced to look at and deal with old problems in order to heal and recover and move on to cope with cancer and its treatment. Dealing with cancer along with a troubled relationship is more stressful than most people can manage alone. Sometimes people worry that relationship problems or unresolved conflict will interfere with their getting well. There’s no evidence that stress causes cancer or affects treatment outcomes. But worry and pressure will affect your emotional responses and make life even harder than it has to be.

How will I know if my children need extra help?

Parents are experts when it comes to their children and often can predict how they will react to new and stressful situations. Many times parents can tell how their children are feeling by how they act. When children are upset, they often react with a more dramatic version of how they behave normally. Quiet children may become more withdrawn, loud and active children crank it up a notch, and children with learning problems start doing worse in school. Some kids may have more trouble being apart from a parent. Some begin to have trouble sleeping. Some kids express their emotional stress with physical symptoms like headaches or stomachaches. They may seem tired or sad a lot of the time. Any change in how your child usually behaves may be a sign that they need some attention.

Young children usually cannot talk easily about their feelings, so their behavior will usually tell you what might be going on. You can learn a lot by watching your child play. Listen to what they say to their dolls and action figures, watch what they draw in school, and observe how they act with their friends. Young children may seem to go backward (regress) instead of forward in learning new tasks. Toilet training may be stalled. Children may be insecure, clingy, or resist your attempts to correct their behavior.

Teens probably won’t regress in such dramatic ways, but they may argue more or be more distant as a way of acting out their distress. They may also have trouble in school. Teenagers may have trouble sleeping, or they may seem to sleep all the time. In theory, at least, teens are able to talk about their feelings, but sometimes that’s easier said than done. Try introducing a light topic and leading into a more feelings-related topic. A direct question like, “You seem worried, what’s going on?” could help open up the discussion.

Remember that not all problems are related to the cancer, even though there are times it can feel as if cancer has taken over your family’s life. But look closely at your child’s behavior and think about what else might be going on. Is your child having trouble adjusting to a new teacher? Are they upset about not being invited to a party? Are they struggling for more independence? While cancer in the family can certainly add a lot of stress, there may be other things going on in your child’s life that could explain their behavior. You might not know unless you ask.

Try to get your children to tell you what’s troubling them, if they can. A simple, “You seem very thoughtful (sad, worried, etc.) these days. Can you tell me about that?” may give you new insight to your child’s behavior. Check with the school to see if the behavior is also noticed there. Maybe a teacher is incorrectly assuming that because a parent is ill, the child should be treated differently. Often this just makes the child feel more isolated. Check out all of the possibilities before you decide what needs to be done to help your child feel better.

Also remember that a child’s personality is an important factor in how they will react to illness in the family. Some children are easy-going and kind of roll with the punches while others tend to make mountains out of molehills. Different things work for different children in a family, so think about how you handled each of your kids before cancer was part of your lives. Those same methods will often work again, even though the problems may be different.

It often helps to get as much information as you can about a problem from all possible resources. This means speaking with your child’s teacher, guidance counselor, pediatrician, or a counselor or social worker on staff where you are being treated. It’s also a good idea to ask your child what you might do to help them feel better. If your child seems distressed and talking about it together doesn’t help, the child may need outside help.

Always tell your children that they had nothing to do with causing your illness. As illogical as this idea may seem to adults, experts know from experience with families dealing with cancer that children usually believe, at one time or another that they had something to do with a parent’s illness. Also remind them that the focus on the cancer is short term. Life will go back to some kind of routine after treatment is over.

Children can become depressed or anxious, just as adults do, though they may not show it in the same ways. For instance, a common sign of depression in a child is a change in behavior, like suddenly getting poor grades or losing friends. Most children whose parent has cancer seem able to cope, but there may be times when it gets to be too much. If a child 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 or of hurting herself or himself
  • Feels extra irritable
  • Becomes very angry very quickly
  • Has changing grades
  • Withdraws or isolates himself or herself
  • Acts very different than usual
  • Has appetite changes
  • Has low energy
  • Shows less interest in activities
  • Has trouble concentrating
  • Cries a lot
  • Has trouble sleeping

When a child shows 1 or 2 of these symptoms, it might help to offer more support. But if the usual ways of handling these problems are not working, or if the problem goes on for more than 1 or 2 weeks, the child may need extra help. (For more serious problems, such as if the child is planning to hurt himself or herself, urgent help is needed.)

It may be useful to start with the child’s pediatrician, school counselor, or with the social worker or counseling staff at the hospital where the parent is being treated. Since these experts know 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 can evaluate the child and make sure that any needed help is given. They can also suggest books, videos, and children’s support groups that may help. Rarely, a child may need to see a psychiatrist for medicine or counseling.

Last Medical Review: 08/09/2012
Last Revised: 08/09/2012