How do children with cancer and their siblings react to a cancer diagnosis?

Children and teenagers often respond to news of a cancer diagnosis with a range of emotions that reflect those of their parents. The child’s age, development, and personality also affect their responses.

Each child is different, but there are some 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 this time. Children with cancer and their siblings can benefit from the cancer team’s help. Be sure you get the help your family needs.

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, hit, or bite
  • Refuse to cooperate, be negative and resist requests
  • Withdraw, avoid interacting with others
  • Cling to parents
  • Be sad that their normal play and exploration are restricted
  • Regress to behaviors such as thumb sucking or bed wetting
  • Have nightmares

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
  • Feel guilty that they caused the cancer
  • Worry that cancer is “catching”
  • 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, detract from it, or try to “think positively”
  • Take risks that could cause problems
  • Rebel against parents, doctors, and treatments

Siblings of children with cancer might

  • Feel shock, sadness, fear, and confusion over what to expect and what’s expected of them during the illness.
  • Feel they somehow caused the cancer with angry thoughts or by wishing the child ill.
  • Feel lonely, less valued, and jealous of the attention the sick child is getting.
  • Resent the changes in their lives, and then feel guilty about that too.
  • Have trouble with memory and concentration, which can cause school problems.
  • Deny or minimize these responses because they don’t want to add to their parents’ distress.

Ways to help children cope with these and other problems are discussed in the section called “ 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 stay in the hospital, it may be a new, scary, and overwhelming experience. Fear and anxiety are the main emotions that both patients and siblings face after diagnosis.

It’s very frightening to be told your body isn’t working right, and that you have cancer. It’s normal for the child or teen to be afraid of new and often painful experiences. It’s hard to face being stuck with needles and having biopsies, bone marrow aspirations, lumbar punctures, scans, or other tests. Some kids are afraid they won’t be able to handle the treatment. It’s also upsetting to see your parents and relatives worried by all that’s happening. It’s disturbing to have to deal with a strange place and many new people. It’s 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 can be terrifying to think you might die.

Siblings of the child with cancer

Brothers and sisters have their own fears. Sometimes they’re afraid that they might get cancer, too. 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’s bad. They may be afraid to visit the hospital or see their brother or sister sick or in pain. They worry that they don’t know the whole the truth about what’s happening. They are concerned when they see their parents distressed and fearful. They’re 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 can’t answer about their sick brother or sister. They’re afraid their sibling will die.

Anger and guilt

The child with cancer

Anger and guilt are normal reactions. The child questions why this has happened to them. It’s not fair! They’re angry at all the things they have to do – be poked and prodded, swallow nasty-tasting liquids, take big pills, talk to 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 – telling lies, smoking, trying drugs, having sex, or even having bad thoughts – caused the cancer. They also may feel guilty that they caused this family crisis and may be concerned about their parents. They feel guilty for causing all this worry and trouble for the people 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 might also be angry that this has happened to their brother or sister. They’re angry that life is disrupted for them and that things are never going to be the same. They’re angry that their parents may not seem to have time for them, or don’t seem to care how unhappy they are. They may be angry because 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 they did or said to the child with cancer. Some might feel guilty just because they are healthy and their brother or sister is sick. They might also worry that something they thought or did might have caused the cancer. Rarely is a 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 won’t be able to do some of the things that are important to them, like 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 ahead and how it might interfere with their lives. They think about how the cancer and its treatment will change their body and feel depressed about how they’ll look and how their friends may see them. They might also feel hopeless, and be afraid that the treatment won’t 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 of the day-to-day care when that parent is unable to return home for days or weeks after the diagnosis. Teens 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.

Signs a child needs extra help

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’re alert to the moods and expression of feelings of those around them, particularly their parents. They aren’t always able or willing to talk about their fear, anxiety, guilt, or sadness, but might 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 might get 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 or hurting himself or others
  • 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 (not counting those that are 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 child’s doctor. You can 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 medicine or counseling.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: September 22, 2014 Last Revised: October 9, 2014

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