How to Talk with Our Kids About Cancer: Age-Appropriate Conversations

Hearing the words, “You have cancer” is a challenging and stressful experience for any individual. From diagnosis through treatment, we’re faced with countless decisions, painful surgeries, constant anxieties and treatments that try our strength and resilience in ways we could never anticipate. Yet, another significant challenge that comes along with cancer is how to share the news with friends and family, especially our children. While it’s important to provide our kids with information and tools to prepare them for the journey, knowing what to say, how much to share and when to share it is not easy.

This week in the Journal, we’re breaking down different aspects of communicating with our children, to both aid these conversations and ensure that they feel nurtured, protected, informed and supported every step of the way.

The hard truth: “Mommy has cancer.” 

Telling our kids that we have cancer may be one of the hardest things we will ever have to do. Being forced to induce sadness and fear, or cause them to feel unsafe in any way feels heartbreaking and completely unfair. But according to  MD Anderson Cancer Center, “Research shows higher anxiety levels in children who aren’t informed of a parent’s decision.” 

“Cancer is scary, and it’s scary to talk about bad things, especially when there are so many unknowns about it,” recognizes child psychologist Kate Eshleman, PsyD. “As an adult, you don’t always know what you’re dealing with, which can make it more difficult to speak to children about it.”

Taking time to think about all aspects of the discussion in advance is critical and can be broken down into a few different considerations.

What is best for my child/children? 

Before sitting down to talk, it’s important to consider our kids’ nature. Are they curious seekers of information? Are they more emotional and tend towards overwhelm? Are they inclined to want to protect us and take on too much? Or are they more social to where informing them that family and friends will be around throughout the process could provide added reassurance? Staying aware of our childrens’ tendencies can help us gauge the style of our conversation in an effective, more protective way.

What’s best for me?

It’s also essential to be present with our own mind state. Some days, we may feel more shaky or uncertain, afraid and vulnerable. Waiting until we're more stable and perhaps asking someone else to participate or lead the conversation can help. Of course, this doesn’t mean that we cannot be emotional with our kids. In fact, being open and authentic is important and may even facilitate a deeper level of bonding. But it’s important to share our news at a time when we feel centered and able to focus on our kids and their concerns. 

Where should the conversation take place?

When starting this conversation, it is helpful to be in a location where our child feels comfortable and safe. This helps to promote a sense of security and reduces the chance of other worries arising simultaneously. It's also a good idea to have other, well-trusted family members or friends present for the dialogue, as they will help instill a sense of community and both visually and audibly communicate that there are other people around to provide support and comfort. 

What exactly should I say?

Every parent-child relationship is different, and our conversations with them will be too. Keeping to the facts, being as natural as possible and encouraging questions right away is a great place to start. We may not always have answers for their questions, and that’s ok. It’s healthy for kids to understand that we are humans, too, learning and discovering things as we go. Following up with answers at a later date is also a great way to continue the discussion, making for an ongoing stream of open communication. 

According to the Dana-Farber Cancer Center, when it comes to talking with our kids, “There are no absolute right or wrongs. Like most parenting, the actual words you use are not as important as letting your children know that you are there for them, and that they can bring their questions and fears to you. You may even find that as you talk about your illness, you and your children develop a closer connection that strengthens your discussions about other issues.”

Questions Our Children May Ask

During our conversation, common questions that our children might ask are:

• “Am I going to get cancer?” 
• “Is it contagious?”
• “Are you going to die?”
• “Who will take care of me when you’re in the hospital?”
• “Are you going to get better?”
• “Will our lives go back to normal?”

Depending upon our circumstances, the answers to these (and many other) questions will vary. The most important thing is to answer them as best as we can, validating our kids' concerns and reassuring them as best as we can. Even if we don’t have answers, such experiences will show them that they can share difficult conversations with us, a healthy tool for all ages.

Age-Appropriate Conversations

Children Under 6 

Very young children are unlikely to have much knowledge about cancer, so it’s up to us to decide how much or how little to share. It’s best not to frighten them or overload them with information. For example, we may decide to tell them we have a bad lump in our body that needs to be removed.

Using dolls, stuffed animals or pictures can help explain things further. Storybooks can also help prompt questions and provide answers. (Though be sure to read the book before sharing it with our children to make sure it’s appropriate and fits our circumstances!)

Most young children don’t like routine changes or may worry about being separated from us. When we go into the hospital, it’s important that they know when we will be back and that they won’t be left alone or with someone they don’t know. They will likely want to know details about their daily schedule, such as who will be feeding them meals, taking them to school/daycare and putting them to bed. 

Children 7 to 12 

In this age group, it helps to first find out what our kids already know about cancer so that we can correct any misunderstandings.

A good place to start is to tell them what’s happened and what we and the doctors are going to do about it. We can then ask them what they want to know about our diagnosis or treatment and when they want to talk (this may be different from what we imagine).

Most children study the human body in primary school, so they will have some basic knowledge about cells and the different parts of the body. We may want to look at some factual information with them or read a suitable story. We can talk with them about our feelings and encourage them to share theirs too.

Teenagers

Most teenagers will have heard of cancer and may know – or think they know – something about it. They may have heard about experiences from friends or people who have died from cancer, so it’s useful to find out how much they know up front.

Teenagers may want more detail about cancer, but they may also prefer to find out about it on their own. If so, guide them towards reliable sources of information. Try to monitor where they research, as some sources can be less trustworthy or inaccurate.

Older children may be anxious about getting cancer too, particularly if they’ve heard that it can run in families. If we are concerned that our children may be at increased risk, we can offer to speak to our nurse, genetic counselor or doctor.

It’s normal for teenagers to want independence and to distance themselves from parents or family. Thus, they may not know how to reconcile a parent who might need to depend on them for a period of time. They may feel torn between wanting to be there for us and dealing with their own lives or problems, such as relationships, friends and school work.

More on advice for various age groups from Living Beyond Breast Cancer.

Explaining Side Effects 

If we are having chemotherapy, it’s important to prepare our children for side effects such as nausea, tiredness, and the possibility of losing our hair. Let them know it doesn’t mean the illness is getting worse. We can also explain that these symptoms will eventually (hopefully) go away, and our hair will grow back.

Once we have a diagnosis, telling their teacher and possibly the school nurse will help prepare them for answering questions or giving our children extra support.

Letting Our Children “Help Out”

Kids like to help out and feel useful. They might like to be involved in everyday tasks such as:

• Helping with our make-up
• Helping us put on a wig or a scarf
• Helping with household chores and shopping
• Watering the garden
• Making us drinks
• Looking after any pets
• Helping to look after younger siblings or grandparents
• Assisting during meal time

Talking to Our Children’s School About Our Cancer

School is an important part of our children’s life, at any age, and the academic community can help provide stability and support at a time of change at home. Interacting with our children’s school may feel daunting, but by working with the school, we can enable the staff to plan and provide additional support they need.

When sharing information with a school, it’s recommended to speak with our kids in advance, to make sure they know who we’re telling and why. Their favorite teacher might not be the one we immediately think of, so it’s a good idea to check with them first. Young children sometimes want their class to be informed, while older kids may want as few people as possible to know.

Seeking Help

If we’re finding it difficult to talk with our children or feel they’re not coping well, we may want to speak to our family doctor, a nurse specialist or a therapist. They can put us in touch with experts and communities who work with children and families affected by cancer. Support services and counseling are excellent ways of facilitating communication, making it easier to answer questions and manage difficult behaviors and emotions. 

After Cancer Treatment

Once treatment has finished, our children may expect everything to return to normal. Yet our body will need to heal and recover, which means it might take a while for us to regain our strength and energy. Keeping our kids abreast of our progress and follow up appointments can be an impactful way to include them on the healing journey. This continued dialogue can help them better understand the different stages of recovery and reduce lingering anxieties.

Continuing the Dialogue

Open communication between parents and children is essential for healthy, functioning relationships. The earlier the diagnosis is shared with our kids, the easier it will be for them to understand the changes happening. Being honest, age-appropriate and empathetic when addressing their concerns will help ease their anxieties and adapt to changes in their lives.

Additional Resources

We are not alone in this journey. Beyond local support groups, therapists and camps for kids whose parents have cancer, here are some additional helpful resources:

• The Bright Spot Network provides free children’s books on the subject, along with a guide for parents featuring age-appropriate ways to discuss cancer with our kids.
• Kid-to-Kid: Your Parent Has Cancer is a video from MD Anderson that explains cancer, its treatments, how kids can support us as parents, and ways they can express their feelings and emotions.
• The American Cancer Society offers practical advice on how to talk to children of different ages about cancer.
• Little Hearts of Hope is a faith-based organization that sends monthly activity packets filled with hope to children who have a parent or sibling dealing with cancer.

"You never know how strong you are until being strong is the only choice you have." — Cayla Mills