Helping children understand cancer:

Talking to a child about illness in the family, or about their own

Reprinted with permission of Cancer Care, Inc.®

Cancer is a complicated disease to understand, even for adults. There are many types of cancer and no easy way to describe them, especially in simple terms. But if your child has cancer, discussing it with your children may be the most important thing you do. Because when someone in your family has cancer, it affects the entire family, including your children.

“Protecting” Children Can Sometimes Make Things Worse

When cancer strikes a family, children sense that something is wrong, even if they don’t know what it is. Talking it over with them, using words that they can understand, is always better than trying to hide it from them. If you keep things from them, children can imagine that things are even worse than the real situation.

For example, it is not uncommon for young children to think their actions somehow cause a parent or sibling to get cancer, perhaps from something “bad” that they did. It is important not only to communicate with your children, but to listen to them to make sure they understand what is happening. No matter what their age, there are ways to communicate with children about cancer, treatment, and, if necessary, life and death.

How to Tell Your Child That You or Someone in Your Family Has Cancer

When a child’s life is touched by cancer, it can cause a great deal of emotional trauma—mostly because any kind of serious illness is scary to a child. Fortunately, as a parent, you can help your child overcome many of his or her fears, often simply by explaining the situation in a calm, reassuring way.

To help you talk to your child about someone in your family who has cancer, Cancer Care offers the following tips on communication:

1. Tell them about the illness. Although cancer is complicated, there are ways of discussing it that are appropriate for a child of any age. For very young children, “Mommy is very sick, so she has to go to the hospital to get well again” is usually enough. For older children, a more detailed explanation is better. The more they can know, the less helpless and afraid they will feel.
2. Practice your explanation beforehand. It will be a great help to your child if you can be as calm as possible when you discuss cancer, especially if you are the one who is ill. You should practice the conversation with your spouse or a friend, so that you can focus on your child’s fears, and put aside your own for a while.
3. Remove any blame. The younger the children are, the more they think the world centers around them, and the more likely they are to feel responsible for a parent’s or sibling’s illness. Assure them by saying that nothing they or anyone else did caused the cancer.
4. Explain to them that cancer is not contagious. Most children first experience sickness when they get a cold, measles or some other childhood disease that might have been fairly contagious. It is important that you explain to them that cancer is not contagious. They will probably already be afraid that someone else in the family will now get it. Assure them this is not true.
5. Try to balance optimism and pessimism. Telling your child that someone will be “all better” will only make them more confused and upset if it is not true. On the other hand, being very pessimistic can scare them needlessly. It is usually best to try to offer a realistic but hopeful assessment of the situation.
6. If you have cancer, try to stay in contact. If you are in the hospital for any extended period of time, your children may think that you don’t want to be home with them. Staying in touch will help reassure them that your illness has nothing to do with how much you love them.
7. Take your children’s feelings seriously. It is common for children to have many different reactions when they learn a parent or sibling has cancer. These can include anger, sadness, guilt, fear, confusion and even frustration. All of these responses are normal. Let them know that it is ok for them to have lots of different feelings—you may have many of them, too.
8. Answer questions honestly. Discussing cancer with a child can be difficult, especially when there are so many questions that adults or even doctors cannot answer. It is best for you to be as honest as you can with your child, and not be afraid to say “I don’t know” if you don’t. For children, the amount of information you give them is usually less important than making them feel comfortable with what you say.
9. Help children understand treatment. Children’s greatest fears often spring from what they don’t know. Their imagination often creates a picture that is worse than what is really happening. Explain the treatment process in a way that is appropriate to their age—don’t forget, it is easy for a child to imagine something like chemotherapy or radiation therapy is “bad” because it can cause hair loss, nausea and other unpleasant side effects.
10. Prepare your children for the effects of treatment. Cancer and cancer treatment can often dramatically affect someone’s appearance. Physical changes such as hair or weight loss can sometimes frighten them, or make them think a person is “changed” or “different.” It is best to explain to them beforehand, so they are prepared. For example, “When mommy was sick in the hospital, she lost weight, and her hair fell out—but don’t worry, it will grow back. And she’s still the same mommy on the inside.”
11. Let children help, but don’t burden them with responsibility. It is important to let children know that they can help their parent feel better. It will make them feel less helpless if you let them run an errand, bring a glass of orange juice or do some other task that is appropriate for their age. But be careful not to burden them with too much. The stress of having someone ill in the family can be great. They will need lots of time to just play, relax and be children.
12. Be prepared to discuss death. This is a complicated topic, but if you or your family member is very ill with cancer, you should be prepared to discuss death with your children. It is impossible in this short space to suggest ways to discuss this with your child. You may want to consult with a trained counselor or clergy first. One of the most important things to remember is to take your child’s age into account—pre-schoolers, for instance, do not understand that death is final; school-age children tend to know that dead things don’t eat or breathe or sleep; by the age of 10, children begin to understand that death is the end of life.

Regardless of your child’s age, when discussing death, remember three things: 1) Try to use very clear, specific terms. Being vague will only confuse your child. 2) Do not use terms like “sleeping forever” or “put to sleep,” because children will think sleeping is like death, or be afraid that if they sleep they might die. 3) Finally, be patient. It will take a long time for a child to fully understand and accept any type of loss. They certainly will not understand the first time you try to tell them.

Remember, when cancer strikes a family, children know something is wrong. Trying to protect them will only make them imagine the worst, and will prevent you from helping them understand and eventually accept what is happening. If you need help in talking to your children, don’t be afraid to ask for it. Being a parent doesn’t always prepare you for every situation, and being unsure of what to say is no reason to be ashamed.

Many parts of this brief were liberally borrowed from Lynne S. Dumas’ book, “Talking With Your Child About A Troubled World,” published by Ballantine Books. Our thanks for her permission of use.

“Mira’s Month,” a book for children whose parents have cancer, is available from BMT Newsletter. Written by a woman who underwent an ABMT for breast cancer, the book is designed to help young children cope with the experience. To order the book, use the order form on page 15.

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