How to Talk to Kids About Cancer

People who are diagnosed with cancer usually have a few immediate questions. What will treatment be like? Am I going to be OK?

And for parents: How will I tell the kids?

It can be a tough reality to face. But Kimberly Fradel, a licensed clinical social worker with UNC REX Cancer Care, encourages parents to talk to children soon after a cancer diagnosis.

“Kids are perceptive,” Fradel says. “They can observe changes in routine, behavior, and oftentimes know more than we realize.”

The benefit of having an honest and age-appropriate conversation with your children is that you can control the information they are given. By talking openly to your children, you are sending them a powerful message that you trust they can cope with this information and that you will fight cancer together as a family. It can be hard to navigate those tough conversations. Here are some tips parents can use when talking to kids of any age about a cancer diagnosis:

  1. Your cancer is not their fault. Whether your kids are preschoolers or teenagers, it’s important they know that mom’s or dad’s cancer is not their fault. They did not cause it or contribute to it in any way.
  1. Use the word cancer,” not sick.” It’s important for kids to know their parent’s cancer is not contagious. They can still hug, kiss, cuddle and spend time with their parent without fear of getting sick.

When you use the word “sick,” children tend to think of conditions such as a cold or the flu. Using the word “cancer” allows you to build meaning of the word. Children are resilient and can often adapt to many situations.

  1. Keep expectations and schedules intact as much as possible. Children respond well to predictability in their daily lives. Because cancer can often bring about uncertainty, try to predict how their day might be different. If you can’t make soccer practice or pick up your children from school, explain why those changes are happening and who will be taking care of them in your place.

It’s also important to keep expectations for children as high as they were before the diagnosis. Life may feel uncertain, but let them know your hopes and expectations for them do not change.

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While it can be tough to have these conversations, there are many resources available to help. UNC REX Cancer Care offers a free program to help children cope with a family member’s cancer diagnosis. KidsCan! provides educational information, emotional support and peer empathy for children.

Talking to 6- to 12-Year-Olds About Cancer

Kids ages 6 to 12 may vary in their ability to understand cancer, but Fradel offers some general tips for how to communicate with them.

Keep the conversation short.

Younger children tend to have short attention spans. When a parent is diagnosed with cancer, you want to keep the initial conversation somewhat brief, but also make sure your kids know they can ask you questions anytime.

Use props to explain your diagnosis and treatment.

Try to explain your cancer diagnosis in a concrete way. For example, you might use a doll or stuffed animal to pinpoint where the cancer is to help your child anticipate physical changes, such as hair loss.

Older kids in this age group may have a basic understanding of the human body. Consider drawing an image to help them better understand how tumors form and grow. You can draw a healthy cell and explain how healthy cells grow. Then draw a funny-looking cell and explain that cancer cells are not uniform or predictable.

Be open to a range of reactions to the news that a parent has cancer.

Remember it’s common for children to have a delayed response and initially run off to play. This doesn’t mean they don’t care. Kids often need time to absorb the news.

Be prepared for other common reactions including sadness, crying, anxiety or even separation anxiety.

Talk to your kids’ teachers.

At school, teachers might see your kids behaving differently or grades may begin to dip. It’s best to reach out to your kids’ teachers as soon as possible to let them know what’s going on at home. If your children display a lack of concentration or difficulty staying on task in the classroom, then teachers will know why and can provide additional support if needed.

Promise to keep your child in the loop.

After learning a parent has cancer, sometimes children can feel anxious at school because they’re constantly worrying if everything is OK. Try combating this anxiety by promising them that someone—a designated family member or friend—will notify them at school right away if something out of the ordinary happens.

Knowing they’ll be told right away if something is wrong can help kids see most days as uneventful, allowing them to concentrate on what’s happening in the classroom instead of worrying about what’s happening elsewhere.

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Give your kid a job.

Sometimes it’s helpful for children to have a role to fulfill or job they can do. This could be as simple as helping with chores or playing with a younger sibling.

But while it’s important for children to have a role to play, it’s also important to explain to your children that the role of caregiver is not for them. Let them know you have adults looking out for you.

Encourage your kids to ask questions.

After you reveal your cancer diagnosis, let your kids know they can always talk to you if they have questions about your cancer diagnosis or treatment.

Some children will take you up on that. Some won’t. Even if they hear you and then say, “OK,” and run off and play, this is a typical response.

Being open and honest with your children will show them you trust that they can cope with the information. It will also set the tone that your family will face cancer together.

Consider discussing your cancer care plan with your child.

Around age 10, children begin to understand the finality of death. One of the most common questions children at UNC REX Cancer Care’s KidsCan! program ask is, “Will my parent die from cancer?”

KidsCan! facilitators tell children that most people diagnosed with cancer get better through surgery, chemotherapy and radiation. Consider talking to your kids about each of these treatment options. You can explain that some parents live a long time with cancer, even if doctors can’t cure it, in the same way people live with chronic diseases such as diabetes or heart disease. In other cases, some parents don’t live as long.

Explain your physical changes.

When kids see the physical effects of your cancer treatment, let them know the physical changes and fatigue are effects of the medicine—not the cancer. This can help alleviate some of their fears about cancer.

If your children see you nauseated or with other digestive issues—or you can’t play because you’re lying on the couch all day—gently remind them it’s because of your chemotherapy treatment, which is powerful and makes you tired. It is not their fault.

Talking to 13- to 16-Year-Olds About Cancer

Teenagers differ from younger kids in the way they value peer relationships. Teens often have concerns about what a cancer diagnosis might mean for them socially. It’s important to keep that in mind when talking to them about your cancer diagnosis.

Remember that teens are still kids who need support.

Sometimes it’s easy to forget that teenagers are still children. They tend to express their abstract thoughts and may even begin to look and communicate like adults. But remember, they’re still developing and growing.

Remind your teens that you have a support system.

Teens sometimes like to take ownership of their relationships. They try to be helpful. They may even try to take on all the worry of their parents.

Sometimes they need gentle reminders that their No. 1 job is to be a teenager: to go to school and be with their friends.

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Let teens talk in peer groups, if possible.

Sometimes teens listen to their peers more than their parents. They want to be independent. They want the respect and decision-making abilities adults have.

Children at this age worry about social isolation and what other teens think about them. Sometimes they feel like they’re on display, even when they’re not.

KidsCan! facilitates a group that provides opportunities for teens who have parents in cancer treatment to relate to peers in similar situations. Having a parent with cancer can feel isolating, so meeting other teens going through the same experience can be beneficial.

Give teens a sense of control.

It’s important to give your teens privacy and autonomy when you can. More specifically, give them the right to be part of your cancer care or not.

In other words, if you go to the doctor and get an update on your condition, ask your teenager if he or she would like to know the latest news about your treatment when you get home. Asking teens if they want to know the information gives them a sense of control, which is important at that age.

Cancer tends to make people feel vulnerable or powerless. Teenagers can experience those emotions, too.

So give them back a little bit of power. Ask them: “Do you want to know? Do you want to come with me so you can also hear directly from the doctor?”

That gives them the choice to participate. It also gives them the option to take a little space if needed.

Reinforce your love.

It may sound simple, but in the midst of a cancer diagnosis it helps to remind teenagers that they are still loved. And it’s still important to tell children at this age that the cancer is not their fault.

Reinforce expectations.

When dealing with a cancer diagnosis, try to maintain stability at home by making sure kids know that expectations remain high. Even though your health is changing, it’s important to tell them that their relationship with you will not change.

Be sure your teen knows he or she is still expected to go to school, make good grades, be a positive role model and maintain activities and friendships.

Remember, you are the real expert.

At the end of the day, parents know their children best. How you choose to talk to your kids about cancer is up to you. Ultimately, you will know how to deliver the right information and how much information is appropriate for them.

If you need help or support, UNC REX Cancer Care offers a free program for children who have family members affected by cancer. To learn more about KidsCan!, email us or call (919) 570-7564.