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How children react

A child’s emotional reaction to the news that someone they know has cancer will depend on many things, including their age, relationship to the person, how the information is given to them, and their experience with illness. For example, if they know someone who has died from cancer, they might think that the same thing will happen again. It is important to be as honest as possible when talking to children, and to encourage them to talk about and express their feelings.  When thinking about how a child might react, it is important to remember:

• Children can’t always tell you in words but may show you how they feel. You might notice your child being more dependent, worrying more, or acting out of character. They might also express themselves through drawing, coloring, or playing.
• Children might regress (act younger) when they are under stress. For example, a child who had just become toilet trained might start having accidents. Some children might begin to have separation anxiety or difficulty paying attention in school.  
• Children might worry about their loved one dying. Be honest and let them know that sometimes people do die from cancer and while there is no way to know what’s going to happen, let the child know about the outlook of the person’s cancer in a way that is appropriate for their age, and let them know that if you find out something new or different, you will let them know. This does not mean that parents should tell their kids everything they know as soon as they know it. It means that children should be given truthful information when they need it to cope well from day to day.

Provide reassurance

When someone is first diagnosed with cancer, the outlook of the cancer and its treatment may not fully be known. Still, it is important to offer a child some level of reassurance. You can assure the child that no matter what happens, they will always be cared for. This is especially important if the person with cancer is the parent of the child. If you have a plan, you may choose to share it with your child.

Children in some family structures may need extra reassurance:

• Children of divorced parents may have more complicated feelings. If they have already lived through their parents break-up and no longer live full-time with a parent they feel close to, their grief over a parent’s cancer can be worsened. If the other parent has a close relationship with the child, extra visits might be helpful to reassure children that their parents still love them.
• For children in a single parent home who have already lost a parent, a cancer diagnosis in the surviving parent can cause the children to be especially anxious and uncertain of the future. They may also wonder if their parent will die from the cancer. It is important to keep open lines of communication, to check in frequently with the children, and get extra help as needed.
• Parents who never married might have problems with certain legal and financial arrangements, but children still need to feel safe. Sharing back-up plans with the children, and making needed legal arrangements, will let them know their parent(s) are thinking of their care and safety.
• In a family that includes lesbian, gay, bisexual, transgender, or questioning (LGBTQ+) or gender nonconforming (GNC) parents, children might feel more different or isolated from their peers when faced with stressful events like a parent’s illness.
• Adopted children often face questions about themselves as they grow up and try to figure out who they are. They may or may not know who their biological or birth parents are. A parent’s cancer diagnosis, whether the parent is their adoptive parent or birth parent, may make adopted children feel less secure. They may need special assurance that they will be cared for if anything should happen to an adoptive parent or birth parent. This is especially true if they are in an adoptive one-parent household.
• Foster children might deal with feelings of not belonging and instability, especially if they have lived in multiple foster homes. A foster parent’s cancer diagnosis may make them feel less secure and stable, and could bring up feelings of anxiety or other negative emotions they may have had previously. These children may need special assurance that they are loved and will still be taken care of, and that their needs will continue to be met.

Keep in mind that there are many kinds of families, and in some of them, children may already feel different from their peers. Children of any age may experience bias toward adoptive, foster, LGBTQ+, single-or one-parent, or blended families. They may also experience bias if they don’t live with their parent(s) and live with a grandparent, relative, or guardian who fills the parental role. Adding a cancer diagnosis to the mix may make a child feel even more different and more isolated from their peers.

In many communities, there are support programs with counselors or therapists who are familiar with the unique needs of non-traditional families. Other special support groups may be available either in your area or online. If you don’t know about these resources, ask your cancer care team what’s available in case you need help.

Keep to routines as much as possible

In cases where the child lives with the loved one who has been diagnosed with cancer, the child’s routine and way of life should be kept as close to normal as possible. Children, especially young ones, thrive on routine and predictability. This helps increase their sense of safety and security. If certain changes are expected to the household’s routine, help the children cope better by communicating to them in advance what to expect. For example, if a parent has cancer, the parent might seek help from a neighbor, friend, or another family member to help take the children to and from school, afterschool or activities like sports. 

Although it’s important to avoid putting too much responsibility on children at this time, some children, especially teenagers, might want to help or contribute to the household more. Younger children might want to help too. It is important to let children help without overburdening them. Have open and constant communication about how things are going for them and what they feel should be different or stay the same.

Reduce stress and family tension as much as possible

If there are communication or other problems between parents, this can add to a child’s stress. This may often be the case for parents who are separated or divorced. If needed, parents should ask someone to help resolve the problems out of sight and away from the stressed child. Otherwise, tension will make it harder for the whole family to get through a cancer crisis.

Sometimes, especially if there is no other adult in the home, a parent will turn to their child for emotional support. This is not usually healthy for the child, but it can still happen. With a serious illness like cancer, the chance of reversing roles, or trying to do so, with children is very real. The parent likely needs more help running the household and more emotional support. Children may start taking on more responsibility, and it’s important to question whether that responsibility is healthy for their age and stage of development. Single parents can set up and maintain a network of friends and relatives who can be called on for emotional and practical support. Usually, when a parent is aware that they might rely too much on their children, they can help guard against it happening.

If treatment side effects embarrass or upset your child

Children are going to react to the physical changes treatment causes. Trying to prepare them can help, but it can still be a shock. The way you react will affect the way they do. Remind them about the purpose of the treatment.

Children also can be sensitive to the way others react, especially their peers, who can be curious about what's happening. This may be harder for teens than for younger children, because teens tend to think constantly about appearance and are concerned about looking foolish or being different. A little advance warning might make it easier for them to accept changes in how you look. Talk to them about what they can say if their friends start asking questions about your health.

Share information with other people in your child’s life

Parents can choose to share some information about their cancer diagnosis and treatment with their child’s school. Be sure to tell the child you plan to do this beforehand to give them a chance to offer their thoughts and prepare. If you choose to do so, talk to your child’s teacher or guidance counselor. You don’t have to tell them everything about your illness, just enough to help them understand what your child is going through. If your child is having trouble, school staff will probably notice changes in them and having some information will help them help the child.

It is probably a good idea to have a talk with the child about what to share on social media about the parent’s cancer diagnosis. You might also prepare your children for people's questions about their parent’s illness that they don’t want to answer and rehearse with them that they might say. Questions about a parent’s cancer can make kids uncomfortable if they’re not ready for them.

If kids at school ask about the cancer, here are some ways that your children can respond to questions they’d rather not answer:

• Maybe you can ask the teacher or the nurse about that.
• Thanks for asking, but it’s kind of hard to talk about this at school.
• I don’t know the answer to that question.

If adults or family friends, ask about the cancer:

• Thanks for asking, but I’m not sure how to answer that.
• You might want to ask Mom or Dad (or name another adult family member).
• I don’t know the answer to that question.

Find a network of support

Access to a good support network can make a difference in how the families and children cope. If a supportive network doesn’t exist, talk to a nurse, social worker, chaplain or clergy member, or case manager about available resources. It might also be helpful to access community-based mentors like school counselors, teachers, coaches, scout leaders, or even trusted friends and neighbors.

Recognize the signs your child might need extra help

Some children might have more trouble than others coping with the news that a loved one has cancer. Extra help, most times professional help, might be 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 themselves
• Feels extra irritable
• Becomes very angry very quickly
• Has declining grades
• Withdraws or isolates themselves
• Acts very differently from usual
• Has appetite changes
• Has low energy
• Shows less interest in activities
• Has trouble concentrating
• Cries more than usual
• Has trouble sleeping

You might find it useful to talk with the child’s health care team, school counselor, a child psychologist or psychiatrist, social worker, or counseling staff at the hospital where the family member is being treated. Get help immediately if a child admits to thinking of suicide or hurting themselves.

Be honest

Parenting while facing cancer is a challenge.  It is a worthy but challenging effort to remain honest with your children about your health. Telling children what is going on is stressful but can also ease your burden.  Telling children the truth helps reduce your concerns about them getting false information from someone else. Having a counselor to speak with them can be helpful. Your provider, nurse, or social worker can offer information about where to find this counseling.

If you are having a hard time keeping up with the usual parenting duties or coping with changes, speaking with a counselor or social worker might help. They might also be able to help you identify resources that can be useful for you and your family.

Financial challenges also are common when faced with a cancer diagnosis. Ask your health care team, including your social worker, if there are any resources that might be helpful for your situation.