Talking to children about your cancer
Talking to children about cancer can be very difficult, but it's important to try to help them to understand. Talking to them will help them to talk openly about their feelings.
Thinking about telling children that a parent or family member has cancer can be overwhelming. Parents sometimes feel that by not telling their children they’re protecting them. It’s natural to want to protect your children from difficult news, worry and distress. But not telling them may make children more vulnerable, as it doesn’t give them the chance to talk openly about their fears and worries.
Children know when something serious is affecting the family. They’ll notice unusual comings and goings, phone calls and hushed conversations. They’ll pick up on different atmospheres and how you and other adults around them are feeling.
Parents understandably have different concerns that delay them or stop them from telling their children. You may feel that it will bring home the reality of the situation when you’re still struggling to come to terms with it yourself. The thought of coping with the children’s distress may feel like too much to cope with on top of everything else. Or you may worry that the news will disrupt family life and that cancer will become the focus instead of things like school and exams.
The benefits of talking
Talking to children about cancer is a hard thing to do. There are many benefits to being open and involving your children:
Knowing what’s going on will make them feel less anxious and more secure.
It gives them permission to talk - they can ask questions and say how they feel.
It shows you trust them and you won’t need to guard what you say all the time.
It can make you all feel closer and your children can help to support you.
They will learn how to cope when life isn’t going to plan.
Remember that children often cope with difficult news better than we think they will.
The effects of not talking
It’s natural to want to protect children from difficult news. But if you don’t talk to them, they may:
feel frightened because they don’t know what’s going on
feel alone with lots of worries and no one to talk to
worry that something they’ve done or thought has caused the cancer
think they’re not important enough to be included
worry something worse than the reality is happening
think cancer is too terrible to be talked about
misunderstand situations and get the wrong ideas.
Children often find out about what’s going on even when they haven’t been told. Finding out like this can have a negative effect on a child’s relationship with their parent. They may wonder if they can trust you or other adults to tell them about important things. Children also pick up things from the television, internet and overheard conversations, but this information can sometimes be misguided and inaccurate.
You’ll probably need time to take things in and cope with your own feelings before you talk to your children. Try to talk to them before they pick up on things and start to worry. Be as prepared as you can and make sure you have all the information you need first and that you understand it.
Who should tell them?
If you’re a two-parent family it’s usually best to tell them along with the other parent, but this can depend on how you usually talk as a family. If you’re a single parent you may feel able to, and want to, do it on your own. Or you can do it along with someone close who your child knows and trusts.
Even if you’re not doing the telling, it’s still a good idea to be there so you know what’s been said.
The right time and place
Choose a time and a place when your children are most likely to listen and feel at ease, and where you won’t be interrupted. There may be places where you and your children feel more able to talk. Make sure it’s somewhere they’ll feel able to express their feelings.
If you have more than one child, you can tell your children together or separately, depending on their ages and personalities. If you’re telling them separately, do this as close together as possible. Some children may wonder why they were told last. Try to avoid only telling the older children, as this can place a burden on them.
Avoid telling them before bed time as they may not be able to sleep. If it’s unavoidable, make them feel supported and answer any questions they have before they go to sleep.
How to tell them
As a parent you’re the expert when it comes to your child. You know how best to communicate with them, how they might react and what support they’ll need. You can practise what you’re going to say beforehand and anticipate some of the questions they may ask.
Don’t try too hard to have the perfect conversation. If you plan too much, a question from your child may throw you. Children can ask questions you weren’t prepared for, and these may come hours or days later.
Choose a time when you’re feeling fairly calm. See the first conversation as a starting point - this is the start of an ongoing process where you’ll gradually give your children small, relevant chunks of information and reassurance. Allow the conversation to be directed by your children’s reactions and the questions they ask. Listen and keep it as open as you can. Try to ask questions that encourage them to express whatever they’re thinking rather than ones that give a one or two word reply.
Some examples of openers are:
’Tell me about …’
’How can we …’
’What do you feel about …’
It’s best to be honest with children. If they think you’re being vague or hiding something, they’ll find it hard to believe they’re being told the truth. Don’t make things sound less serious than they are. Be hopeful with them and let them know that although cancer is serious, many people get better. Tell them that you and your doctors are doing everything you can to get well again.
It’s fine to say you don’t know if you don’t have all the answers to their questions. Tell them you’ll try to find out and will tell them when you know.
Making a start
You’ll need to use words your children will understand and this will vary depending on their ages. Here are some tips to help you through the conversation:
Find out what they know and correct any misunderstandings.
Use simple, straightforward language and short sentences to explain what’s going on.
Keep information relevant to the current situation rather than things that will happen in the future.
Be as specific as you can - children worry more when things aren’t clear.
Ask them if there’s anything else they want to know.
Take it at the child’s pace and be prepared for them to react in their own way.
Repeat the information for younger children, especially those under seven, as they may not take it in or understand.
Children also need to understand how their lives and routines are likely to be affected.
There are some helpful books that help explain cancer to children. You may be able to use our other information booklets about cancer types and treatments to help explain cancer to older children.
Children need some information about the name of the cancer, where it is in the body and how it’ll be treated. Here are some examples of how you can explain cancer to young children:
‘I have a lump growing inside my body (explain which part) that shouldn’t be there. It’s called cancer and I’m going to have an operation to take it away. After that, the doctor will give me medicine so that the lump doesn’t come back.’
‘I have an illness called cancer. The doctor is giving me medicine to help me get better. The medicine might make me feel sick or tired some days, but other days I’ll feel fine.‘
If your child asks you what cancer is - ‘Our bodies are made up of lots of tiny things called cells. They all have a different job to make our bodies work and keep us healthy. Cancer is when some cells in the body stop working properly and stop the healthy cells from doing their jobs. The cancer cells can grow into a lump.’
Important points to get across
Children, particularly those under 10 years old, often worry about things like causing the cancer or catching it. All children need reassurance that:
nothing they, or anyone else, did or thought caused the cancer
cancer isn’t like a cold and you can’t catch it - it’s okay to sit close, hug or kiss
there will always be someone to take care of them
they can always ask you questions and talk to you about how they feel
you’ll listen to their worries and try to help them to cope.
Knowing about your treatment and its side effects will help your children prepare for what to expect and will make them feel less anxious. What they’ll need to know will depend on their age. It can vary from simple information for young children to the same information you need for teenagers.
If you’re struggling to take it all in yourself, it may help to talk to our cancer support specialists first. They can send you booklets about your type of cancer or treatment, which may help you explain treatments to children.
Explain that this is an operation and the doctor/surgeon will:
cut out the cancer or
remove the part of the body where the cancer is.
Before they visit you in hospital prepare them for how you’ll be after the operation. For example, if you’ll have drips or tubes, tell them what they’re for and explain that you’ll only have them for a short time to help you get better.
If children want to look at a scar it’s usually fine to let them see it, but it may be best to wait until the swelling and redness settles down. If they’re not interested or seem reluctant to look, don’t push them.
Explain to them that chemotherapy is:
special medicine that destroys the cancer, or
special medicine that stops or slows down the growth of cancer cells.
It’s also helpful to tell children how the chemotherapy may change your routine and how it may make you feel. Let them know that:
Chemotherapy can sometimes make you feel sick, but you’ll take other medicine to stop the sickness.
Chemotherapy can make you feel very tired, so you’ll usually need to get lots of rest or sleep after having it.
Germs don’t cause cancer but chemotherapy can make it easier for you to catch a cold or infection.
Your hair may fall out, and if it does, you’ll be able to wear a wig, bandana or hat - you can reassure them that your hair will grow back again after the chemotherapy finishes.
Explain to them that radiotherapy is:
the use of x-rays or a laser beam to destroy the cancer, or
strong x-rays given to the part of the body where the cancer is to destroy the cancer cells so they can’t grow.
Depending on where you’re having the radiotherapy, you can explain that:
it can make the skin in the part being treated a bit red and sore
it makes you feel very tired, even after it’s finished, so you’ll need to rest a lot.
Children need to know that side effects will usually go away when your treatment is finished, but that this is often gradual. They should also know that side effects don’t mean you’re getting sicker and that not everyone gets the same side effects. Some children may worry that the cancer is getting worse if they see you unwell, or they may think that the treatment isn’t working if you don’t get side effects.
Tell your children that treatment can be hard and it’s normal for you to feel down or frustrated at times, but it’s not because of anything they’ve done. Help them feel involved by asking them to get you a drink or to do little things to help around the house, like tidying their toys away.
Changes in physical appearance
Children usually cope and adjust well if they’re told about any changes in your appearance in advance. Younger children, particularly those under 10 years old, struggle most with this. Letting them know in a matter-of-fact way is often the easiest way to explain things. Older children may feel embarrassed and want to avoid talking about it. If you’re struggling to cope with it yourself, you may prefer someone else to explain it to them or to get further help.
Who else needs to know?
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You’ll usually want to tell your close family and other adults your children know and trust. Tell them what you’ve told your children - it’s important they get the same message from everyone. Let your children know who you’re going to tell and why.
It’s usually helpful to talk to your children about who else needs to know, for example friends’ parents or club leaders. Older children may have strong feelings about who should and shouldn’t know, so it’s good to talk this over with them. Some teenagers don’t want to be seen as different from their friends - but it’s important that certain people know and can be there to support them if they need it.
It’s a good idea to let nursery/school teachers and the school nurse know. They can be sensitive to your child’s needs, and it will help them understand any unusual or difficult behaviour. Ask them to let you know if your child shows any signs of worrying behaviour. You can ask them to support your child by giving them more one-to-one time, or you can involve the school nurse or counsellor.