Talking to children and teenagers

People sometimes feel they are protecting children by not telling them about a cancer diagnosis. It is natural to want to protect children from difficult news.

You may have worries of your own that stop you talking about it. You may feel that talking about cancer will make it feel more real when you are still struggling to accept it. But explaining what is happening may make things less unsettling for children.

Children often know when something serious is affecting the people they are close to. They may also notice changes in how the adults around them are feeling and behaving.

There are many benefits to talking to children and teenagers:

• Knowing what is happening may make them feel less anxious.
• It shows you trust them.
• You will not worry about them hearing your conversations with other people.
• It can make you feel closer and able to support each other.
• It might help them cope better with a difficult situation.

It is important to give them the chance to talk about their fears and worries, and to ask questions. Talking about the cancer shows you trust them and can help them feel more secure.

You will probably need time to manage your own feelings before talking to children. You might first want to speak to one of the following healthcare professionals:

• a clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment.
• a psychologist – someone who gives advice about managing feelings and behaviours
• a counsellor – someone who is trained to listen to people’s problems and help them find ways to cope.

Try to talk to children before they realise something has changed and start to worry. You can do the following things to prepare yourself:

• Have all the information you need and make sure you understand it.
• Think about the questions a child might ask.
• Think about the words you will use to explain things.

You could start by asking them what they already know. You may find they know more than you think.

It is usually best to have another adult there when you talk to children. This should be someone they know and trust, such as someone in your family or a close friend. But you may want to do it on your own.

Even if you are not the person telling them about the cancer, you may want to be there. This means you know what is being said and how the child reacts. Some people with cancer prefer not to be there themselves. You should do what feels right for you and the child.

There may be places where you feel more able to talk to the child or children. Make sure it is somewhere they will feel able to talk too. You might want to tell them somewhere away from home. It might be a place you go back to every time you want to speak about cancer.

Try not to tell them just before bedtime, as they may not be able to sleep. If this is the only time you can talk to them, it is important to make them feel supported. Try to answer any questions they have before they go to sleep.

If there is more than 1 child, it might be best to tell them together, if you can. This prevents them feeling like others know more than them. If you are talking to children separately, do it as close together as possible. Some children may wonder why they were told last.

Try to avoid only telling older children, as this can be difficult for them to cope with.

You will need to use words that children will understand. These will vary depending on their age. Here are some tips to help you through the conversation:

• Find out what they know and explain anything they are not sure about.
• Use simple, clear language and short sentences.
• Talk about what is happening now, rather than things that may happen in the future.
• Be prepared for them to react in different ways.
• Ask them if there is anything else they want to know.
• Repeat the information for younger children, especially those under 7. They may not understand or remember everything you tell them.

You may also want to use our other information about cancer types and treatments to help explain cancer to older children. We also have easy read booklets with illustrations.

Children need some information about the name of the cancer, where it is in the body and how it will be treated. You should try to prepare them for any physical changes that may happen. They may cope better with the changes if you are honest with them.

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 is called cancer and I’m going to have an operation to take it away. After that, the doctor will give me medicine, so the lump does not come back.’
• ‘Gran has an illness called cancer. The doctor is giving her special medicine to help her get better. The medicine might make her feel sick or tired some days, but on other days she will feel fine. The medicine might make her hair fall out, but it will grow back when she finishes taking the medicine.’
• If your child asks you what cancer is, you can say ‘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 doing their jobs. The cancer cells can grow into a lump.’

Teenagers or older children will often know what cancer is. They may have heard about it at school or have a friend with cancer. They may look for information about cancer on the internet. You could help them understand whether the information they find is accurate and relevant.

You could show them:

• Macmillan’s cancer information
• Hope Support Services
• Riprap - a website for teenagers who have a parent with cancer.

Children, particularly those under 10 years old, often worry about things like causing the cancer or catching it. Children need reassurance that:

• nothing they did or thought caused the cancer
• cancer is not like a cold and you cannot catch it – it is 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 will listen to their worries and try to help them cope.

Children’s understanding and emotional reactions can depend on how old they are. They are usually able to understand more about illness as they get older, but this depends on the child.

We have more information about how children may react at different ages.

You may want to tell close familyand other adults who your children know and trust. Let them know what you have told your children. It is important that your children get the same message from everyone. Let your children know who you are going to tell and why.

It can be helpful to talk with children about who else they think should know. For example, they might want a teacher, club leaders or their friends’ parents to know. Older children may have strong feelings about who should or should not know so it is a good idea to talk to them first.

At nursery or school

It is a good idea to tell nursery staff, schoolteachers and the school nurse. It will mean that they can be aware of the child’s needs. It will also help them understand any unusual or difficult behaviour.

Ask them to let you know if your child shows any changes in behaviour. You could also ask them to support your child by giving them more one-to-one time. You can ask if your child can have some time with the school nurse or counsellor too.

Older children or teenagers may not want to be seen as different from their friends. But it is important that certain people know and can be there to support them if they need it.

You should speak to your teenager before talking to their school or college. They may not want people to know, as this may be a place where things still feel ‘normal’. Asking them will make them feel that you are telling them everything and including them.

Teenagers may be facing exams or coursework at school, college or university. Teachers or staff can offer support. They may also notice issues or changes in behaviours that are not shown at home.

Children can have lots of different feelings and reactions. They can show their feelings through anger or ‘bad’ behaviour. A child may react to someone’s cancer diagnosis with behaviour you would not normally accept.

Some children may have problems with eating, sleeping or bed-wetting, or problems at school. They may seem sad and withdrawn, or have physical symptoms like not wanting to eat, headaches or tummy aches.

These changes are not unusual. If they carry on, or if there is anything worrying you about the child, you can ask for help from:

• your GP
• teachers
• the school nurse
• social workers
• psychological services at your hospital
• local counselling services
• health visitors (for pre-school-aged children).

Your cancer doctor or specialist nurse can give you advice about counselling or psychological services to help you support a child.

You may be able to get help from social workers. In England, Scotland and Wales, social workers are accessed through your local authority (council). You can search for contact details of your local council online.

In Northern Ireland, social services are accessed through Health and Social Care Trusts