Why talking is important

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.

Booklets and resources

The risks of not talking

It may be difficult starting to talk to children about cancer. But if you do not talk to them, they may:

  • feel frightened because they do not know what is happening
  • get the wrong idea about what is happening
  • feel alone and worried with no one to talk to
  • think they are not important enough to be included
  • worry that they have done or thought something that has made someone unwell.

Children often find out about what is going on, even when you have not told them. For example, they may hear something from friends whose families know yours. They may wonder if they can trust you to tell them about important things.

Children also learn things from TV, the internet and conversations they hear. But this information is not always accurate. If you do not speak to them about what is really happening, they may continue to believe this information.

Preparing to talk to children

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.

Who should tell them?

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.

Choose the right time and place

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.

How to talk to children and teenagers

If you are the parent, you are the expert when it comes to your child. You know the best way of talking to them, how they might react and what support they will need. If you are not the parent or guardian, you should talk first to the person who is.

Try to find a time when you are feeling calm. The first conversation is just a starting point. You can then slowly give your children small, relevant pieces of information and reassurance.

If you can, let your child’s reactions and questions direct the conversation. Listen and keep it as open as you can. Try to ask questions that will encourage them to say what they are thinking, rather than giving a ‘yes or no’ reply.

Be honest

It is best to be honest with children. If they think you are hiding something, they may think they are not being told the truth. Try to not make things sound less serious than they are.

Depending on the situation, you may be able to tell them that cancer is serious, but many people get better. You might be able to tell them that doctors are doing everything possible to help.

You may not be able to answer all their questions. Tell them you will try to find the answers and will tell them when you know.

Teenagers may react differently from younger children when they are told someone has cancer. They may ask for more information about the diagnosis and what it means for family life. They may need time to work through their feelings.

As with younger children, it is best to tell teenagers the truth about the cancer and your treatment plan. Encourage them to ask any questions they have, and answer these gently but honestly. Remember teenagers value their independence, but they will still look to you for reassurance and support.

Tips for having the conversation

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.

Explaining cancer

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:

Important points to tell them

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.

Children with additional needs

Children who have learning disabilities, learning differences or who are neurodivergent can find talking about change hard. But in most situations, they will cope better if they are involved and prepared. Some children may think or learn in a different way to others. Try to use communication styles that the child is comfortable with.

  • Plan what you want the child to know, and how much information you need to share.
  • Pick a quiet space to talk.
  • Talk slowly and clearly.
  • Give a small piece of information and then stop.
  • Give the child time to process each bit of information before talking again.
  • If you need to repeat the information, use the same words. You might have to explain more than once, especially if you are having a long course of treatment.

If the child finds diagrams helpful, our easy read booklets may help with your conversations. They have simple diagrams about cancer, cancer treatment and life with cancer.

You could try using calendars that show your hospital appointments or visits, and your child’s activities. It will help your child see how your treatment will fit in with their life. Try to keep their routine the same if possible. Keep things they are used to around them and explain what is happening every day.

It may also help to prepare them for possible physical changes. They may cope better if they have time to prepare. Reassure your child that they are coping well with the change.

It might be useful to talk to any teachers or support workers who are involved in your child’s care.

You may find our podcast, Talking to children about cancer, helpful. The National Autistic Society also has more information on helping children prepare for change.

Who else needs to know about the cancer

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.

At school, college or university

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.

Understanding children and teenagers' reactions

How children understand about cancer and how they react will depend on how old they are. You may have to repeat the things you tell them. Younger children may not understand what is happening, but they will notice changes to their routine.

Teenagers or young people usually understand, but they may find it hard to talk about what is happening. They may ask for more information and what it means for family life. They may also need more time to work through their feelings.

Babies and toddlers

Babies and toddlers will not understand what is happening. They will be aware of changes to their routine, or to who is looking after them.

How to help

Try to keep their routines as normal as possible, such as bedtimes, meals and nursery. If possible, someone who knows the child well should care for them.

Children aged 3 to 5

Young children do not really understand illness. But they often notice physical changes, or changes in adults’ emotions. They react to changes in their routine and to being separated from the people who usually care for them.

Young children may feel guilty that they have done something to cause the cancer. Or, if you are in hospital, they might worry that they have made you go away.

Some children in this age group may understand what illness is. They may worry that they will get cancer too.

They can become clingy and scared of being separated from the people who care for them. They may become quieter than usual or have bad dreams. They may start to do things they have outgrown, such as:

  • sucking their thumb
  • wetting the bed
  • talking like a baby
  • having tantrums.

How to help

  • Ask someone they know and trust to take care of them.
  • Keep to everyday routines when you can.
  • Stick to their usual boundaries. Do not be surprised if they start doing things they have outgrown.
  • Let them know that the cancer is not their fault, and they cannot get cancer from you.
  • Use a doll, soft toy or simple drawing to explain where the cancer is or where an operation may be.
  • Try to prepare them for any physical changes.

Children aged 6 to 12

At these ages, children can understand more about cancer and its effects on the body. They often have fears they may not talk about. This includes worrying that the person with cancer is going to die, that they have caused the cancer, or that they can catch it.

They may try to be especially good and set high standards for themselves. You may see changes in their behaviour, concentration, schoolwork or friendships.

How to help

You may find the following tips helpful:

  • Use books to explain the cancer and its treatment.
  • Reassure them that many people with cancer get better.
  • Make sure they keep up with school, other activities and friendships.
  • Let them know it is okay to enjoy themselves.
  • Give them little things to do to help out.
  • Let their school know, so they can also offer support.

Teenagers

Teenagers usually understand what it means to have cancer, but they may not want to talk about it. They may find it hard to talk to you or show how they feel. It is important to encourage them to ask any questions they have and make sure they feel involved.

Some teenagers may be keen to help out. But they may have to take on more responsibilities at home at a time when they want to be more independent.

This can make them feel angry and guilty. Sometimes their behaviour may seem hurtful to themselves or others.

How to help

  • Ask them what they think and talk to them like an adult.
  • Help them see that talking is a good way of coping. Encourage them to talk to someone close, such as their friends, a relative or a family friend.
  • Make sure they keep up with friendships, activities and normal life as much as possible.
  • Give them time and space to themselves when they want it.
  • Keep to usual rules and limits – these can be even more important now than before.
  • Explain that they might need to help a bit more with things like cooking, tidying up or looking after younger children. Letting them help shows that you need and trust them. But reassure them you do not expect them to do everything, and that people will care for them too.
  • Show them you appreciate their help.
  • Tell them about information that may help, such as Riprap and Hope Support Services.

When children need help

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

When teenagers need help

Being a teenager can be an emotional time. But this can be even harder if a family member or friend has cancer.

Some teenagers may not be comfortable talking about their emotions. They may prefer to express themselves through writing, art or music. Remember that if they are not talking to you about how they feel, they may be talking to someone else. They may have support from their friends, or another adult such as an uncle, aunt or grandparent. It is important to make sure they have someone to speak to outside of the family.

Teenagers may feel more comfortable joining a support group than speaking to a counsellor.

About our information

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.

Date reviewed

Reviewed: 01 March 2024
|
Next review: 01 March 2027
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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