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Children of different ages will understand a cancer diagnosis differently. Here are a few things to help you explain what is happening and comfort them.

Talking to children up to age 3

These children have a hard time understanding what they can’t see or touch. They also have a hard time understanding what causes the illness and what to expect right away and in the future. Here are some things you can do that might be helpful in comforting them and keeping their lives as normal as possible.

Children of this age are most afraid of separation and feeling abandoned, especially if it’s a parent who has cancer . If there is a change to their routine, babies and toddlers might get easily confused, become more clingy, and might have changes to their usual sleeping, eating, or other daily habits.

• Keep the baby or child near the parents or a trusted adult who is a regular part of the child’s life, if possible.
• If a parent must be in the hospital, caregivers can use video, phone, and other means so the child can see and hear their parent in real time.
• Ensure that anyone caring for the child tries as much as possible to keep the child’s routine.
• Explain things in the simplest way possible. Focus more on what is happening at the time, for example, today, rather than what will happen in the future.
• Offer frequent reassurance to toddlers if a parent is away for short times that Mommy or Daddy will soon be back.
• Cuddle and hug them often.
• If you are a parent with cancer, talk with the team social worker or nurse about your own emotions in dealing with your child’s distress.

Talking to children ages 4 to 6

Children in this age group might struggle to understand the complexity of a cancer diagnosis. They might think of being sick as having a cough or cold and might be confused and think that they can also "catch" cancer .

If it’s the parent who has been diagnosed with cancer, a child this age will likely show more fear and anxiety when away from them .

In times of distress, children at this age might regress (go back to behaviors they have already outgrown, like being toilet-trained). They might also have changes in sleeping patterns and have temper tantrums.

• Keep communication about the loved one’s cancer simple and clear.
• Try to stick to the child’s usual routine as much as possible.
• Reassure the child that they will always be cared for, especially if it is the parent that has been diagnosed with cancer.
• Reassure the child that cancer is not contagious.
• Check on the child’s understanding of what’s happening. Remember that the child may be able to say back to you what they heard the first time or so, but this doesn’t mean they understand it.
• Arrange for reliable daily care if it is a parent with the cancer diagnosis.
• Have a parent or trusted adult who is a regular part of the child’s life spend time with the child daily, if possible.
• Reassure children that the loved one’s distress and sadness is because of the cancer, not anything they’ve done; and that the family will get through this difficult time.
• Use play and artwork to explain what is happening, if you can and encourage the child to play out what’s going on. That way, you can see what the child understands..
• Set up a consistent time each day, like bedtime, when the child can ask questions and share feelings.
• Do not try to convince your child using reason or logic.
• Offer choices when possible (for example in clothes, food, or activities).
• Do not tolerate biting, hitting, kicking, or other aggressive behavior. Teach your child how to express feelings in healthy ways (that don’t hurt the child or other people).
• Teach acceptable expressions of angry feelings such as talking, drawing, or pounding a pillow.
• Create opportunities for physical activity.
• If a parent is in the hospital, caregivers can use video, phone, and other means so the child can see and hear their parent in real time. Arrange in-person visits when possible.
• Arrange for one family member or trusted friend to take a special interest in each child.
• Consult with the child’s health care team about any concerns or changes in the child’s behavior.

Talking to children ages 7 to 12

At this age, children are more likely to have a better understanding of cancer. They might also understand the concept of time better and be able to anticipate the future.

Children of this age might have a hard time telling an adult about any distress they are experiencing and might be afraid that what they say might upset loved ones.

• Tell the child about the illness and keep them up to date about the parent’s treatment and be sure to explain what the child sees and hears. Be prepared to repeat the explanation.
• For older children, more detail about the cancer can be given, as appropriate. Try not to overwhelm them with information, but be open and honest in answering any questions they might have.
• Listen for unasked questions, especially about the child’s own health and well-being.
• If it’s a parent that has cancer, tell the child’s teachers, coaches, and other school staff about the family’s cancer situation.
• Support the child’s having fun, despite the parent’s illness – make sure they don’t feel guilty about it. It’s OK to still be a kid!
• Plan for daily time with a parent or trusted adult who is a regular part of the child’s life.
• Give the children permission to ask you questions and express feelings that they think might upset others.
• It’s OK for the child to see the parent cry or be angry if the child understands that they’re not to blame for these feelings. Try to help them understand that it’s normal to have strong feelings and it’s good to express them.
• If it’s the parent that has cancer, suggest the child write or phone, and send drawings, text messages, or voice messages to the parent when the parent is away.
• Ask one family member or trusted friend to take a special interest in the child.
• If the child shows severe anxiety, is afraid to go to school, blames himself, acts depressed, or shows low self-esteem, talk to the child’s health care team.
• Help the child stay involved in after school activities and sports and keep them in contact with friends. Remind the child that it’s OK to still have fun.

Talking to teens

At this age, they can understand the complexities of a cancer diagnosis and treatment more. they also have a better understanding of how the cancer diagnosis can affect a loved one’s future, and because of that, they can worry more. Teenagers are highly influenced by their friends and are developing their own identity so this can impact how they look at a cancer diagnosis, especially if it’s a parent who has been diagnosed.

Teenagers experiencing distress might act out, withdraw from friends and family, and feel overwhelmed. Reassure them that it is OK to have these feelings and encourage them to learn how to respond and cope in healthy ways. Teenagers may try to protect parents by hiding their sadness, anger, or fears, so it’s important to check in with them regularly. They might also ask fewer questions and turn to the internet, social media, or friends as sources of information. They might also try to find ways to help their loved one.

• Give detailed information about the parent’s condition, symptoms, possible side effects of treatment, what they might expect, and other information, if they’re interested.
• Keep open lines of communication and let them know they can talk to you at any time and ask any questions. Be honest and open when communicating with them.
• Keep the teen up to date with what’s happening with the parent’s treatment. Answer all questions honestly.
• Find out if the cancer center has a special group for teens with cancer in the family and encourage them to be a part of such available groups.
• Reassure them that cancer is not contagious.
• Assure them that nothing they did or said caused the cancer.
• If it’s a parent who has cancer, tell the teen’s teachers, coaches, and other school staff about the family situation.
• Encourage sharing of feelings and talk about what’s normal.
• Arrange to keep a normal daily life at home, as close to the usual routine as possible. Offer choices and promote independence as appropriate.
• If it’s a parent who has cancer, let the teen help choose where to go after school and have a voice in whose care they prefer when a parent can’t be there, when possible.
• Encourage teens to keep up their usual involvement in school and other activities.
• Be sure that the teen knows parents are aware that having fun and spending time with friends are important parts of their lives, so there’s no need to feel guilty about it.
• Teens can step up to the plate and help with some tasks at home, such as cooking meals. You don’t want the teen to be overwhelmed but helping is part of becoming an adult. Be sure you balance what you ask of the teen with their needs. If you realize they’re doing too much, talk with the cancer care team about your family situation and see if you can get other help.
• Check in with your teens often and let them know that everyone has feelings that can be confusing and overwhelming. Tell the teen it’s OK to ask you questions and express feelings that they think might upset others.
• Address feelings of anger and frustration (even if they are unspoken).
• Be willing to tolerate some reluctance to share thoughts and feelings.
• Encourage your teen to keep a journal or log.
• Ask a relative or trusted friend to take a special interest in each teen.