Why honesty usually helps
Many parents want to protect their children from frightening news, at least until they know more. The trouble is that children notice. The National Cancer Institute points out that even very young children can sense when something is wrong, and that children as young as 18 months old begin to notice what is going on around them. They see the appointments, the tiredness, the hushed phone calls.
When no one explains, children tend to fill the gap with their own explanations, which are often worse than the truth. The American Cancer Society notes that telling children the truth lowers the chance they will pick up partial or false information from someone else, and builds the trust they will need as things change.
What children of any age usually need to hear
The amount of detail will depend on your child, but a few messages matter at every age:
- The name of the illness ("I have a kind of cancer called lymphoma"), so the word is not a secret
- Where it is in your body, and what the treatment will be
- How treatment may change how you look and feel, and how their own routines may change
- Nothing they did, said or thought caused your cancer
- Cancer is not contagious; they cannot catch it from you
- It is okay to feel upset, angry or scared, and okay to ask questions
- They will be taken care of, no matter what happens
You do not need to have every answer. "I don't know yet, but I'll tell you when I find out" is honest and reassuring. It can help to plan the first conversation with your partner or another trusted adult, choose a calm time, and give information in small amounts, checking what your child understood before adding more.
Fitting the conversation to your child's age
The American Cancer Society offers age-based guidance that many parents find useful:
- Under 3: very young children mostly fear separation and are sensitive to changes in routine. Keeping their day as consistent as possible, with familiar caregivers, matters more than explanations.
- Ages 4 to 6: children may think of illness as a cold, worry they can catch cancer, or slip back into behaviors they had outgrown. Simple words, a focus on what is happening now, and lots of physical comfort help.
- Ages 7 to 12: children understand more and can think about the future, but may hide distress to avoid upsetting you. Repeat information, keep them updated, and set aside time each day for questions.
- Teens: teens may understand the full seriousness and worry more, yet act out or withdraw, or protect you by hiding their feelings. Offer information honestly, check in regularly, and include them in some decisions.
If your children are adults, the shift is different: they may become helpers, decision partners or a source of support for you. The NCI notes that many parents find it hard to accept care from grown children, and that it still helps to include them in conversations about your treatment.
Prepare children for visible changes before they happen. The American Cancer Society notes that side effects such as tiredness, weight changes, hair loss or vomiting can be frightening for a child to see, and that the way you react will shape the way they do. Remind them what the treatment is for. Older children and teens may also need help deciding what to say when friends ask questions or what, if anything, to share on social media; practicing a simple answer can make those moments easier.
How children may react
Children rarely respond the way adults expect. According to the NCI and the American Cancer Society, they may be confused, scared or lonely; feel guilty, as if they caused the illness; resent extra chores or quiet; become clingy; regress; or get into trouble at home or school. Often they show feelings through behavior, play or drawing more than through words.
None of this means you told them the wrong way. It usually means they are working through it. Keeping routines steady, telling them ahead of time about changes, and reminding them it is still okay to have fun can all help. Let older children help at home, but be careful not to hand them more responsibility than fits their age. Even after treatment ends, the NCI notes, children may read your low energy as unhappiness with them, so keep explaining what you can and cannot do yet.
Teachers and school counselors can be allies. The American Cancer Society suggests telling the school enough to help staff understand what your child is going through, and letting your child know beforehand that you plan to do so.
Support for your child, and for you
If your child shows signs of serious distress, such as severe anxiety, refusing school, blaming themselves, or seeming depressed, the American Cancer Society recommends getting support from the child's healthcare team or a mental health professional. Your child's pediatrician is a good first call. You can also ask your cancer center whether it has a social worker or child-life specialist who works with families; the ACS suggests nurses, social workers and case managers as people who can point you toward support groups or camps for children whose parents have cancer.
Parents need support too. The ACS cautions that leaning on a child as your main emotional support is often not healthy for the child, which makes it all the more important for you to have adults to lean on. Talking with a psychologist can give you a place to work through your own fear and guilt, plan hard conversations, and respond to your children's reactions more steadily. Dr. Lehmann works with adults on parenting and family concerns and the wider emotional impact of cancer. Whether she sees children or teens directly is something to ask when you call; if your child needs their own therapist, she can talk with you about finding one.