Q. A teacher asked me (a school social worker) how to help an 8-year-old student with his/her own cancer diagnosis and loss of hair. Any advice?
Children who are diagnosed with cancer face unique challenges and adjustments. Parents, teachers and other caretakers often struggle with how to explain cancer and its effects. When speaking with this child’s teacher, you may want to consider the following points.
Children understand simple and clear explanations best. Provide concrete, age-appropriate information when speaking to this student. Explain that there are special medications that they will need to take that will help stop the cancer from growing. These medications may also cause his/her hair to fall out. Some children will want to hear a more detailed scientific explanation while others will be satisfied with more general information. Reassure the child that hair loss is temporary and explore whether he/she would feel most comfortable wearing a hat, scarf or wig in the meantime.
It is common for children to feel an array of feelings when they begin losing their hair including anger, sadness, embarrassment and fear. Let this child know that it is safe to express those feelings to you and his/her teacher. Validate the way they feel and remind him/her that although it is upsetting to deal with these side effects, it means that the treatment is working hard to stop the cancer and make his/her body healthy again. You may also want to preemptively prepare this child for questions his/her classmates may ask and come up with ways the child will feel most comfortable responding. While some children would rather not discuss their diagnosis with classmates, others may be more open with regards to what they are going through. There is more than one right way for the child to interact with their classmates and understanding your student’s specific wishes can inform the way you and the child’s teacher help the child’s classmates support the child with cancer.
You may find the following books helpful when explaining cancer and its side effects:
- Chemo, Craziness & Comfort by Nancy Keene is a book for children between the ages of 6-12 that provides clear explanations about cancer and treatment.
- KidsCope has a free comic book called KemoShark that helps explain cancer and chemotherapy
The American Childhood Cancer Association provides books to families with a child with cancer free of charge. Educating the Child with Cancer: A Guide for Parents & Teachers edited by Ruth Hoffman is a book for parents and teachers that provides guidance regarding the impact of cancer on a child’s education. It is free for families and for the child’s teacher.
For more information, support or guidance, call us at 800-813-HOPE (4673) to speak with an oncology social worker.
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Answers from Other Experts About Children and Cancer
Q. A kindergartner’s twin brother died from cancer. What are some things to best help the family and the surviving child?
This family is adjusting to a major loss, and now more than ever, they need patience, love and understanding. The first rule in helping is: “Listen.” What are the parents telling you? Most often, the best way to be of service will come out in their words, although probably subtly.
Grief is an ongoing and lifelong journey, and there is no right or wrong way to grieve. In terms of the parents, very often, those who are grieving will forget to take care of themselves. This can take a toll on their health and can impact the household even more. You may need to remind the parents of the importance of self-care. Let them know that you are there for them, in whatever way they need. If they are not in a place to ask for help, be proactive. Some suggestions that might be helpful include cooking meals, cleaning, organizing, helping with thank you notes or grocery shopping. Just as friends rallied around them when they were taking care of a sick child, they now need a different kind of support, as they work on adjusting to their loss. Your helping out with everyday tasks may allow them more time for self-care, as well as more time with their child who is now adjusting to life as an only child.
At a kindergarten age, generally, children think in more concrete terms and do not understand the concept of “forever,” so it would be likely for this grieving child to think that his twin will come back. The family may need to remind the child that his sibling will not be coming back. Using euphemisms for the word “death” can be confusing to children, as in, “My brother is lost, and I am going to find him!” If the family has a belief system that includes heaven, the child may need to know that they cannot visit the twin in heaven. Younger children are less able to use words, but will express themselves in games, play or drawings. Through play, the parents might be able to pick up on thoughts or concerns that the child finds too complicated to express directly.
Children also use “magical thinking.” This child may think that what happened to his twin may also happen to him. Lots of reassurances need to be given, and questions need to be answered honestly with the child. More than ever, this child will need hugs and kisses and “I love you’s.” Many studies indicate that twins have a deep level of connectedness, and this may make this new separation more difficult. The child may also experience survivor’s guilt, and an open discussion to address this is important.
When life can be so challenging, it can be hard to express that life can also have joy and beauty. In fact, it may be impossible to see it at times, especially when there is such profound loss. But it important that children learn over time that even though life may be difficult or unfair, wonder and joy can still exist. We need to keep the sense of joy, wonder and happiness alive in children.
I think it is both very helpful and important to keep the memory of the twin alive in the home. But how is that memory kept alive? Every family is different. The family may want to plant a tree, or create a memory garden. Perhaps they create a spot where photos of the twin are kept, or maybe the pictures remain throughout the house. If the family is spiritual, maybe they want to create a special prayer that will become part of an evening ritual.
Additional resources for families coping with loss include:
Q. I have cancer and have been struggling to be a “normal” parent. My biggest challenge is disciplining my children because I feel guilty that I’m tired and not available as much to them. Is there any info out there about raising children while living with cancer?
Your question is one that we often hear. Without a doubt, cancer can impact your home life, and this disruption may cause a change in your children’s behaviors. Children want consistency and actually like guidelines, but it may be harder to set boundaries when you are not feeling well due to your diagnosis or its treatment.
There are some things that you can do to reduce stress, and perhaps make things a little easier in your home:
- Give hugs and say “I love you”: The primary need of children is safety and security. Let them know that they are loved and heard, and that in no way did your cancer impact your love for them.
- Allow yourself “me time”: As a parent – with cancer or not – it is vital that you remember to take care of yourself. Self-care is rejuvenating; it fuels the system both physically and emotionally. It is also a good lesson to impart to your children.
- Be on the same page: Explain to your children, in age-appropriate terminology, your cancer and what the treatment will be. Use the word “cancer.”
- Be available: Let your kids ask questions, and give honest responses.
- Explain your treatment and what the side effects might be ahead of time: Prepare your children for the “what ifs.” Hair loss, fatigue or nausea may be side effects of your treatment. Maybe they want to meet your oncologist, or see where your treatment will be. Seeing, touching and feeling can make things less scary.
- How you act and react is most likely what your children model their behavior on: A parent who reacts to their cancer by shutting down, having life revolve around the diagnosis, and creating a home life ensconced in cancer may have young ones mimicking that behavior. A parent who acknowledges the cancer, addresses the possible limitations, yet continues to live, is building resilience in their children.
- Let the school know: The more people on your children’s team, the better. Inform the principal, guidance counselors and teachers of your diagnosis.
- It is okay to ask for help: Others want to help, and letting them do so is a gift you give them. Take friends up on their offers. Think about what might help you, and ask.
- Draw a “circle of love”: Younger kids are visual. Sit down with them and help them draw a picture of all the people who love them. Let them know that if you aren’t here for them, all these other people will make sure that they are “okay.”
- Journaling: Older kids may have questions for you that they are uncomfortable asking. Give them a book they can jot their questions in and leave by the side of your bed. This will allow you to open up a meaningful discussion.
- Schedule in some fun: Cancer is part of your life, but don’t allow it to be your family’s whole life. Watch a funny movie, dance and sing in the kitchen, work on crafts. Continue to grow, learn and explore as a family.
The most important thing to remember is that while you may have cancer, your children are so happy to have you there. As a parent, you are a symbol of safety and security, and just having you nearby can bolster your children’s sense of comfort.
Two good books that might be helpful to read for more information include:
- Raising an Emotionally Healthy Child When a Parent Is Sick by Paula Rauch, M.D. and Anna Muriel, M.D.
- When a Parent Has Cancer: A Guide to Caring for Your Children by Wendy S. Harpham.
Q. This is a hard time of year for us as my wife has cancer. Would you recommend any books about talking to and doing the best for our kids?
When coping with a cancer diagnosis, families often experience a variety of changes and adjustments during the holidays and other significant events. Discussing and preparing for these changes with your children can open up dialogue, elicit questions and help you to understand what your child is feeling. Although certain rituals or customs may change, it can also be helpful to honor old traditions as a way of maintaining a sense of normalcy for your children. Remember that cancer doesn’t have to be the focus of the holidays, and you have discretion over how much room cancer gets during your celebration.
Books can be helpful tools or supplements to reinforce language and ideas to help children cope with a parent’s cancer diagnosis, but should not replace a conversation. The holidays may be an opportunity to have such discussions, as you are likely joining together as a family to reflect on the past year and to make plans for the year ahead.
When selecting literature to help you talk to your children, consider your child’s age, developmental stage and maturity level. Being honest allows children of any age an important opportunity to ask questions and express how they feel. You may not have all the answers, but you can remind your child that you will always be available for them to ask.
For more information about coping with the holidays and communicating with children about cancer, read CancerCare’s Coping with Cancer During the Holidays and Helping Children When a Family Member Has Cancer, or review the following books to help you navigate these conversations:
- How to Help Children Through a Parent’s Serious Illness by Kathleen McCue and Ron Bonn (St. Martin’s Press: 1994)
- Helping your Children Cope with your Cancer by Peter Vandernoot (Hatherleigh Press: 2006)
- When a Parent Has Cancer : A Guide to Caring for Your Children by Wendy Schlessel Harpham, MD (Harper Collins: 2004)
Q. My 5-year-old nephew has lost an eye due to retinoblastoma. He has started asking questions we do not know how to answer (e.g., What does cancer look like? Was I born with it?). How do we answer these questions and ease his anxieties?
When talking to children about a cancer diagnosis, it’s important to provide honest, age-appropriate answers. For instance, when the child asks if they were born with cancer, you can tell them that the cancer happened on its own—nobody did anything to make it happen. There may also be questions that you may not know the answers to and it’s okay to simply say “I don’t know,” which is an honest answer.
The reason why we stress being honest when talking with a child about cancer is that by doing so, you’re letting the child know that you can be trusted. For more information about talking to children and helping them cope with cancer please read our booklet, Helping Children When a Family Member Has Cancer.
Children may not have a clear understanding of what cancer is, which is why we recommend using arts, crafts, toys, and games to assist in talking about cancer. For example, you can take a small piece of clay and place it on a doll to show where the cancer is located. One might also draw a picture of a person to show the child where the cancer is located on the drawing.
It can be helpful to read books which are specifically written to help children understand cancer and its treatment. Kemo Shark is a downloadable comic book that is designed to help kids understand cancer and chemotherapy.
At times, counseling may be useful to assist children in working through the feelings behind their questions. If you think this might be helpful for your nephew, CancerCare’s professional oncology social workers can help you find local children’s counseling services. Please call us at 1-800-813-HOPE (4673).
Q. I've recently started treatment and I'm trying to find things that can help support my 13-year-old such as groups, counseling, etc. Do you have recommendations?
Being diagnosed with cancer not only affects a cancer patient but the family members as well, especially children. Oftentimes, children are overwhelmed with worries about the cancer patient, and can feel alone and different from their peers.
We’re glad you decided to seek support for your 13-year-old, especially since most children do not know there is help available to them. Let your child know that they can always come to you to talk about their worries. They can also talk to another adult such as a teacher, counselor, or a relative who they can trust and who knows about your diagnosis.
Some children may also benefit from connecting with other children affected by cancer by joining an online or in-person support group. Having such an opportunity allows them to relate to one another and feel less alone or different.
You can contact CancerCare at 1-800-813-HOPE (4673), and our oncology social workers can help you find support programs that may assist your child. I’d also recommend contacting a local hospital social worker or patient navigator for referrals to local organizations that offer in-person support groups for teens.
The American Cancer Society (1-800-227-2345) may also provide a listing of local organizations that provide support groups.
Sometimes children may be shy and not feel comfortable about meeting others in person. If this is something your child may experience, they may sign up for an online support group offered through online organizations, such as
Q. Are there books written specifically for children that can help them understand and cope with a parent's cancer diagnosis?
After talking to your child about a cancer diagnosis, books can be a helpful follow-up to encourage learning more about cancer, exploring feelings and asking questions. It can also be a nice opportunity to spend quiet time together or give your child some autonomy to learn independently. Books are available for different age groups and developmental stages. It is important to choose books that are appropriate for your child by not only looking at the recommended age on the book, but also by looking through the book in its entirety.
The American Cancer Society offers:
- Mom and the Polka Dot Boo Boo tells a story about a young mother’s journey through breast cancer (ages 2-5)
- Our Mom Has Cancer helps children understand and cope with a parent’s cancer (ages 5-12)
- Our Mom is Getting Better and Our Dad is Getting Better helps children understand a parent’s special needs when recovering from active treatment (ages 5-12)
- Because Someone I Love Has Cancer offers activities to help children navigate a loved one’s cancer experience (ages 6-12)
KidsCope has a free comic book called Kemo Shark to help kids understand cancer and chemotherapy.
The National Cancer Institute has excellent free booklets to help teens cope with cancer:
- When Your Parent Has Cancer: A Guide for Teens
- When Your Brother or Sister Has Cancer: A Guide for Teens
If you choose to share books with your child about cancer, be sure to check in with them to see if they have questions about what they read or if they want to talk about it.
Q. My daughter is having separation anxiety now that she knows about my cancer. She also wakes me up every night saying she is scared. She won't go to sleep without me. Any suggestions?
Children who have a parent with cancer often experience separation anxiety. They may be reluctant to go to school or to a friend’s house, or they may be afraid when a parent has to leave them to go to the doctor or even on an errand. Because fear is often driven by the unknown, it is important to make sure your children know about your cancer and how you will be cared for to give them as much peace of mind as possible. In addition, when you leave the house to go somewhere, tell your children where you are going and when you expect to return. Leave a contact number where they can reach you in case of emergency. By including your children in your cancer experience and daily routine, they have some control and participation, and may feel less helpless.
It’s common for children’s fears to come out at bedtime. They may feel more emotional because they are tired, or the natural separation of going into their own bedroom may trigger anxiety. If you haven’t already, set up a bedtime routine for your daughter that is comforting, such as listening to music, reading a story, or talking. Spending peaceful time with her before she falls asleep will help her relax and feel safe. It is also important for children developmentally to learn to self-soothe. Teach her techniques she can try should she wake up during the night, such as reading to herself or listening to a recorded story in your voice. Reinforce that you are safe in bed nearby. Establishing routines and communicating with her about your cancer should help alleviate some of her fears.
For more information about communicating with children about a cancer diagnosis, read CancerCare’s Helping Children When a Family Member Has Cancer. The American Cancer Society also has a helpful guide, Helping Children When A Family Member Has Cancer.
You might also want to seek counseling for your daughter so that she can express and work through her fears. Our staff of professional oncology social workers are knowledgeable in children’s issues related to a parent’s diagnosis, sibling or other loved one. To speak with a social worker, call us at 1-800-813-HOPE (4673) or email firstname.lastname@example.org.
Q. My 7-year-old daughter is sure she did something to cause my cancer. What can I say to her to convince her otherwise?
It’s normal and expected for children to fear they have somehow caused a parent’s cancer. When children don’t understand something they sometimes use “magical thinking” —the belief that one can bring about an event by thinking about it or wishing for it. By continuing to think she caused your cancer, your daughter is likely telling you she loves you, is afraid, and has no other explanation other than she must have done something to cause it.
You have already taken the first step to help your daughter, which is to take her concerns seriously. The next step is to plan a talk with her addressing her feelings and providing accurate information. Simply telling your daughter that she didn’t cause your cancer is not enough—you need to give her an explanation that she can understand.
Pick a quiet time when you and your daughter will not be rushed or interrupted, and sit next to her or hold her hand so she feels safe. It is important to praise your daughter for talking to you about her thoughts and feelings and encourage her to continue. You can also let her know that many children worry that they caused their parent’s cancer, but it’s not actually possible. Our booklet, Helping Children When a Family Member Has Cancer, offers suggestions on what you might say to your child including:
“Mommy (or daddy) is sick with an illness called cancer. The cancer happened on its own—nobody did anything to make it happen. I have very good doctors, and I am going to do everything possible to get better.”
Your daughter may accept this explanation, or may want more concrete information. Depending on her level of maturity and interest, you may use books or the internet to help her learn more about your cancer. Make sure to preview any materials or websites before sharing them with her and allow her to continue to share her feelings.
Q. Last week I told my son that I had cancer and we have barely spoken about it since. What can I do to help support my son?
As a caring parent you want to help your son understand what you are going through. Children want to know the facts and how they will be affected.
If your son is under 5, he is likely to ask you a question or bring up your cancer when he is most closely engaged with you one on one. His questions will most likely be brief and concrete, such as: What does your cancer look like? Does the medicine taste bad? Your answers should be brief, factual and in words he understands.
Children ages 6-11 typically are more interested in the mechanics of treatment. The “killing” of cancer cells and seeing your treatment as a “battle” or “fight” — whether or not you yourself use these images — is very likely how your son will think of your experience. Some parents are comfortable using this language; others may choose to describe their experience using non-violent imagery. Either way is okay.
If your son is a teenager, he will be wrestling with a variety of conflicting thoughts and feelings. He will want to ask questions but think it is “babyish” to be worried about you. He may feel sad about the situation but think it is “unmanly” to have that feeling. He will be certain that none of this “shows” at all but you will see it clearly in his face and demeanor. If you ask him questions he will most likely tell you that he is “fine.” Keep in mind that just because you have cancer, does not change the fact that your son is still a teenager.
No matter what age your son is, he will let you know when he is ready to talk. There may be times when you need to start the conversation because you are going to lose your hair, or need to rest more, or will be hospitalized. In these cases, be factual, brief, and use words you know your son will understand.
Here are some additional tips:
- Let your child know that you are always available to answer their questions
- Try to keep family time consistent
- Ask your child if there are aunts, uncles, school counselors or other professionals (social workers, psychologists) that they would like to talk to about how they are coping
- Find age-appropriate support groups for your children that will help them feel connected to other children who have a similar experience
Helping your Children Cope with your Cancer, by Peter Vandernoot (Hatherleigh Press, New York), is an excellent resource.
Q. I've been recently diagnosed and I'm not sure quite how to tell my kids. Is it ever a good idea to not tell them?
Talking to your children about your cancer and how it will affect the family isn’t easy, but it is important and necessary. By talking to your children honestly and helping them express their feelings, you can make it easier for them to feel safe and secure.
Here are my suggestions for talking to your children about cancer:
- Use understandable, age-appropriate language. Keep in mind that an eight-year-old will understand cancer differently than a teenager.
- Explain your treatment and any possible changes you may be facing, such as hair loss or being more tired than usual. Reassure them that their needs will be taken care of despite these changes.
- Let your children ask questions and answer them as accurately as possible. If you don’t know the answer, be honest and tell them you will try to find out.
- Let your children know that it’s okay to express their feelings, and who they can turn to for support.
- Write down or practice beforehand what you would like to say to your children; couples may find it helpful to talk to their children together.
- Choose a quiet time when your children are rested to help make the discussion less stressful.
While the discussion of cancer is serious, it is important to use a calm and reassuring voice with children, even if you become sad while talking. You can help them to see how you are trying to cope, which will help them feel okay with their own feelings about cancer.
You’ll find more tips in CancerCare’s fact sheet, Talking to Your Kids About Your Diagnosis.
Q. I have a 14-year-old son who doesn't seem to want to talk about my cancer at all. I know it's hard for him, but it also can't be good for him to keep things bottled up. What should I do?
Teens are at a stage in life when they are trying to develop their own identity, sense of self, and independence. Your son’s not wanting to talk about your cancer is a common reaction many teens have. Teens may feel that their questions or concerns might be hurtful or even scare the parent. It’s important for you to keep communicating with him and show him that it is okay to talk about feelings. Keep him up to date about your cancer and treatments, and let him know that if he has any questions or concerns he can always talk with you about them.
It’s important to respect his privacy and to offer him additional support that may be helpful to him. Identifying a relative like an aunt or uncle, or a teacher, coach, or school counselor with whom he can talk more openly can give him a sense of feeling more in control of his situation, and allow him to voice questions or concerns he may not want to with you.
If you haven’t done so already, I would also encourage you to inform his school. Teachers and school counselors can be supports for both your son and yourself. They can watch for and inform you of any concerns or behavioral changes your son may be displaying, and can advise you should they feel your son might need additional professional help.
The following publications may help as you navigate the sometimes tricky territory of having cancer while parenting a teen:
- CancerCare’s Helping Teens When a Parent Has Cancer
- CancerCare’s Helping Children When a Family Member Has Cancer
- How to Help Children Through a Parent’s Serious Illness by Kathleen McCue and Ron Bonn (St. Martin’s Press: 1994)
- When a Parent Has Cancer : A Guide to Caring for Your Children by Wendy Schlessel Harpham, MD (Harper Collins: 2004)
Q. I am 16 years old. My mother died of cancer when I was 12. I am still grieving deeply about it. What can I do to feel better?
For children and teens who have lost a parent, feelings will be continue to come up as you get older. As a 12 year old, the death of your mother was extremely difficult for many reasons that are personal for you. As you are growing and experiencing different life events such as turning 16, driving, going to high school events, etc., you may experience increased feelings of grief.
There are several things you can do to cope better with the loss of a loved one.
Allow yourself the time and space to grieve. During significant moments in your life, you will feel a range of emotions and intense feelings, and these are typical and are part of the grieving process. Give yourself the opportunity to acknowledge these feelings and work through them at your own pace.
Reach out to supportive people in your life to help you manage through these difficult times. Friends, family, teachers, coaches, school counselors, are all people who may be available when you are in need of support. While some of these people might be better at listening to you, others might be helpful by taking you out to a movie or dinner. Both types of support are equally important. Reaching out to a grief counselor or joining a support group for teens who have lost a parent could also be helpful.
Plan for special days or holidays. Your mother’s birthday, Mother’s Day, and your birthday are all days when you may need additional support. Planning a way to honor your mother on these days may help you in your grieving process.
Here are a few additional resources on coping with loss for you to read: