How They Understand Illness

• Their age and level of thinking makes it difficult for them to understand illness and death.
• They may believe they have caused the illness.
• They may believe they can catch the illness.
• They are able to sense changes and distress in the home.

What to Look For

• More emotion when you separate from them (separation from the primary caregiver can become their greatest source of stress)
• Changes in behavior (such as bed-wetting, clinginess, stuttering, nightmares, and thumb-sucking)

Possible Responses from Parents

• Read a book that explains cancer to kids.
• Explain changes in their routine or their caregivers’ responsibilities.
• Provide a brief and simple explanation about the diagnosis and care plan.
• Provide reassurance that your child will always be cared for.
• Encourage emotional expression throughout the family, like saying, “It’s OK to cry.”
• Encourage them to have fun.
• Provide reassurance that they can’t catch cancer like a cold or a virus.
• Provide reassurance that they did not do anything to cause the cancer.
• If they ask how to help, encourage them to do chores or small tasks in the house.
• Maintain their routine as much as possible.
• If visiting a parent in the hospital, prepare the child for what they will see and structure the visit with a fun activity to do in the room.

After the conversation, young children may go play or change the topic. It is important to remember that this does not mean they don’t care — they process information differently than adults and often need time to absorb the information.

How They Understand Illness

• At this age, children believe in cause and effect. They might think, I said, “I hate you” to Daddy and that’s why he got cancer.
• They’re developing logical thinking skills that can impact how they process a parent’s illness. For example, they understand the difference between real and pretend, but they may think that their thoughts or wishes can influence the future. They might think, If I hope Mommy gets better, she will.

What to Look For

• Difficulty containing their emotions
• Blaming themselves when bad things happen
• Separation anxiety or clinginess
• Physical complaints, such as stomachaches
• Changes in grades or academic performance
• Signs of withdrawal from their friends or favorite activities

Possible Responses from Parents

• Read a book that explains cancer.
• Provide simple, concrete, disease-related information, such as the name of the disease, its symptoms, the care plan, and the prognosis.
• Give a simple explanation of the relationship between the ill parent’s behavior and the symptoms or treatment of the cancer, such as, “Daddy is tired from his medicine.”
• Provide reassurance that they did not do anything to cause the cancer.
• Provide reassurance that they can’t catch cancer like a cold or a virus.
• Think about planning a hospital visit as it may assist with relieving worry about the unknown.
• Maintain their routine as much as possible.

How They Understand Illness

• Children at this age are developing critical thinking skills and can understand cause and effect.
• They can understand more detailed information about a parent’s cancer. Ask them what they understand, and correct or add information for clarity.
• Children at this age can understand the concept of death — our social workers can help you talk to your children about end-of-life concerns.

What to Look For

• Daydreaming, lack of attention, difficulties in thinking clearly, and issues with concentration
• Changes in academic performance
• Physical complaints, such as headaches or stomachaches
• Sadness or frequent crying
• Trouble regulating emotions in general
• Using distraction to avoid strong emotion

Possible Responses from Parents

• Read a book that explains cancer. 
• Use the proper name of the disease, such as breast cancer or brain tumor.
• Provide detailed, concrete explanations about the parent’s illness and care plan to help them gain a sense of control.
• Explain that cancer is not contagious like a cold or virus.
• Provide reassurance that they did not do anything to cause the cancer.
• Ask them about their understanding of the illness, and correct or add information for clarity.
• Validate their feelings.
• Invite them to ask questions about the cancer diagnosis and treatment. If you don’t know the answers, assure them that you’ll find out.
• Maintain their routine as much as possible.
• If a parent is hospitalized, think about planning a hospital visit. It may assist with relieving worry about the unknown.

How They Understand Illness

• Teenagers are better able to comprehend illness and treatment.
• They are capable of abstract thinking, meaning they can think about things that they have not experienced themselves.
• They are able to begin thinking more like adults.
• They are able to understand the cause of a treatment’s side effects.

What to Look For

• Guilt about spending time with friends and doing activities without their parents
• Denying fear and worry to avoid a discussion about cancer and treatment
• Behavioral and emotional changes, such as withdrawal, apathy, arguing, depression, anxiety, or self-harm

Possible Responses from Parents

• Explain that there is no wrong or right way to feel, and that fear, sadness, anger, and even having no feelings at all are all normal reactions.
• Let teenagers know that if it’s difficult to talk to you about feelings, there are others who can listen and help. These include the Talking with Children about Cancer staff, nurses, social workers, and your care team, as well as teachers, school social workers, and guidance counselors.
• Provide them with information in a factual and age-appropriate manner.
• Delegate appropriate tasks to allow them to feel included in the process and give them a sense of control in an uncontrollable situation.
• Talk about potential role changes in the family and prepare them for possible changes in their routine.
• Offer resources for learning more about cancer and getting support.
• Encourage them to talk about their feelings but realize they may find it easier to confide in friends, teachers, school counselors, or other people close to them.
• If a parent is hospitalized, it can be empowering to give teens the opportunity to decide whether to visit the parent.

This online support group is for people who have children and are currently undergoing treatment at MSK. Spouses and partners are also welcome. The group offers the opportunity to share personal experiences, discuss ways to help children throughout different stages of the process, and provide practical and emotional support to one another around balancing parenting and treatment.

When: First Wednesday of each month

Time: 12:00 to 1:00 p.m.

Facilitators: Natalie Santos and Johanna Tappen  

For more information and to register, email [email protected]. You must have access to a computer and telephone to participate in this program.

A Night for Families is a program for children who have a parent or caregiver diagnosed with cancer. This is a unique opportunity for families to connect with other families facing cancer. Pizza, art projects, and group discussion are included.

Location: Manhattan

For more information, call 212-639-7029.