Talking to children of different ages

Children at different ages and stages of development understand cancer differently. They will have different feelings and reactions to the news that they have cancer and need treatment. Members of the healthcare team, such as doctors, nurses, social workers and child life specialists, can help you talk to your child in a way that suits their age and understanding. Let your child know that the healthcare team is working to help them and that they are safe people they can trust.

Babies are too young to really understand what is going on, but you may still find it helpful to talk to your baby. It can be upsetting for babies to be separated from parents, but using soothing tones and remaining calm will help you and your baby get through it. Assure your child you will be there. In a soothing tone, you might tell your baby, “You are sick. The doctors will give you medicine to help you get better. You have to sleep at the hospital, but I will be with you.”

Toddlers can’t understand an illness such as cancer because they can’t see it or touch it. Toddlers are often anxious about what’s happening to them. They may be afraid of being separated from their parents. They may be afraid of medical tests that they cannot understand.

Toddlers need a simple, clear and reassuring explanation of what will happen. They should be told when they are going to the hospital. They should be told if they need to be away from you for special tests or surgeries. Sometimes you will need to tell them that you are leaving the hospital, but another family member will stay with your child. Being honest with your toddler will also help get through some of the hard times.

Be honest with your child about procedures that will hurt. Telling your child that needles will feel like a sharp poke, and that it is OK to cry, lets them know that you understand and accept their feelings. Being honest also helps your child trust you.

Toddlers still don’t know how their bodies work, and they sometimes think they make things happen. They might think, “I’m sick because I was bad.” Use very simple words, toys and books to help them understand what’s happening to them.

Preschoolers are better able to understand simple ideas about their bodies and illness. They tend to look at things from one point of view (their own) and believe that the world revolves around them. They also link events to one thing. Children at this age may think that their illness was caused by a specific action, like not eating their lunch. So, they often think getting better will happen automatically or by following the rules.

A child this age needs to be reassured that they did not do anything to cause their illness. The illness or treatment is not punishment for something they did wrong. Preschoolers should be told when they are going to the hospital. They should be told if they need to be away from you for special tests or surgeries. Sometimes you will need to tell them that you are leaving the hospital, but another family member will stay with your child. Being honest with your preschooler will also help them get through some of the hard times.

Children this age are also often afraid of pain. Explain medical procedures to them honestly and realistically. Remind them that all of the tests and treatments are to help them get better. Also explain that the doctors and nurses will try to help make tests and treatments less painful.

Simple explanations about cancer are also important. Stories that relate cancer to familiar ideas will help in explaining the diagnosis. These comparisons may be adapted to the child’s specific cancer type. A preschooler is able to understand when something hurts (an “owie”) or when someone is sick. For example, you might explain the disease by saying that a part of the body or cells in the body that are sick or not working the way the other cells do. Taking the medicine will help fix the cells so that they work like they are supposed to. Your healthcare team can recommend books to help your child understand what is happening in their body.

Pay attention to your child’s feelings by listening to what they say and by watching when they play. Children often act out their feelings and ideas with toys and games. Preschoolers often find it hard to express their feelings in words. They often show their feelings in their behaviour, by acting younger than they are, by being aggressive or by clinging to you.

School-age children are able to understand a more detailed explanation of cancer. They are still limited by their own experiences but are starting to understand cause and effect. For example, if you are hungry and you eat, you are no longer hungry. And so they are better able to understand that getting better comes from taking medicines and doing what the medical team tells them.

An explanation of cancer to a child this age can be more detailed but should include familiar situations. Comparisons may also be useful. You might say that the body is made up of many different kinds of cells and these cells are so small that you need a microscope (a big magnifying glass) to see them. Different kinds of cells have different jobs to do. Like people, these cells must work together to get their jobs done. Cancer cells can be described as cells that don’t do their jobs like the other cells. They crowd out the other cells and they don’t listen to the rules. Treatment helps to get rid of the cancer cells so the other cells can work together once again. Your healthcare team can recommend books to help your child understand what is happening in their body.

Children this age may be afraid of pain. Be honest about how a test or procedure might feel, what they might hear (for example, a loud banging sound) and what they may see (for example, a bright light). Also explain that there may be ways to lessen the pain of a test or treatment.

Children this age will also hear messages about cancer from other sources, such as school, the web and television. Encourage your child to share any information they learn with you so that you can discuss it together rather than have your child worry about it alone. Let them know they can ask you or their healthcare team any questions.

Teenagers can understand a more complex explanation of cancer and may have many detailed questions. Teenagers are most likely to think about cancer in terms of specific symptoms, such as tiredness, and how it affects their everyday activities. But they also understand the reasons for their symptoms. They may believe that they caused their cancer. Reassure your teenager that they did not cause the cancer. Encourage your teen to learn more about the type of cancer they have. They can talk with their healthcare team, read, watch videos or talk to other teenagers who have been in a similar situation.

Teenagers may be able to give their own consent for treatments. Just as they are starting to make decisions for themselves in other areas of life, they may want to make some of their own decisions about their healthcare. The healthcare team may also speak to your teenager without you being there. Try to strike a balance with teens. Sometimes they may want to be involved and at other times they may not want too much information and may need parents to take the lead. Always ask teens about what they prefer.

Answer your teenager’s questions as openly and honestly as you can. Try to talk about possible side effects before they happen. Teens want to be like their friends, and they are often are very concerned with how they look. They may worry a lot about side effects such as losing hair or weight loss or gain.

Give them time and space to deal with their feelings. Teens can give their parents the impression that they don’t want you around. But at the same time, they need to know that you’re there, caring for them. It can be hard to strike the right balance between supporting your child and giving them the space they need. They may not want to show their feelings or talk to you about them. Many teens would rather talk to their friends or find information on their own. If they don’t want to talk to you, help them connect with friends or other adults who can help. Encourage them to talk to their healthcare team about information that they find on their own.