In the Spotlight

Childhood Cancer: Talking With Your Child About Cancer

Questions your child may ask

Children often are curious and may have many questions about their illness and treatment. Your child knows and trusts you and will expect you to respond to questions. Some children will ask questions right away, while others will ask them later. Here are some ideas to help you answer some of the questions your child is likely to ask.

"Why Me?"

Children, like adults, wonder why they have cancer. They may feel strongly that their cancer was caused by something they did. A child with cancer should be told honestly that no one-not even the experts-knows why a person develops cancer. Children need to be reassured that nothing they did, or didn't do, caused their disease. Children also need to know that their illness is not contagious-they did not "catch" cancer from someone else.

"Will I Get Well?"

Often, children know about family members or friends who have died from cancer. As a result, many children are afraid to ask if they will get well; they fear the answer will be "no." You should tell your child that cancer is a serious disease but that the medicine, x-rays, and/or operation will help to get rid of the cancer.

You should also tell your child that the doctors, nurses, and family are trying their best to cure the cancer. By using this approach, you are giving your child an honest, hopeful answer. Knowing there are caring people such as doctors, nurses, counselors, and others also may help your child feel more secure.

"What Will Happen to Me?"

When children are first diagnosed with cancer, many new and frightening things happen to them. While at the doctor's office, clinic, or hospital, they may see other children with cancer who are not feeling well, are bald, or have had amputations. A child may be too afraid to ask questions and may develop unrealistic fears about what will happen.

For this reason, children should be told in advance about their treatment and possible side effects. They should know what would be done to help if side effects occur. Children also should know that there are many types of cancer and that what happens to another child will not necessarily happen to them, even if they have the same type of cancer or the same type of treatment.

Children should know about their treatment schedule. They also should be told about any changes in their schedule or in the type of treatment they receive. Having your child keep a calendar that shows the days for doctor's visits, treatments, or special tests will help prepare for these visits.

"Why Must I Take Medicines When I Feel Okay?"

Most of us link taking medicine to feeling sick. It's confusing to children to take medicines when they feel well. Answers to this question may relate back to the original explanation of the cancer. For example, children could be told that even though they are feeling well and have no signs of disease, the "bad-guy cells" are hiding. They must take the medicine for a while longer to help find the bad guys and stop them from coming back.

"What Should I Tell the Kids at School?"

Children with cancer are concerned about how their friends and schoolmates will react. This is especially true when they have missed a lot of school or return with obvious physical changes such as weight loss, weight gain, or hair loss. Encourage your child to keep in touch with close friends and classmates.

Friends often want to know what happens when a child is away from school. Encourage your child to talk honestly about the disease and the kind of treatment being given. Suggest that your child reassure friends that they cannot "catch" cancer from anyone. You or one of the teachers at school also may be able to talk to other students.

Try to help your child understand that not all people, including some adults, know about cancer. People who don't understand cancer often act differently or may give your child incorrect information.

Such talks with others may cause your child to have doubts and fears despite all your reassurance. Ask your child about conversations with others so that you can correct any misunderstandings.

You may want to ask your child's doctor, nurse, or social worker about a school conference, classroom presentations, or a school assembly that includes a question and answer session to help other students better understand cancer and what is happening to your child. Your child's teachers or the school counselor can help.

Your child will learn two important lessons about how people react to illness. First, some people, no matter what they are told, may act different because they do not know much about cancer. Second, good friends will remain friends. They know your child is still the same friend as before.

Will I Be Able To Do the Things I Did Before I Got Cancer?

The answer to this question is individual and depends on the child's type of cancer and treatment. Most likely, your child will need some restrictions at different times during treatment. Tell your child why the doctors or nurses think it's best to restrict certain activities and how long this will last.

Help your child substitute one kind of activity for another. For example, you could suggest that friends come over to paint, have a snack, or play video games if the doctor feels that your child should not ride a bike because the chance of injury is high.

Supporting your child

Like adults, children with cancer feel uncertain, anxious, and afraid at times. But, unlike many adults, children often are not able to talk about their fears. Instead, they may express their feelings by being unpleasant, boisterous, or bossy, or by being quieter than usual. As a parent, you know how your child usually behaves, so you will probably be the first to notice any differences.

Play is a way for a child to express and reduce fears and anxieties, and you should encourage it. Drawing pictures and playing with puppets, dolls, and even medical supplies are ways children may show that they don't understand what is happening or that they need more reassurance and love.

Some children find it hard to express their feelings. These children may have nightmares or eating or behavioral difficulties. They also may not do as well in school. Some children resume behaviors that they had outgrown, such as bedwetting or thumb sucking. You should talk about these things with your child's doctor, nurse, social worker, or school counselor.

Remember that through the years, you as a parent already have developed a "sixth sense" about your child. You do not need to look for problems in the way your child behaves. If problems exist, they will be obvious to you. Also, remember that your child's doctor, nurse, social worker, teachers, and school counselor have had experience with situations like yours and are willing to help.

Here are ideas for reassuring your child during the cancer diagnosis and treatment:

• Remind your child that the cancer is not caused by anything he or she did. Neither the disease nor the treatment is punishment.
• Be honest and realistic in your explanations of procedures and treatments. Let your child know about any changes in treatment.
• Nobody-not even your child-expects you to know everything. Don't be afraid to say, "I don't know." If your child has questions that you cannot answer, tell him or her that you'll try to find the answers.
• Don't be afraid to ask your child questions. Asking children what they are thinking and feeling does not create new fears; it gives them the chance to express the fears they already have.
• Tell your child that it is okay to feel sad and cry. This provides an outlet for emotions.
• Set limits. During this period, your child may challenge the rules you've set. It's natural to let ill children "bend the rules," but this actually may make them more anxious. They may imagine that things are worse than they really are.
• Let your child have some control as long as it does not harm his or her health or interfere with treatment. This allows your child to grow in spite of the needed restrictions.
• Encourage activities to reduce anxiety. Drawing, playing with medical supplies or puppets, and role-playing may help your child express feelings. Therapeutic play with a social worker or psychologist can help young children better understand and adjust to their illness.
• Encourage your child to talk about his or her feelings. Frequent family talks can help reduce anxiety. Talking helps the whole family cope with this illness together.
• Recognize that children, like adults, have good days and bad days.
• Remember that the health care team is there to answer questions and give support to you and your family.
• Children, especially those younger than age 5, worry about being separated from their parents. Reassure your child that even though you have to leave, you love him or her and will return as soon as you can.
• Help your child keep in touch with friends, family members, and schoolmates while away from school. This tells your child that he or she is still a normal kid with friends, interests, and responsibilities.
• Encourage your child to do homework and to go back to school as soon as possible. If your child is unable to attend school, even for a short amount of time, you may be able to request a tutor or a teacher to come to your home. Encouraging your child to keep up with schoolwork, even at home, will send a positive message.
• Despite all that is going on, your child is the same person as before, with the same emotional needs as any other growing child. Take some time each day to love and enjoy each other as much as you can.

Resources

As you and your family learn to cope with cancer, you undoubtedly will have many questions. Information about cancer is available from many sources, including the American Cancer Society and the Cancer Information Service, a program of the National Cancer Institute. You may wish to check for additional information at your local library or bookstore and from support groups in your community.

Source: National Institutes of Health National Cancer Institute