Talking to children about cancer

Cancer is a difficult topic to talk about. You might have doubts or concerns about talking to your kids about a cancer diagnosis. It is not easy to decide what or when to tell them.

The information on this page aims to help you talk to children about cancer. We use the term ‘your child’ and ‘your cancer’ on this page. But of course, the information is not only for parents. It is for anyone who is talking about cancer with a child.

Useful tips:

Be as prepared as you can be – there are resources to support and help you
Take your time – you don’t have to tell them everything at once
You can say "I don't know" to questions for which you don't know the answer
Reassure children that they will still be loved and cared for, whatever happens

Why does talking about cancer help children?

All adults want to protect children from the pain of knowing that someone they care about is ill. You might be struggling to cope with the diagnosis or prognosis. So you may not feel ready to have difficult conversations.

You might also be worried about how your child will react, and about how to answer their questions.

Being open and honest is almost always the best way with children. Remember that uncertainty or not knowing may be harder for them to cope with than the truth.

There are many benefits to being open with children:

Children pick up on things not being right, even if they haven’t been told. They notice changes in atmosphere and routine. Not talking about what is happening can leave them worrying on their own.
Children have big imaginations and will fill in the gaps. Their fears about what is going on can be worse than the real situation. The uncertainty or not knowing might be harder to cope with than the truth.
Children might find out another way if friends and family know about the cancer. Keeping a big secret is stressful. It might be that they may feel that they can not trust you, or feel they are not included in the family.

What do children understand about cancer?

As children get older, they can usually understand more about illness and treatment. But it depends on the child. Age is only a general guide to what children understand.

Your child’s understanding depends on how they think and learn. It also depends on their previous experience of illnesses such as cancer.

Very young children don’t really understand about illness or cancer. But they can pick up on your feelings and will notice physical changes.
Preschool and young primary age children have a basic understanding of illness. They often worry that something they have done has caused the cancer. Or that the cancer is catching (contagious).
Older children have a better understanding of how the body works. They are beginning to understand that people can have serious illnesses.
Teenagers might understand in more detail about cells and body organs. But older children and teenagers can still have mistaken beliefs.

Talking to your children means you can find out if they have misunderstood anything. You can then offer them the correct information, reassurance and support.

How will my child react when I tell them?

You might feel worried about how your child will react to difficult news. Their reaction might depend on many factors including:

their age
their ability to understand, express and control their emotions (emotional maturity)
how they usually cope with difficult situations
their understanding and experience of illness and cancer
their relationship with you

Many children need reassuring regularly that your illness is not their fault. Whether they show it or not, children often feel in some way to blame. And they may feel guilty for a long time.

Younger children and primary school age

Young children may not be able to use words to say how they are feeling. They often express their feelings through play or their mood instead. So you might see a change in your child’s behaviour. Naughty or unusual behaviour might be their way of showing how upset they are.

Your child might:

seem unsettled and more clingy than usual - for example, at bedtime and school or nursery drop offs
regress back to old behaviours such as thumb sucking, tantrums or bed wetting
appear more withdrawn than usual
develop new worries and fears such as being scared of the dark or dogs
be extra well behaved to mask how they are feeling
develop some physical symptoms such as headaches or stomach pains
have trouble sleeping or have nightmares
be curious and ask questions about your cancer in a way that might feel insensitive
show no reaction at all

Older children and teenagers

Being a teenager can be a time of emotional ups and downs. Teenagers can feel confused and unsure about themselves. This can make the way they deal with a parent’s illness very different from that of a younger child.

Although they might be more able to talk about their feelings than younger kids, they might be less forthcoming. Their reactions can be more intense than an adult's. It is very important that they have the time to grieve about the illness and be included in what is happening.

Teenagers can find it hard to cope with cancer in the family. Just when they want to get away and become independent, they feel that they ought to be at home. This can make them feel guilty too.

They might want lots of detail about your illness and ask many questions. But some young people may feel afraid to ask too much.

It can be difficult for teenagers to ask for support. They often prefer being with their friends than their family. So they might become distant from their family and talk to their friends instead. Or they may keep it all to themselves.

You might also see a change in your teenager’s behaviour or mood. Your teenager might:

become angry, moody and depressed
pretend that they are coping very well - but actually they might feeling scared and lonely
regress and behave as if they were younger
seem more anxious and withdrawn
develop some physical symptoms such as headaches or stomach pains
seem like they do not care and act as if nothing is happening

When do I tell them?

Some people tell their children as soon as they are diagnosed. You might feel it is better to wait until you have all the test results back and know a bit more about the treatment plan.

There isn’t always a right time. But keeping it secret can be stressful. It is likely that your children are aware something is wrong. So, it might be best not to delay telling them for too long.

It is hard to talk to children about things that are painful for you to discuss. You might need some time to cope with your own feelings and process what you have been told.

When you are ready to talk, remember, you don’t have to tell them everything straight away. This conversation is just the starting point. You can tell them that you don’t know everything yet. But you can reassure them that you will tell them more when you have that information.

Telling your children

Before you tell them

Be as prepared as you can be. You could:

talk to your doctor, nurse or counsellor before you speak to your children - they can help you prepare what to say and how to answer any questions your child might have
rehearse what you are going to say or write it down
say the words ‘I have cancer’ aloud to yourself so it is less of a shock when you say it to your children
have some resources or props with you - they may help you talk, or may simply make the first conversations less intense

Don’t worry if it doesn’t go as you planned. You don’t know in advance how you or your child will react. This is just the first conversation in a process, and you will have opportunities to talk about it again.

You might feel worried that your child will ask "Are you going to die?". Thinking about your answer to this question in advance can help with your anxiety.

It is important not to dismiss this question as most children will be thinking it, even if they don’t say it. But how you answer it will depend a bit on your situation. It is important that you avoid lying to your children.

If you, or someone close to your child is dying, they will probably need a lot of support. You can read more about supporting children in our section about dying with cancer.

Marie Curie provide information about talking to children when someone is going to die.

Choosing the right time and place

Tips:

Try to find a quiet time to talk to your child - it is best to avoid talking before going to school or before bedtime.
The weekends are good as there is time for them to process the news and come back to you with questions
Try to be on the same eye level as them, for example on the floor or sat beside them on the sofa. You can hold their hand or be physically close.
Some people find it helps to have the conversation whilst they are doing something else.
Make sure you tell them in a safe place for them, where they can be upset or angry if they need to be.

Who should be there?

If your kids are a similar age it can be a good idea to tell them together. If you do tell them separately, try to tell them as close together as possible.
If both parents live together, it might be best to both be there. This means both of you know what was discussed, and how much your child has understood.
You could ask someone to be with you who can support both you and the children. This should be someone your child trusts, for example a friend or relative. Or you could ask a nurse or counsellor to be there to help answer their questions.

If someone else tells the children, it might be good idea to be there so you know what was said. But if you prefer not to be there, you should do what is right for you.

What do I tell them?

It might help to ask your doctor, nurse or counsellor for advice about what to say.

Tips:

You don’t have to tell them everything. Give them small pieces of news, gradually building up a picture of your illness.
You can find out what they know or ask them what they want to know. Try and explain any misunderstandings.
You can ask them if they have any questions - don’t assume that they have the same concerns as you. Try and answer these but you can be honest and tell them you don’t know some answers.
Try and keep the conversation about what is currently happening. You don’t have to predict the future or what might happen.
You can explain to your children how this might affect their daily life and routines. For example, if you are in hospital, who will take them to school or be there when they come home.

It is important to use words that your child will understand. So what you say will depend on how old your child is. Young children only need a simple explanation. You might need to repeat this. For example:

“Mummy is sick and needs to have some medicine”.

You might tell older children a bit more. You can be led by your child, and the amount they want to know. You can tell them the name of the cancer and where it is in your body. You can explain a little bit about what the treatment plan is, and how this will affect you. Remember that many children do not have any fear around the word ‘cancer’ and they are generally curious to learn about it.

But keep it simple and use clear language. There are some useful books and websites listed on the resources page. These might help you choose words to explain different terms about cancer.

Supporting your child

It doesn’t matter if you cry or show them you are upset. In fact it can help them to see that its normal to cry and be honest about feelings.
Show your children that you love them by telling them and hugging them. And remind them that they will always be looked after.
Ask them what they are worried about.
You can reassure them that you will update them when you know anything else.

Practical ways to support your child

Try and stick to normal routines

Make sure they know and understand why any changes need to happen and how these changes will affect them. Keep boundaries in place for teenagers.

Include your children in family decisions

This will help them feel more in control.

Encourage some fun activities or special time

It can be good to write these down and stick them up. This can help if you are feeling weak and tired. Your child can look ahead to a fun time in the future when you are stronger.

Have a calendar or daily timetable

For example, the kids can see when you have hospital trips. This helps them understand the changes, give them a sense of control, and helps them manage their own expectations. Remember to add non-cancer related things.

Have a worry box

This is somewhere your children can write down and then place their worries. You can ask your children if you are allowed to look at their worries.

Listen to them playing

This may help you find out if they have any worries or misunderstandings. Young children use a lot of role play to work out the world around them.

Dealing with separation anxiety

This can be very hard for some children. One suggestion is to have a special soft toy that you wrap in your tshirt for them to cuddle. Or have two soft toys, and you keep one and they keep the other. It forms a connection that can soothe them.

Have different ways of communicating

This is within your family and wider circle. For example you could have a chalk board, family discussions or a closed Facebook group.

Keep your child’s school or childcare provider up to date

This will help them know what is happening. Talk to your child first, and ask them which member of staff they would like to know about what’s going on at home. Remember some teenagers do not want anyone to know, as school can be seen as a safe place away from cancer. If this is the case, try and help them see that if, for example, homework is late, the school would understand if they know what is happening at home.

Direct your teenagers to reliable websites

This is for them to find cancer information (for example, Cancer Research UK or Macmillan). Remind them not everything they hear or read on unreliable websites is true.

More information

Maudsley Learning, part of the South London and Maudsley NHS Foundation Trust, has a set of cancer and mental wellbeing videos for people affected by cancer.

The videos have information and advice on what to do if a cancer diagnosis affects your mental health. They cover several topics, including breaking bad news, managing anxiety, common reactions to a diagnosis, and relationships.