Last reviewed December 2012
- Helping older children, 6 to twelve years, adjust
- What words should I use?
- What older children, 6 to twelve years, understand about death
- Support services, resources and information
Children’s understanding of illness and the implications of bad news varies depending on their age and family experiences. The information below gives an overview of the needs of older children, 6 to twelve years, which can be helpful when working out what to say to them and how you might respond to lessen the impact of the news on them. Professional help may benefit a child who does not seem to be coping.
|Understanding of disease||Possible reactions||Suggested approaches|
• Able to understand more complex explanations of cancer and basic information about cancer cells.
• Some children may have heard about cancer but may not know how it starts. They may fill gaps in their knowledge with simple cause-and-effect logic.
• They may feel responsible for causing illness because of bad behaviour.
• Younger children may be starting to understand that people, including parents, can die. Older children tend to understand the finality of death and its impact. If a child has been exposed to illness or death at a young age, they may have a more mature understanding of dying.
• They’re aware of differences between themselves and others (e.g. if you wear a pressure garment or have lost your hair).
• Sadness, crying.
• Anxiety, guilt, envy.
• Physical complaints: headaches, stomach-aches.
• Sudden worry about the health of the well parent.
• Separation anxiety when going to school or away to camp.
• Regressive behavior.
• Hostile reactions like yelling or fighting, including towards the sick parent.
• Poor concentration, daydreaming, lack of attention.
• Poor marks.
• Withdrawal from family and friends.
• Difficulty adapting to changes.
• Fear of performance, punishment or new situations.
• Sensitivity to shame and embarrassment.
• Trying to be extra good, with the risk that their distress and anxiety is not identified by parents – this is more common in girls.
• Listen and be alert to their feelings, which they may express through speech or play.
• Use books to explain the diagnosis, treatment and side effects.
• Use sport, art or music to help children express their feelings and cope with them.
• Assure them that they did not cause the cancer by their behaviours or thoughts, and that it is not contagious.
• Reassure them about their care and schedules. Let them know that it’s okay to have fun.
• Let them know that their other parent and relatives are healthy.
• Tasks to do around the house.
• Let them know you care about their feelings.
• Tell them that you won’t keep secrets and will always tell them what is happening.
• Help them understand that what their schoolmates say may not always be right. Encourage them to always check the details of what they hear from others.
• Discuss the issue of dying if your children bring up the topic.
• See also ideas for younger children.
It’s often hard to find the right words to start or continue a conversation. These ideas may help you work out what you want to say. Although grouped by age, you may find that suggestions in a younger or older age bracket are more suitable. See here for tips on how to answer specific questions.
Younger school-age children, 6–9 years
Young children can understand basic explanations about many things, including illness and family routines. They need reassurance to correct misunderstandings so they continue to feel loved, safe and cared for.
“I have an illness called cancer. It means some lumps are growing inside my body that shouldn’t be there, and they’re making me sick. I am going to have an operation in hospital to have the lumps taken out. Then I’ll have some more medicine to make sure they don’t grow back.”
“The doctors say that Dad has a problem with his blood. That’s why he’s been very tired lately. The illness is called… Dad’s going to have treatment to make him well again.”
“Lots of people get cancer. We don’t know why it happens. Most people get better and we expect I will get better too.”
To address misunderstandings:
“We can still have lots of kisses and cuddles – you cannot catch cancer from me or from anyone.”
“Cancer is a disease of the body that can be in different places for different people.”
“Even though your school friends say that cancer is really bad and I will get very sick, they don’t know everything about this cancer. I will tell you what I know about my cancer.”
To explain changes and reassure them:
“The doctors will take good care of me. I will have treatment soon, which I’ll tell you about when it starts.”
“Even though things might change a bit at home, you’ll still be able to go to tennis lessons while Dad is having treatment.”
“Mum is going to be busy helping Grandma after she comes out of hospital. There’s ways we can all help out, but mostly things won’t change for you.”
“You don’t have to tell your friends about me having cancer if you don’t want to, but I would like to let your teachers know so they understand what’s happening at home.”
Older school-age children and teenagers, ten to eighteen years
In upper primary and high school, children have a more complex understanding of illness and issues affecting them and their families. Teenagers are starting to think more like adults. Explanations about the cancer can be more detailed. Children of this age not only need reassurance about their own well-being, but also about the person with cancer.
“We’ve had some bad news. I’ve got cancer. We don’t know what we’re dealing with yet, but I’m going to have surgery so that the doctors can have a look and find out.”
“You know that Mum has been sick a lot lately. The doctors told us today that the tests show she has cancer. The good news is that she has an excellent chance of beating it.”
To address misunderstandings:
“There are lots of different types of cancer and they’re all treated differently. Even though Uncle Bob had cancer, it might not be the same for me.”
“The doctor doesn’t know why I got cancer. It doesn’t mean that you’ll get cancer too. It’s not contagious (you can’t catch it) and the cancer I have is not genetic (it doesn’t run in families).”
“Even though Grandma has cancer, the doctors say she’ll probably be okay because she was diagnosed early.”
To explain changes and reassure them:
“Things will be different at home when Dad’s having treatment but we’ll be able to visit him at the hospital often.”
“After my operation, there’s a few things I won’t be able to do for a while, like lifting things and driving. So you’ll all have to pitch in at home, and Dad will leave work early to take you to your after-school activities.”
“Whatever happens, you will always be cared for and loved. We will tell you what’s going on as soon as we are told.”
“If you think of any questions or have any worries, you can come and talk to me. It’s okay if you want to talk to someone else too.”
In preparing children for the loss of a parent or other loved one, it can help if you understand how death is perceived at different ages.
|Understanding of death||Possible reactions||Suggested approached|
• Understand death but often don’t have the emotional maturity to deal with it.
• Younger children may think death is reversible and that they are responsible.
• Older children have more of an understanding of the permanence of death.
• Sadness or distress.
• Worry about being responsible.
• May ask questions about what happens when somebody dies.
• Encourage them to talk about their feelings, but realise they may find it easier to confide in friends, teachers or other trusted people.
• Provide plenty of physical and verbal expressions of love.
• Be sensitive but straightforward.
• Talk about role changes in he family.
• Provide privacy as needed.
The information below includes a list of reliable internet sites, books, library resources and organisations where you can learn more about cancer-related issues.
|Organisations that can help||Contact details||Information|
|Cancer Council||13 11 20||Cancer Council offers a range of information and services to help people with cancer, their families and friends, including telephone support groups, Cancer Connect and the online forum www.cancerconnections.com.au.|
1800 226 833
|The national support organisation for young people aged 12 to 24 living with cancer, children of people with cancer and siblings of people with cancer.|
|Kids Helpline||1800 55 1800 www.kidshelp.com.au||Kids Helpline is a telephone, web and email counselling service with a fun, interactive website for kids, teens and young adults. It offers confidential counselling for anything worrying a child.|
|Lifeline||13 11 14 www.lifeline.org.au||A general telephone counselling service.|
|youthbeyondblue||1300 22 4636 www.youthbeyondblue.com||Supports young people dealing with depression, anxiety and other mental health problems. They provide tips on how to talk about depression and get help.|
|Australian Centre for Grief and Bereavement||1300 664 786 www.grief.org.au||This organisation provides information and support for people caring for children and adolescents who have been impacted by trauma and loss.|
|Young Carers (Carers Australia)||1800 242 636 www.youngcarers.net.au||This organisation supports young people who are caring for a parent who is physically or mentally ill. They run support programs and provide information.|
|Website for children, age three to 12 years||Contact details||Information|
|Bearing Up Club||www.bereavementcare.com.au||An internet club for kids dealing with bereavement. Once a child is registered, they can join an online chat room. The developers of this site, Mal and Valerie McKissock, are well-known bereavement therapists who have written grief books for children and adults dealing with grief.|
|Websites for teenagers, age 12–18 years||Contact details||Information|
|CanTeen||1800 639 614 www.nowwhat.org.au||This is CanTeen’s website for teenagers and young adults who have cancer in their lives. There are lots of real-life stories, blogs and forums and information. You can also download all the Now What...? books.|
|Kids Konnected||www.kidskonnected.org||A US website for children with a parent with cancer or who have lost a parent to cancer.|
|Reachout||www.reachout.com.au||A site for young people going through difficult times and experiencing challenges on a wide range of issues. Covers general mental health and well-being.|
|Rip Rap||www.riprap.org.uk||A UK site for 12 to 16 year olds who have a parent with cancer. It includes information about cancer and its treatment, and individual stories of how cancer has affected other kids.|
Books for younger readers
She’s Got What? A story about cancer
by Carrie Lethborg and
Angela Kirsner, St Vincent’s Hospital Melbourne, 1999
When Someone You Love Has Cancer: a guide to help kids cope (Written from a Christian perspective), Alaric Lewis Abbey Press, 2005
Beginnings and Endings with Lifetimes in Between by Bryan Mellonie and Robert Ingpen, Penguin, 2005
I Miss You: a first look at death, Pat Thomas Barron’s Educational Series, 2001
Because... Someone I Love Has Cancer (Activity book for kids aged 5–10), American Cancer Society, 2002
What About Me? (Comic book for children aged eight to 14 who have a parent with cancer), Cancer Council SA, reprinted 2011
Information reviewed by: A/Prof Jane Turner, Department of Psychiatry, The University of Queensland; Frankie Durack, Counsellor and Play Therapist, WA; Carol Hargreaves, Cancer Council Helpline Consultant, Cancer Council NSW; Dr Carrie Lethborg, Clinical Leader, Cancer Social Work, Coordinator, Psychosocial Cancer Care, St Vincent’s Hospital, VIC; Angelita Martini, Consumer and Karin Steinhoff, Consumer.