Older children, six to 12 years

• 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).

• Irritable.
• 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.

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.

About cancer

“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.”

“How do you think Daddy got 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.”

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.

About 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.”