Children’s understanding of illness and the implications of bad news varies depending on their age and family experiences. These charts give an overview of children’s different needs, which can be helpful when working out what to say to children and how you might respond to lessen the impact of the news on them.
Newborns, infants and toddlers
|Understanding of illness
- They have little awareness of illness.
- Infants are aware of feelings that parents show, including anxiety.
- They are aware of periods of separation from parents.
- They can get upset when the physical presence of a loving parent is missing.
- Toddlers may react to physical changes in their parent or presence of side effects (e.g. vomiting).
- newborn and infants: unsettled, especially if weaned suddenly
- newborn and infants: may want to increase breastfeeds for emotional comfort
- fussy and cranky
- change in sleeping or eating habits
- toddlers: tantrums, more negativity (saying ‘no’)
- return to, or more frequent, thumb sucking, bed-wetting, baby talk etc.
- Maintain routines. Ask any caregivers to follow your baby’s or toddler’s established schedules as much as possible. Tell them that their teachers (and other trusted adults) are aware of their parent’s wishes.
- Give plenty of physical contact (e.g. hugging, holding, extra breastfeeds) to help them feel secure.
- Ask family members and friends to help with household tasks and care.
- Observe play for clues to their adjustment.
- Use relaxation tapes, music or baby massage.
- Express your feelings and fears with others.
Younger children, 3-5 years
|Understanding of illness
- They have a beginning level of understanding about illness.
- Children may believe that they caused the illness, e.g. by being naughty or thinking bad thoughts. This is called magical thinking.
- Children are egocentric and think everything is related to them – Did I cause it? Can I catch it? Who can look after me?
- Children may think cancer is contagious.
- fear of the dark, monsters, animals, strangers and the unknown
- sleepwalking or sleeptalking
- stuttering or baby talk
- hyperactivity or apathy
- fear of separation from significant others, especially at bedtime and going to preschool
- aggression (e.g. hitting or biting), saying hurtful things or rejecting the parent with the cancer diagnosis
- repeated questions about the same topic, even if it has been discussed several times.
- Provide brief and simple explanations about cancer. Repeat or paraphrase when necessary.
- Talk about the illness using picture books, dolls or stuffed animals.
- Read a story about nightmares or other problems.
- Assure them that they have not caused the illness by their behaviour or thoughts.
- Explain what children can expect; describe how schedules may change.
- Reassure them that they will be taken care of and will not be forgotten.
- Encourage them to have fun.
- Listen and be alert to their feelings, which they may express through speech and play.
- Continue usual discipline and limit setting.
- Let children get physical activity every day to use up excess energy, get rid of anxiety and to provide a positive outlet for any aggression.
Older children, 6-12 years
|Understanding of illness
- 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
- 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).
- sad, 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 behaviour
- 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 to diagnosis, treatment and side effects.
- Use sport, art or music to help express their feelings and cope with them.
- Assure them that they did not cause the illness by their behaviours or thoughts, and that it is not contagious.
- Reassure them about their care and schedules. Let them know it is okay to have fun.
- Let them know that their other parents and relatives are healthy.
- Give them age-appropriate 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.
Teenagers, 13-18 years
|Understanding of illness
- They are capable of abstract thinking: they can think about things they have not experienced themselves.
- They are starting to think more like adults and may want lots of information about the diagnosis.
- They are able to understand that people are fragile.
- They are able to understand complex relationships between events.
- They are able to understand causes and effects: relating to symptoms and illness or between actions and outcomes.
- They are more likely to deny fear and worry in order to avoid discussion. They may talk to friends about what is happening, and act as though their friends are more important than family.
- want to be more independent and treated like an adult
- anger and rebellion
- critical of how adults react to or handle the situation
- depression or anxiety
- worry about being different
- poor judgment and risk-taking behaviour (e.g. alcohol abuse, smoking, staying out late, unsafe sex)
- physical symptoms from stress (e.g. stomach-aches, headaches)
- more likely to turn feelings inward (so adults are less likely to see reactions)
- regression: some lapse into previous behaviours such as watching children’s TV shows or being very insecure and dependent on parents
- worry that they will also get the cancer, particularly if they’re a daughter of a woman with breast cancer
- 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.
- Talk about role changes in the family.
- Provide privacy as needed.
- Encourage them to maintain activities and friendships. Talk about a balance between going out and staying at home.
- Set appropriate limits.
- If there are problems, provide opportunities for counselling.
- Don’t rely on them to take on too many extra responsibilities.
- Provide resources for learning more about cancer and getting support.
- Make agreements that you don’t always want to talk about cancer: you still want you and your kids to talk about homework, sport, friends, boyfriends/girlfriends, their part-time job, etc.
- See also ideas for children, 6-12 years.