Family Connections

For parents: How to help children cope with your cancer diagnosis

For most families, a parent's diagnosis of cancer represents a crisis. Family members find that they must adjust not only to the diagnosis, but also to a prolonged period of treatment. This presents a major challenge to both parents and children.

Supporting your children through this time is not easy, and no one can do it perfectly. Here are some tips and tools to help you help your children cope.

Topics discussed in this section

• Find opportunities to share relaxed time with your children 
• Maintain consistent routines and limits 
• Aim for a balance between asking your kids to help out and letting them be children 
• Help your children anticipate how their lives might need to change 
• Try to notice how your children cope with your illness 
• Remember that your children will worry, and try to anticipate their concerns 
• Accept your children's resentments 
• Look for changes in your children's behavior 
• Accept your need for help 
• Talking with your children's school 
• Reaching out to other adults who can support your child 

Find opportunities to share relaxed time with your children

Most kids appreciate spending time with their parents, especially during periods of stress. So to the extent possible, spend as much time as you can with your children, either all together or one-on-one. What you do is not so important. More important is the message you send when you focus your energy on your children.

Even everyday "normal" chores offer a chance for you to be together. As you are able, drive the carpool, shop for clothes, or make dinner with your kids. If you are tired or not feeling well, watch a favorite movie or TV program together, listen to music, snuggle on the couch to rest or read, or play a board game. Find ways to have fun, laugh together, or play. One mother told of bringing her wig home for the first time, and having everyone in the family try it on – even the dog!

When you spend comfortable, unstructured time together, your children may be more likely to bring up their concerns and ask you questions about your health and treatment. You also may find that you are better able to talk about your cancer or give an update when you and your children are quietly enjoying each other's company.

Maintain consistent routines and limits when you can

Kids usually find routines to be comforting, because they represent a life that is normal and predictable

As much as possible, try to maintain your child's usual mealtimes, bedtimes, and other activities. If people come into your house to help, let them know about and ask them to follow these routines whenever possible. Try to alert your children to any upcoming changes, and ask for their thoughts about what they would like to happen.

For instance, if you are going to be in the hospital for a few days and if you have a choice of caregivers, ask your kids if they have any preferences about who will take care of them. Honor their requests when you can, and try to explain your reasons when you can't. If your choice of caregiver is more limited, offer options for other, more flexible, arrangements (e.g., when to have friends over, what to eat for dinner).

Don't overlook the importance of maintaining regular contact with your children. If you plan to be hospitalized, talk with your sons and daughters about how you will communicate: by phone, through email, or in person, as well as when and how often.

When your children know they will speak to or see you at a specific time, they may be less anxious about your absence. You are helping them know what to expect, and including them in a positive way.

Most children, regardless of age, need and want limits, especially during times of stress

Like routines, limits provide predictability and order, helping kids feel safe and supported. So even if you think you should ease up on family rules for the time being, consider that your children may not want you to. For example, if your children were required to finish homework before watching TV, or were responsible for certain household chores before you were diagnosed with cancer, keep these expectations in place whenever you can.

Consequences continue to be important, too

Now that you have been diagnosed with cancer, you may find it difficult to maintain regular discipline. This is not surprising: when you don't feel well, are tired, or stressed, you simply may not have the energy to struggle with your children. Ask for their cooperation, and let them know that you hope they will be as caring and understanding as possible during this difficult time. Let your kids know what you expect from them, and that major breaking of the family rules will have consequences, if not right now, then at some time in the future. It is best to share what those consequences would be, being as specific and clear as possible.

Talking with your partner or other involved family members is also an important step. Check to see that you all are on the same wavelength about family rules and expectations. Try to talk through differences of opinion and enlist their support. And if other adults become part of your household for some period of time, ask for their cooperation as well.

Whenever possible, aim for a balance between asking your kids to help out and letting them be children

Children often feel good about contributing to the family, especially during difficult times.

Consider asking your children how they might like to help out. You may be pleasantly surprised by their ideas! You can also identify some practical tasks that your children can do, such as walking the dog or clearing the dishes. Invite them to take care of you in small ways. You may all feel closer as a result.

Keep in mind that not all children will want to help at all times

Sometimes they may even resent the extra burden placed on them. If this happens, try to empathize. Acknowledge that the cancer is a burden for everyone, and that you understand their reactions. If it is not crucial that they help, let them know that while you would appreciate their lending a hand, they don't need to do so right now.

However, there may be times when you really need your children's assistance, even if they object. If this happens, they may be more cooperative if you explain why you need their help. Whenever possible, give your kids a chance to resume their own activities after they are finished helping you.

If you can, encourage your children to see their friends and continue with their usual activities

Even when a parent is ill, children need to have fun, enjoy themselves, and keep up with their regular activities. Remember that such involvement actually helps kids recharge and cope with the disruptions that go along with your illness. Everyone needs some time like this.

Be realistic

Let your kids know that while you will do your best, there may be times when they're not able to invite their friends to your home, or to take them places. On the other hand, if you worked full-time before your diagnosis, and are now spending more time at home, your children may find that they enjoy this opportunity to be with you.

Help your children anticipate how their lives might change

No matter how hard you work to keep things normal during cancer treatment, you will not be able to maintain every rule and routine

Despite all your careful planning and efforts, your children still may need to adjust to some unfamiliar, and occasionally upsetting, events or experiences. Your sons and daughters are more likely to weather these changes smoothly if they know what to expect. So, whenever possible let your kids know about any such changes ahead of time.

For instance, before you start a new treatment, you might talk to your medical team about possible side effects, and then describe these to your children. If you will lose your hair, tell them. If it is likely that you will feel sick for two days after each chemotherapy treatment, let them know. When you plan for a friend or relative to come into the household to help, give your kids advance notice. When it is possible, let your children choose who will take care of them, what meals the neighbors might bring, or other details of daily life.

Your children also may need some help explaining such changes to others, particularly their peers

Preteens and teens are especially worried about fitting in and not being different from their friends. Ask your kids if they are concerned about this. If so, talk with them about how they might explain the situation to their friends. It may also be helpful to talk about your diagnosis with the parents of your children's closest friends. (If you do this, try to let your kids know ahead of time.) This way, you can have some control over what your children's peers hear, and your sons and daughters might be relieved that their friends already know what is going on.

Try to pay attention to your children's reactions and needs

Notice how your children cope, and whenever possible, support the positive aspects of their coping behavior

"Coping" includes everything we do to help manage stressful events and feelings. Within the same family, each child is likely to have a unique or different coping style. Consider the following questions to help you to understand each child's coping strategies:

• What kinds of activities help your child express herself and handle day-to-day stress?

  What does your daughter do that helps her feel confident? What is she good at? Does she usually want to talk, need time by herself to "think things through," or work things out through sports? Does she use writing, art, or music to express her reactions? Does she feel better when she has lots of planned activities, or does she need more unstructured time?

• How does your son let you know when he is feeling upset?

  Does he withdraw, seek attention by whining or misbehaving, come to you for a hug, or tell you directly that he's sad or worried? Does he talk more readily when he's riding with you in the car, making a batch of brownies together, or snuggling at bedtime?

• Who or what comforts your child when she is upset?

  Does your daughter feel better staying close to you, or spending time with friends or siblings? Who is your child most likely to confide in, and under what circumstances? Who does he turn to in the family – maybe an older brother or sister? Does joking or gentle humor help to lift her bad mood? Does your daughter have a comfort object, such as a blanket or stuffed animal, or find relief in listening to music?

Anticipate your children's worries

When they learn of a parent's cancer diagnosis, children often worry whether the illness will affect them and their day-to-day lives, and whether the ill parent will die

Many young – and sometimes older – children also are afraid that they caused the cancer or can catch it from the ill parent.

Try not to be surprised if these issues come up. In fact, you might consider raising them even if your children don't. Opening the door to this conversation may help some kids find words for their fears or talk openly about their worries. Children can have incorrect ideas or beliefs about cancer, and you can help set them straight on certain key facts and help reduce some unnecessary worry.

In preparing for these conversations, you might think about how you would say, given your situation and the ages of your children.

But be careful: if you bring up a subject and your child tells you it is not of concern or they don't want to talk right now, try not to push. It's often enough to introduce the topic. Give your son or daughter a chance to decide if and when to return to the discussion.

If your children are open to talking about what's bothering them, listen carefully and answer their questions directly

You may want to let them know that their worries are normal. ("Of course you're worried right now. That's only natural.") At the same time, remind your children of any positive changes in your illness or treatment. And reassure your kids that you love them, and that you and others who care about them will be there to help, no matter what happens.

Try to accept your children's resentment of the cancer and subsequent changes in their lives

Many parents with cancer find it hard to accept that their kids do not always maintain a concerned, sympathetic response to the illness. While some children may be empathetic and generally helpful, many children feel anxious or resentful when something interferes with their usual experience of life. Frustrating as this can be, try to remember that it is normal.

For instance, your 6-year-old might get agitated or throw a tantrum if you spend part of Christmas day in bed, instead of playing with her and her new toys. When you feel your sickest, your 13-year-old may be angry that no one can drive him to his friend's house after school.

When these situations come up, try to stay calm. Acknowledge to your children that the situation is unfair for everyone, including them, and that you, too, wish it were different. When you can, think together about how to solve the problem.

It may help your 6-year-old if you suggest that she bring her presents into your room and play there quietly. Your 13-year-old might ask you to call his friend's mother for a ride or you might ask a friend of your own to give your son a lift.

Be prepared for your kids to react with anxiety or irritation, even when you do a terrific job of predicting and informing them of any necessary changes.

One mother tells of her children's resentment when their ordinarily beloved grandmother came to stay with them during their mom's surgery. Her oldest explained angrily, "She's not you, and besides we don't want anyone else in our house!" After their mom patiently accepted their dissatisfaction, carefully explained (again) why grandma was needed, and reassured them that the household would get back to normal as soon as possible, her children settled down. The visit went relatively smoothly after that, demonstrating that when children are kept informed, their resentment is usually short-lived, and they can adapt to changes.

Notice any changes in your child's behavior, and try to find their cause

Children rarely come out and say, "I'm upset because dad has cancer." More typically they show their feelings through changes in their mood or behavior, or in how they treat family members or friends. For instance, you may notice that your son or daughter is more clingy than normal, is agitated, worried or sad, or loses his or her temper much more easily than usual-or you may notice nothing at all.

Children often return to behavior more typical of a younger child

For instance, an independent 11-year-old is suddenly afraid to spend the night at her friend's house, or a 7-year-old searches for his old baby blanket. Getting into trouble at school by disrupting the class or doing poorly on homework and tests are other common reactions.

Try to watch for such changes. Also ask teachers and others who see your child frequently to let you know of anything unusual.

Try not to judge or criticize your kids' reactions, but do ask about them. Saying, "I notice that you seem really mad at your sister. Want to talk about it?" opens the door for conversation in an emotionally neutral (no one is being blamed) but caring way.

Acknowledge the possibility that your illness may contribute to your children's behavior, too. ("I know things have been a bit crazy since I learned I had cancer. It's been hard on everyone, don't you think?")

At the same time, try not to blame everything that your children say or do on your illness

When your kids act out of the ordinary, consider asking them what's going on, and if it might have anything to do with your cancer diagnosis. If your children seem frustrated with your response, ask them to explain how your illness affects them, and how they would like you to react.

Persistence and patience also come in handy

A patient recently offered an excellent example. After observing her young son's unusually sarcastic and angry behavior, a mother of four repeatedly asked him if anything was wrong. He continually said no, but several days later, confided that he had overheard a neighbor saying that his mother had "four months left." This young mother realized that her neighbor had been discussing her chemotherapy, not her prognosis. When she told her son that she had four months left of treatment, not that she had four months left to live, he was visibly relieved. His behavior improved dramatically and quickly.

As you can, develop and maintain a support network for both you and your children. If possible, accept your need for help

No parent can do it all

And when you have a diagnosis of cancer, your life gets harder, not easier. So try to become more comfortable asking for help – from your partner, your friends, and your relatives.

Most people have a hard time asking others to lend a hand. You might find it easier if you can make specific requests that fit into helpers' daily lives and schedules. For example, ask your stay-at-home neighbor if she could baby-sit while you go to the medical center. Ask your brother if he could pick up groceries for you. Ask the parent of your son's teammate if he would drive him to and from soccer practice.

When people offer to help, try to resist saying, "That's kind of you, but we're doing fine"

Instead, practice saying, "Yes, thank you." If you have help when you need it, you will be more available to your kids when they need you.

Your children need a support network outside the family, too

Encourage your children to see friends and continue with outside activities. (If you don't have the energy to arrange play dates for your younger kids, or drive to and from after-school lessons, ask a friend to help, as described above.) Ask friends and relatives to invite your child to play or to join their family for the afternoon. If you are comfortable doing so, let the parents of your children's close friends know of your situation. This way, these adults may offer support to your child and, perhaps, to you, too.

If your child is interested in a more formal type of support, ask your treatment team about groups specifically for children whose parents have a chronic medical illness

Children often benefit when they realize they are not the only ones with an ill parent, and may gain a lot of comfort from talking to others who really "get it." Groups specifically organized around the needs of children may be particularly helpful. Your children's school counselor, a hospital social worker, or resource room may have information on such groups.

And if you are concerned that your child is having an unusually hard time coping, you might consider taking him or her to an individual therapist. And even some children who do not appear to be struggling may appreciate the chance to talk with an objective person like a therapist or school counselor or hospital social worker. Again, you can consult with your medical team or school for referrals.

Consider talking with your children's school

Your children's teachers, guidance counselors, and school nurse can play a very important role in supporting your children during your illness. After all, they see your kids every day, and may be the first to notice changes in behavior or mood. They may be able to support your children by providing extra help or special attention when times are difficult.

Consider contacting the school principal or another staff person to tell him or her what is going on, and to ask for suggestions on how best to inform other staff, if appropriate. Together, you can develop a way to maintain ongoing contact, so that the school can alert you to changes in your children's behavior or performance; and you can update key personnel on any changes in your health or treatment.

Try to reach out to other adults who know your child

Your children may know and interact with several adults outside the family, including coaches, friends' parents, neighbors, and religious schoolteachers. Think about whether it would be helpful to let them know what is going on at home. If you do contact any of these adults, consider asking them to tell you if they notice anything unusual or concerning about your children.

Suggest ways in which they could support your children, such as taking them to a movie, inviting them for an over-night, or lending a sympathetic ear. You might also choose to tell these adults what you have already shared with your children about the illness, so they can reinforce your message. Finally, let your children know that you've talked with these adults, and that they are ready and able to listen, support, and spend time with them.