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    For parents: Stress warning signs in children

    When your children find out that you have been diagnosed with cancer, they will probably react in many different ways. Maybe your 7-year-old hugs you one moment, and ignores you the next. Perhaps your 6th grader moves between thinking you are going to die before his next birthday, to forgetting that you are even sick. Maybe your teenage daughter alternates between feeling very sad and acting angry. Maybe they have trouble sleeping, and can't seem to concentrate in school.

    All these actions, thoughts, and feelings are normal. No matter how your kids respond, you might find yourself worrying that your illness is placing too much of a burden on them. How can you tell when your concerns are justified?

    Children naturally worry about their parents and themselves when a parent is ill. What behaviors, thoughts, or feelings may suggest that your son or daughter is really struggling to cope with your illness, and may need some extra help?

    Topics discussed in this section

    Possible signs of significant stress

    You know your own children, and are in the best position to determine if their responses are in character with their personalities and normal coping styles. So try to pay attention to your own instincts concerning your children's stress level, even when their reactions don't match what you or others might expect.

    But maybe you're just not sure if your kids' responses are within the range of normal, or if they are trying to let you know that they need additional support. The following list is offered to help you recognize when your children may generally be going through a particularly tough stretch. Of course, children of various ages and at different points of development may react in different ways and degrees. Note that these signs can come in the form of behaviors and thoughts as well as feelings, although these categories tend to overlap.

    Behaviors

    When you look for signs of stress, try to pay attention to how your kids act throughout the day. The following behaviors may indicate that your child is experiencing more worry or anxiety than he or she can manage.

    Remember, however, that many children will show some of these signs, even when life is relatively calm. Pay attention to how long your child continues to have these behaviors. If they do not disappear within several days or a few weeks, or if they seem to indicate that your child is overwhelmed, he or she needs extra support.

    Possible indicators that your child is stressed include:
    • Having nightmares or trouble getting to sleep or staying asleep
    • Experiencing problems at school (receiving unusually bad grades, wanting to stay home from school, or getting into trouble at school)
    • Behaving in ways that seem more appropriate for a much younger child, such as wetting the bed or thumb-sucking
    • Crying frequently or throwing tantrums
    • Acting "clingy" or having trouble separating from you or other loved ones
    • Complaining more frequently of headaches, stomach pain, nausea, chest pain, or other physical problems
    • Eating too much or not enough
    • Being overly responsible or "good"
    • Disobeying your usual family rules and neglecting normal responsibilities
    • Acting in a hostile manner toward others
    • Fighting more with brothers and sisters
    • Refusing to take part in usual activities and friendships
    • Abusing alcohol or drugs, or engaging in other dangerous or risky behavior
    Thoughts

    High levels of stress can affect both the ways your children think as well as what they think about. If your child shows any of the following signs, he or she needs some additional help:

    • Intense preoccupation with your cancer, so that your child can think of little else
    • Fears that you, and perhaps other family members, will die even though you repeatedly offer reassurances that you are not dying
    • Ongoing difficulty focusing on day-to-day routines and activities
    • Recurring thoughts of death, or thoughts of wanting to die
    • New fears or phobias
    Feelings

    You may be able to detect signs of stress through the ways in which your children feel about the future, interact with others, or handle daily tasks of living. The following list describes some possible signs of emotional stress:

    • Being afraid of you and your illness
    • Feeling different, and ashamed, because of your illness
    • Feeling mad, worried, or anxious most of the time
    • Reacting with anger toward, or being overly attached to, substitute caregivers
    • Worrying that others don't like them
    • Assuming guilt for things that are not their responsibility
    • Crying too easily or too often
    • Worrying that they will be abandoned
    • Feeling discouraged most of the time

    What do I do now that I think my child is struggling?

    As you review this list, remember that no single distressing feeling, thought, or behavior is proof that your child is in trouble.

    A good rule of thumb: if, over an extended period of time, you notice your child consistently acts differently than he or she would have in the past, you may have cause for concern. In these situations, do not worry alone. Talk with your partner, your child's teacher or pediatrician, or other close support, and consider asking for outside help.

    For most people, it can be difficult to admit that someone in the family needs help from a social worker, school counselor, or psychologist. After all, you are the parent, and want to be able to comfort and support your son or daughter. But sometimes children are afraid to burden their parents with their problems, especially if the parent is ill. In this situation, kids might find it easier to confide in a neutral outsider who can focus on their concerns and questions.

    Sometimes you may need help with your own stress and the challenges of parenting, too. By talking with a social worker, psychologist, or other supportive person, you may get a clearer sense of what is going on and how you can be the most effective parent possible during this difficult time. Obtaining help for your family is not a failure: it is a concrete sign of your love and commitment.

    If you decide to seek professional help, consider telling your children, who may then have an easier time accepting their own need to talk to someone outside the family. You may want to stress that this is an unusual event for all of you, and that it is good to talk to people who have helped others to get through similar difficult times.

    Kids also often benefit from learning that they are not the only ones living with illness in the family. Consider looking for support groups for children whose parents have cancer, and then talk to your sons and daughters about participating. Simply knowing that others face the same challenge can be very comforting to them.

    So if you are worried about any of your children, talk to your healthcare provider, a social worker, or your child's pediatrician. Share your observations, specify your concerns, and, if you can, identify what you think your child needs. Try to ask for help with figuring out what to do, and, if necessary, finding someone to help you do it.

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