How to talk to your kids about cancer - plus the 6 most common questions asked and expert-led advice on answering them

You're not alone if talking to your children about cancer is challenging. Charities and experts are there to help manage difficult conversations and offer their advice.

Talking to kids about cancer is never going to be easy. Don't be worried if you're not quite sure how to begin, that's a normal feeling to have. And, once the conversation is flowing, checking in on their mental health and helping your child use their voice to express their feelings, would be a great habit to start - there are subtle ways your child expresses anxiety, and tuning in to these can be useful for future conversations.  

Macmillan Cancer Support suggests one in four parents with a diagnosis are concerned about discussing it with their children. Along with the expert we've spoken to about broaching discussions around cancer, Macmillan's insights will make the process easier. BACP Accredited Member, Therapeutic Counsellor, and Life Coach Nicole Green, shared her insights relating to discussing a cancer diagnosis with a child.

She told us "How we talk about cancer to our kids will depend on their age and understanding. For very young children keeping the conversation brief and using simple language will be best. Use pictures, dolls, or soft toys if needed as props to help explain where in your body the cancer is and also the impact of the treatment such as hair loss. Young children will likely be more focused on the symptoms and side effects that they can see. Let them know if you will be in hospital or away from home and also how it might affects their usual routine."

This article will offer expert guidance on talking to kids about cancer, and how to change up what you tell youngsters about a diagnosis, in an age-appropriate way. We've covered the questions your children might ask, and what could be the best way to answer them. Although your first instinct might be to protect your child from the news at all costs, our expert shares why this might be detrimental.

How to talk to kids about cancer

Macmillan Cancer Support reminds parents that trying to protect children from difficult news and any associated worry and distress is natural. However, they stress that however difficult a parent might find having a conversation about cancer, parents are always the expert when it comes to their children, and know the best way of communicating with them. Experts from the charity, and BACP Accredited Member, Therapeutic Counsellor and Life Coach Nicole Green, suggest: 

• Allow yourself time to process a cancer diagnosis before discussing it with children. Speaking to a dedicated nurse specialist, psychologist or counsellor before having the conversation, can be a good way to come to terms with it before telling young people. As an expert in your child, you'll also know how they might react, and whether they'll need further support. Anticipating certain reactions and having coping mechanisms in place, could make the process run more smoothly. 
• Find out everything you need to know about your diagnosis. Once you've had time to process, arm yourself with everything you need to know about your diagnosis to prepare for your child's questions. Gather information on your type of cancer, what sort of treatment you'll be having, and what your future could look like. Speaking confidently about your illness will put your child at ease.
• Consider whether your child knows what cancer is. It's a word they might've heard, but don't truly understand the meaning of. Starting the conversation with an explanation of cancer will get everyone on the same page, and offer your child insight into what you're about to discuss.
• Choose the right time and limit distractions. Nicole Green said "If you are the person who has cancer and are telling a child then choose an appropriate time to have the conversation with no distractions. This will allow you to take the time to answer any questions the child has and to comfort them. Choose if you would like anyone else to be with during the conversation such as a close friend or relative, who can provide support for you and your child." 
• See the first conversation as a starting point. The initial discussion will be the beginning of an ongoing process of gradually offering your child small, relevant pieces of information and reassurance as you enter treatment. Your situation will always be evolving, and you'll want to keep the conversation going about any changes, every step of the way.
• Use words your children will understand. Avoid confusing medical jargon, and check they've understood what you've told them. The right words to express yourself will vary depending on age. To make sure they've understood, find out what they know and explain anything they have misunderstood. Simple language and short sentences will work well, and keep asking them if there is anything else they want to know.
• Allow the conversation to be directed by your children’s reactions and the questions they ask. Listen and keep the discussion as open as you can. Ask questions that encourage children to express their feelings, rather than initiate short responses. If your child struggles to answer questions or is very quiet, that's ok too, and to be expected with the arrival of such big news. 
• Explain how their lives and routines may be affected. Children like routine, and need to be warned if their daily structure is going to change. If they're prepared for changes, it'll be easier for them to adapt to their change in circumstances.
• Know when to end the conversation. Nicole Green told us "Be mindful of signs that your child has had enough and draw the conversation to a close and return to it later. Don't be surprised if the conversation is short and your child returns to an activity such as playing. Allow them time to process the information and reassure them they can ask questions any time they need." 

What cancer means

When discussing the meaning of cancer, Nicole Green emphasises the importance of using age appropriate language. She suggested the following strategies: "With young children a simple explanation around how the good cells within our bodies become outnumbered by bad cells, is appropriate. Add that this can make us sick and cause a tumour or lump in our body called cancer. 

Nicole added "When talking to older children about cancer the starting point would be to ask them what they already know about cancer, and what is their understanding of it. This will allow a natural conversation to flow from where their understanding is at the present time. Secondary school children will have studied cells and have a basic knowledge of this so you can build upon this in your conversation and explanation of good and bad cells but build upon it to talk about how these can create tumours."

Questions your kids might have, and how to answer them

Nicole Green reminds parents that initially, it’s important to answer just the  questions children ask, so that you can stay with their individual concerns or worries.

They might also ask:

• Will you die? Nicole said "Most parents dread this question. Parents are unsure of how to respond and worried about their children’s reactions. Consider saying something like 'People do sometimes die from cancer, but lots of people don’t. I’m not dying. I am going to see the best doctors. I'll have surgery and take strong medicine to remove the cancer, and I’ll be checked by the doctors regularly."
• Can I catch it? You need to reassure them that they won't catch cancer in the way they would a cold. Nicole's advice is "It’s really important to emphasise that cancer is not contagious and that it’s something that happens within the body, and no one has done anything to cause it happening and it’s no one’s fault."
• Why did this happen? In response to this, Nicole said "Referring back to the part of the conversation around what cancer is and how it develops will be useful to help them understand what happened in the body. and the process that caused it to occur."
• Who will take care of me if you die? Nicole told us "Again, reassure your child that you are not dying. Tell them changes in routine may happen to accommodate hospital visits while you are being treated may happen, and revisit the question in the future should you need to.

Nicole suggested collecting your child's worries in a worry box. She said "Using a worry box can a useful tool to allow your child to voice all of their worries and concerns. This can be as simple as you sitting down with your child and allowing them to write down or draw everything they are worrying about and feeling. These drawings and notes will then go into a box and stay there as long as they remain a worry for your child.

Using a worry box allows your child an avenue to voice their feelings and emotions and not keep them inside. It allows then to name and process their feelings in a safe and contained way. And once the worry is no longer a worry they can remove it from the box."

What if you choose not to talk to your kids about cancer?

The majority of available advice encourages parents to tell their child about their diagnosis early. There are many potential pitfalls involved with delaying breaking the news. Nicole Green said "Ideally, talk to your children as soon as possible after diagnosis but if  you choose not to tell your child you have cancer, then be prepared that they may find out another way."

She added "They may overhear conversations or be told by a someone else . They might notice you are unwell or see changes to your appearance and routines. It’s useful to plan for such things as children will worry and can become anxious and upset leading to further stress for them."

Children might feel hurt, or some level of mistrust, if they don't find out the illness straight away. Nicole told us "Be honest about why you choose not to tell them, it may be you didn’t want to worry them or didn’t know how to tell them. If they ask you outright it will be best not to lie to them but if you can’t have the conversation then ask a trusted friend or relative to be involved."

She concluded "Talking about cancer is never easy especially if it is you that has the diagnosis. Allow that you may get upset or angry and ensure you have support for yourself. It’s ok to cry and get upset in front of your child as this will show them that it’s ok to show your emotions and keep the dialogue between the two of going. Check in with them regularly or return to the worry box to ensure their feelings are validated."

Nicole Green

Nicole Green is an experienced therapist, counsellor and life coach. She has worked in private practice for many years as well as with a bereavement agency helping adults as well as children and young people negotiate their way through the difficult path of loss and bereavement. She provides training and runs courses for parents and teachers as well as proving therapy to secondary schools. She is a Registered Member of the British Association for Counselling and Psychotherapy. To find out more about counselling visit www.bacp.co.uk

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