It’s common to feel unsure about the best time to tell your children. Often, there is no right time. Keeping the diagnosis a secret can be stressful, and your children will probably sense that something is wrong. It’s also a good idea to tell children if:

• You think they may have overheard a conversation
• They are scared by adults crying
• They are shocked or confused by physical or emotional changes in them by symptoms such as frequent vomiting, weight loss, hair loss, or is admitted to hospital for immediate treatment
• You notice changes in their behavior.

The information you share with your child depends on his age and what they can understand. Children of all ages need clear, simple information that makes sense to them. As much as possible, help your child know what to expect by using ideas and words that they understand. Tell your child how treatment will make them feel and when something will hurt. Explain that strong medicine and treatments have helped other children. Explain that treatments may cause changes in your child’s schedule and how your child may feel.

Toddlers (1-5 years) and very young children understand things they can see and touch. They fear being away from their parents and want to know if something will hurt. Prepare your child ahead of time if something will hurt. Not doing so may cause your child to become fearful and anxious. You can also distract your child and try to take her mind away from the pain by reading a story or giving them a stuffed animal to hold.

School-aged children (6-12 years) understand that medicines and treatments help them get better. They can cooperate with treatment, but they want to know what to expect. Children this age often have many questions, so be ready to answer them or to find the answers together. Talk with your child’s doctor or nurse for answers to difficult questions or situations.

Teens (13-18 years) often focus on how cancer changes their lives—their friendships, their appearance, and their activities. They may be scared and angry about how cancer has changed their lives. Teenagers may feel that cancer has taken a lot of their freedom and privacy away. They may need to depend on you at a time when they are trying to become their own person. It will likely help give them a theme of the space and freedom they had before treatment and encourage independence.

Parents often doubt their ability to find the right words and to answer the questions their children may ask. It’s not a matter of “getting it right,” but rather doing the best that you can at a challenging time. Take the time to plan what you’ll say. Role-playing the conversation with your partner, friend, relative, counselor, or hospital social worker can help.

You may find it helpful to say certain phrases out loud before talking to your children. For example, you might practice saying, “I have cancer” or “Grandma has cancer”. This means you’ve spoken the words and perhaps dealt with some of the anxiety attached to those words before you talk with your kids. You can also practice the conversation in front of a mirror.

Some parents worry about crying in front of their children. It can be helpful for kids to know that strong feelings such as anger and sadness are normal, and expressing them can make people feel better. Being open with each other about feelings can help your children cope.

Changes to your child’s daily routine, appearance, and friendships may be especially challenging to deal with. Not being able to go to school or do other normal activities can make your child feel alone. Long hospital stays and time away from friends and family can also take their toll. You can help your child by letting her live as normal a life as possible. Although many activities may need to be changed, new activities and people can be added in their place. Talking with other families who are going through similar events may also be beneficial.

Here are some ways to help your child:

• Learn what to expect: Ask how the type of treatment your child is receiving has affected other children, so you can prepare your child.
• Be open and ready: Encourage, but don’t push, your child to share their feelings. Be there when your child comes to you.
• Check out activities at the hospital: Learn about events and programs at your child’s hospital.
• Take care of yourself: Children sense when their parents are stressed. It helps them cope to know that their parents and siblings are getting support.
• Prepare for hair loss: If treatment will cause your child’s hair to fall out, let your child pick out a fun cap, scarf, and/or wig ahead of time. Try to pick out a wig before the hair falls out, so you can match it to their hair color. Sometimes cutting your child’s hair short before treatment helps make hair loss a bit less upsetting. 
• Be aware of weight changes: some treatments may cause weight loss and others may cause weight gain. Get advice from a dietician so you know what to expect and how you can help your child prepare for and cope with physical changes.
• Be creative:  You and your child may shop for outfits that your child likes. Sometimes a cool t-shirt or fun hat helps to build self-esteem.

• Some children think that cancer is contagious. For them, we should explain that cancer is not contagious. It’s not an illness children catch from someone or can give to someone else.
• Some children may know or have heard about a person who has died from cancer. Your child may wonder if she will get better. We can explain to them that your doctors and nurses are giving you treatments that have helped other children. We are going to do whatever we can to help you get better.
• Some children think they did something bad or wrong to cause cancer. Others wonder why they got sick. Tell your child that nothing he or anyone else did caused the cancer. Not even doctors know exactly why one child gets cancer and others don’t. We do know that you didn’t do anything wrong, you didn’t catch it from someone, and you can’t give it to anyone.

Honesty builds trust. Tell your child about the treatment options and what to expect. This will help your child trust you and the health care team. Children who are not told what is happening or why are often fearful and may imagine the worst. Make sure your teenage children are included in treatment planning and other choices.

Tell your child how treatment will make him feel and when something will hurt. Explain that strong medicine and treatments have helped other children. Explain that treatments may cause changes in your child’s schedule and how your child may feel.

Encourage your child to come to you with questions. Use your child’s questions as a guide to understand what is on her mind. Children often use their imaginations to make up answers to unanswered questions and may fear the worst. Answering your child’s questions and having honest, ongoing conversations can help your child. Some children feel better after talking. Others prefer to draw, write, play games, or listen to music. Allow them to do so.

We know that siblings of a child with cancer face many difficulties. Many are sad, scared, and confused. Although many try to be brave and helpful, they may feel left out, alone, neglected, or sad.

• Listen to and talk with your other children: Set aside some time every day, even if it’s just a few minutes, to spend with your other children. Tell them and show them that they are loved. Ask how they are feeling. Sometimes, just listening is very important.
• Keep them informed and involved: Talk with your other children about their sibling’s cancer and tell them, as best you can, what to expect during treatment. If possible, find ways to include them in visits to the hospital. If you are far from home, stay connected through e-mails, texts, and phone calls.
• Keep things as normal as you can:  Arrange to keep your other children involved in school-related events and other activities that are important to them.

Long-term effects of childhood cancer treatment:

• Organs, tissues, and body function.
• Growth and development.
• Mood, feelings, and actions.
• Thinking, learning, and memory.
• Social and psychological adjustment.
• Risk of relapse.

Long-term follow-up may improve the health and quality of life of cancer survivors. Healthy and well-being-promoting behaviours have the potential to enhance the quality of life for cancer survivors. These include a healthy diet, exercise, regular medical and dental checkups, and meditation. These self-care behaviours are especially important for cancer survivors because they risk health problems related to treatment. Healthy behaviours may make late effects less severe and lower the risk of other diseases. Avoiding behaviours that are damaging to health is also important.

• Kurukshetram 2.0 by Dr. Julius Xavier Scott
• Children With Cancer (A Guide For Parents)
• Hope Shining Through The Darkness Of Cancer By Collette A. Henry
• Childhood Leukemia (A Guide For Families, Friends, And Caregivers)