Children and Cancer: Coping and Development

There is no “right” or “normal” way for a child to respond to a loved one’s cancer experience.

Some children may become distraught and anxious, while others may ask to go play. Behaviors and feelings may come and go, and varying responses can be a source of concern for caregivers. It’s important to remember that your child’s age is not only an important factor when communicating difficult news, but in how they will respond and cope with this news as well. Recognizing how they have responded in previous times of stress and change can help you anticipate how they could potentially respond to your cancer diagnosis and treatment plan. By anticipating their responses and creating an environment of open communication, you are offering them a place to safely express their feelings, worries, and concerns, and identifying past and present coping strategies for further support.

The information below is tailored to each developmental level. It’s important to remember that children have their own unique coping style. They may also exhibit responses from a higher or lower developmental level based on past experiences as well as at different points in your cancer journey.

Infants (Birth – 2 years)

While infants can’t understand what is happening medically, they can sense changes and stress in the world around them. They can recognize changes in their routine, as well as in their primary caregivers or those with whom they have a secure attachment.

Common stress reactions in infants include:

• Changes in eating and/or sleeping patterns
• Increased clinginess to primary caregivers
• Increased fussiness
• Harder than normal to comfort

Strive to keep your infant in their normal environment as much as possible and maintain a consistent routine (meals, sleep, play). If you are needing help with caregiving, choose someone your infant is comfortable with and who knows them well. Offer increased opportunities for physical comfort (hugs, kisses, snuggles) and remember to be patient if they are upset – again, they can sense stress and reacting will only intensify their response.

Toddlers and Preschoolers (2 years – 6 years)

Children this age may or may not understand what their loved one’s cancer diagnosis and treatments mean, but they do understand that something is happening.

Common stress reactions in toddlers and preschoolers include:

• Developmental regression, such as baby talk, bed-wetting, asking for a pacifier, or wanting to sleep with you
• Increased irritability, tantrums, or outbursts
• Asking or choosing to play and then appearing disinterested in what is happening

Try to maintain consistency in your child’s routine and caregivers as much as possible. Let them know before a change happens when able, so they can be prepared. Make time for play – young children need many breaks from stressful situations and play is their way of understanding, processing, and coping with the world around them. Allow opportunities for age-appropriate choices about how much or how little they would like to be involved in your cancer experience.

School-age Children (6 years – 12 years)

School-age children can understand more about a loved one’s cancer diagnosis, treatment plan, and effects it can have on the body. Due to their developing ability to understand cause and effect, they will likely need reassurance in knowing people with cancer can get better. When communicating information and reassurance, try to avoid absolutes (e.g., it will get better) as there are no guarantees and children tend to hold tight to absolute language.

Common stress reactions in school-age children include:

• Difficulty focusing or a decline in grades at school
• Behavioral changes such as withdrawal from peers/classmates, lack of interest in extracurricular activities, or internalizing feelings
• Headaches, stomach aches, or other physical manifestations of stress

Increased communication with your child’s school is of upmost importance during your cancer experience. It is common for children to display changes at school, as this is often their secondary safe place outside of home. You may need to lower your expectations during times of change, or even ask for help such as extensions on homework assignments, increased time on tests, or the opportunity for your child to call home at lunch to help them remain focused for the remainder of their day.

Let your child know it is still okay for them to have fun because their number one job is to be a kid. Encourage them to remain involved in their extracurricular activities, as this can also provide them with a sense of normalcy during uncertain times. Your child may also demonstrate a need for increased sleep or physical comfort during this time, similar to younger children. Kids use a lot of energy to cope with the changes that come with a cancer experience, so know this is normal and should resolve with time.

Teenagers (13 years – 18 years)

Teenagers are not only able to understand a cancer diagnosis and treatment plan in a more detailed way, but they are also able to comprehend the long-term effects it can have on their loved one and their family. They still need open and honest communication in a developmentally appropriate way. It can be easy to see teens as “little adults” due to their increased understanding of a cancer experience, but this is not the case. Teens do not have the same life experiences as adults to know how to cope with these changes and stressors, and they will often need additional support from a trusting adult.

Common stress reactions in teens include:

• Intense emotional reactions, particularly to things that are not related to their loved one’s cancer experience (e.g., school, friendships/relationships, and extracurricular activities)
• May feel a pressure to be “more grown up”
• Feelings of isolation due to believing they are “the only one” going through this
• Could appear to lack concern for their loved one due to increased focus on other aspects of their life

Encourage them to maintain relationships and involvement with their classmates, peers, and any extracurricular activities they may be involved with at school or in the community. Allow them the opportunity for privacy and space to cope, while also remaining available if they want to talk, ask questions, or seek increased physical comfort. In these moments, you can also demonstrate how talking about their feelings can be a positive way of coping during difficult times, as opposed to keeping everything inside.

Open communication with your teen’s school throughout your cancer experience remains of upmost importance for teens as well. Reassure them that their teachers, coaches, school counselors, or other trusted adults at school are there to support them.