How children understand cancer

Children’s understanding of illness and their reactions to news of a cancer diagnosis will vary depending on their age, personality and family experiences. You may find that siblings, even of similar ages, respond differently.

As children grow up, their understanding of the world will also develop. As they mature, they may become ready for more in-depth conversations.

Newborns, infants and toddlers (0–3 years)

Very small children have little understanding of illness but may pick up on their parents’ anxiety and other feelings. They are aware of periods of separation from their parents and can get upset when a parent is not there.

They may become clingy or unsettled, especially if they need to be weaned from breastfeeding suddenly. Toddlers may react to physical changes in their parent or relative (such as hair loss) or noticeable side effects (such as vomiting).

They may react with more frequent thumb sucking, bedwetting or baby talk. You can help them cope by:

• maintaining usual routines as much as possible
• giving them plenty of physical comfort
• playing age-appropriate relaxation podcasts or calming music.

Preschoolers 3–5 years

By the age of 3, children have a basic understanding of illness. Younger children may believe that they caused the illness (e.g. by being naughty or thinking bad thoughts). They may also think they can catch cancer.

It is natural for young children to think everything is related to them: Did I cause it? Can I catch it? Who will look after me?

They may also express their concerns or feelings through imaginative play. Young children might become aggressive, or return to behaviour that is developmentally younger than their age, such as thumb sucking, bedwetting or baby talk.

They may seek comfort by using security blankets or a special toy, or they might have trouble falling asleep or being separated from their parents.

These behaviours are how some kids will communicate their worries and fears if they don’t have the words.

You can help them cope by:

• explaining what they can expect and how schedules may change
• arranging daily opportunities for kids to use up excess energy, anxiety or aggression through sports, the park or using playdough
• using picture books, puppets, dolls or toy medical kits to talk about cancer and provide short explanations about what is happening
• reassuring them that their behaviour or thoughts have not caused the illness, and that they will always be taken care of.

Primary school children 5–12 years

In the early primary school years, children have a basic understanding of sickness, and by later primary years, they are usually ready for more details about cancer. They may use simple cause-and-effect logic to fill gaps in their knowledge.

For example, they sometimes feel that their bad behaviour might have caused the disease. They may understand that people, including parents, can die.

Primary school children may feel a range of emotions such as irritability, guilt, envy or sadness. They may lose interest in school and refuse to go, become distant or quiet, or feel separation anxiety at the thought of leaving a parent.

They may return to behaviour that is developmentally younger than their age (such as bedwetting or thumb sucking), and be extra concerned about the health of others.

You can help them cope by:

• informing their school about the diagnosis
• regularly asking the child how they feel
• talking about cancer and treatment using age-appropriate material such as books, apps and videos
• discussing dying if kids bring up the issue
• keeping children connected to friends and community through maintaining regular routines and after-school activities
• using sport, art or music to help them express their feelings
• updating them about progress and treatment
• giving them age-appropriate tasks to do around the house.

Teenagers 12–18 years

During the teen years, young people start to think more like adults. They are able to understand complex cause-and-effect relationships, such as illness and symptoms.

With increasing maturity, teenagers understand that people get sick, but they may avoid talking about difficult issues and are more likely to deny feeling scared or worried.

Teenagers may also worry about being different and not fitting in. They may not want to tell anyone at school because they want to stay “normal”.

There are a range of responses your teenager might have, and these may change over time – from hiding their feelings and withdrawal, to “lashing out” in anger and rebellion.

Some may want to help more around the house; others may take risks (e.g. with drugs and alcohol), or stay out late. As teenagers, they are still working out how to respond to strong emotions and big changes.

You can help them cope by:

• encouraging them to talk about their feelings with you or other people they trust (e.g. school counsellors)
• reassuring them with words and acts of kindness to let them know you love them
• chatting about things other than cancer, like school, sport and friends
• providing privacy as needed.