Children's understanding of illness and their reactions to bad news will vary depending on their age, temperament and family experiences. You may find that siblings, even of similar ages, respond differently. This page gives an overview of children's possible reactions at different ages, which might help you work out how best to support them.

Newborns, infants and toddlers

Infants 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. Toddlers may react to physical changes in their parent or relative (such as hair loss) or noticeable side effects (such as vomiting).

Possible reactions

• newborns and infants: becoming unsettled, especially if they need to be weaned suddenly
• newborns and infants: wanting to breastfeed more frequently for emotional comfort
• becoming fussy and cranky
• becoming clingy change in sleeping or eating habits colic
• toddlers: tantrums, more negativity (saying "no")
• return to, or more frequent, thumb sucking, bedwetting, baby talk, etc.

Suggested approaches

• maintain routines: ask any carers to follow the established schedules for your baby or toddler as much as possible
• give plenty of physical contact (e.g. hugging, holding, extra breastfeeds) to help them feel secure
• watch play for clues to how a child is coping
• use relaxation tapes, calming music or baby massage

Preschoolers

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?

Possible reactions

• return to behaviour that is developmentally younger, e.g. sucking their thumb
• comfort-seeking behaviours, such as using a security blanket or special toy
• fear of the dark, monsters, animals, strangers and the unknown
• trouble falling asleep or sleeping through the night, refusal to sleep
• nightmares, sleepwalking or sleeptalking bedwetting
• baby talk
• hyperactivity or apathy
• fear of separation from parents or other significant people, especially at bedtime and when going to preschool
• aggression (e.g. hitting or biting), saying hurtful things or rejecting the parent with the cancer diagnosis
• repeated questions about the same topic, even if it has been discussed several times.

Suggested approaches

• provide brief and simple explanations about cancer; repeat or paraphrase when necessary
• use picture books, dolls or stuffed animals to talk about cancer
• read a story about issues such as nightmares or separation anxiety
• assure them that they have not caused the illness by their behaviour or thoughts, nor will they catch cancer
• explain what they can expect; describe how schedules may change
• reassure them that they will be taken care of and will not be forgotten
• encourage them to have fun listen and be alert to their feelings, which they may express through speech or play
• arrange opportunities for children to be physically active every day to use up excess energy, anxiety or aggression
• continue usual discipline and limit-setting.

Primary schoolchildren

In the early primary school years, children have a basic understanding of sickness, and by later primary years, they are ready for more details about cancer cells. 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.

Possible reactions

• irritability, anxiety, guilt, envy
• sadness, crying physical complaints, e.g. headaches, stomach-aches
• trouble sleeping
• sudden worry about the well parent's health
• school refusal
• separation anxiety when going to school or away to camp
• returning to behaviours that may be developmentally younger
• hostile reactions, e.g. yelling or fighting, including towards the sick parent
• poor concentration, daydreaming, lack of attention
• unexplained change in school marks
• withdrawal from family and friends
• difficulty adapting to changes
• fear of new situations
• sensitivity to shame and embarrassment
• trying to be extra good
• nailbiting.

Suggested approaches

• look for clues in their stories and play for how they feel, and let them know you care
• talk about cancer and treatment using books
• use sport, art or music to help children express and manage their feelings
• assure them that they did not cause the cancer by their behaviour or thoughts, and that they cannot catch it
• reassure them that they will be taken care of and tell them that it's okay to have fun
• let them know their other parent and relatives are healthy
• give them age-appropriate tasks to do around the house
• tell them you won't keep secrets and will always let them know what is happening
• suggest letting school know
• help them understand that what their schoolfriends say may not always be right – encourage them to check with you
• try to continue after-school activities to maintain routine and to encourage fun
• discuss the issue of dying if your kids bring up the topic
• see also ideas for preschoolers

Teenagers

During adolescence, young people start to think more like adults. As their ability for abstract thought develops, 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 are more likely to deny fear and worry to avoid discussion.

Possible reactions

• wanting to be more independent and treated like an adult
• becoming very insecure and dependent on parents, or lapsing into previous behaviours, such as watching children's TV shows
• criticising support offered by adults preferring to confide in friends, and acting as if friends are more important than family
• depression or anxiety
• worry about being different and not fitting in
• anger and rebellion
• poor judgement and risk-taking behaviour, e.g. binge drinking, smoking, staying out late, unsafe sex
• withdrawal
• apathy
• physical symptoms caused by stress, e.g. stomach-aches, headaches
• hiding feelings – adults are less likely to see true reactions
• changes in academic performance
• worrying they will also get cancer (e.g. daughter of a woman with breast cancer or son of a man with prostate cancer)

Suggested approaches

• notice any changes in their behaviour and ask them about it – this can lead to a conversation about their concerns
• encourage them to talk about their feelings, but realise they may prefer to talk to friends or other trusted people
• use words and gentle touches to the arm or back to let them know you love them
• talk about role changes in the family
• provide privacy, as needed; highlight the importance of respecting privacy and using social media appropriately
• encourage them to keep up activities and friendships; talk about finding a balance between going out and staying at home
• set appropriate boundaries
• arrange opportunities for counselling
• don't expect them to take on too many extra responsibilities
• let them know of resources for learning more about cancer and getting support
• reassure them that you don't always need to talk about cancer – you still want to chat about things like homework, sport and friends
• see also ideas for younger children (above)

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