Talking to Children About Cancer

Kathrin Schwickerath: A cancer diagnosis never affects just the person who is sick. It changes the lives of the entire family. That’s why we always consider the entire family system in our counseling. In addition to parents and children, siblings, grandparents, or other close caregivers can also play an important role. Together, we examine the challenges the family is currently facing, the resources available to them, and the support the family needs at this time.

It always depends on the individual case. During counseling, we always start by talking with the parents to clarify: How openly do the parents want to address the issue? What are we allowed to share? We then outline age-appropriate ways to deal with the illness.

Even very young children are sensitive to changes. They sense when their mother or father is undergoing treatment more frequently, seems exhausted, or when suddenly not everything is possible in everyday family life.

If children aren’t given an explanation for this, they often look for the cause within themselves. That’s why we recommend talking to the children and explaining, in a way appropriate to their developmental stage, that there is an illness. However, this does not mean overwhelming them with too much detail. The key factor is always:

• How old is the child?  
• What do they want to know?

Some children ask a lot of questions, while others initially want to know only a little. Both are fine.

Children often come up with their own explanations. They might ask themselves, “Did I do something wrong?” or “Is it my fault?” I remember a child in counseling who believed he had caused his mother’s cancer because he had once wished her a stomachache after an argument. Such feelings of guilt can take a heavy toll on children. 

That’s why it’s so important to provide them with a safe space where they can voice their fears and we can help them make sense of them together. Our goal in these conversations is to bring unspoken thoughts and feelings to the surface before fears and feelings of guilt become entrenched.

It’s best to take it one step at a time. No one has to explain everything during the first conversation. It’s important to address the child’s questions in an age-appropriate way. Children often decide for themselves how much information they’re ready to take in at any given moment.

One tip is to be mindful of the words you choose. For example, when talking about death, people often use a typical phrase like “the person has fallen asleep.” Children, however, can easily misunderstand this and develop fears about going to bed as a result. Honest, age-appropriate explanations, on the other hand, provide guidance and reassurance.

Another thing parents should avoid as much as possible is raising false expectations. They should try not to promise their child anything they won’t be able to deliver on later. Instead of saying, “We’ll do something fun tomorrow,” it’s more honest to say, “I’d like to go on that outing with you soon, but I’ll have to see when I have enough energy for it.” This builds trust and spares children the disappointment when plans have to be changed at the last minute.

We can sensitively support affected families in precisely these situations and offer practical, everyday advice.

This varies greatly and depends on the individual case, the child's age, and personality. Some children simply want to talk. Others express their feelings through drawing, arts and crafts, or play. To support this, our systemic family therapists use creative methods such as hand puppets or figures. Our goal is to help children express their concerns and find healthy ways to cope with stressful situations. To that end, we provide a safe space where fears can be processed before they become entrenched.

We actually see this quite often. Many families often feel lost after receiving a diagnosis. That’s exactly where we come in. We see ourselves as guides through the support system. Together, we figure out what kind of support will be most helpful right now. Sometimes psycho-oncological counseling is enough. In other cases, we refer people to self-help groups or other regional resources.

No one has to face their worries alone or navigate the maze of support services on their own. In most cases, talking with others helps—whether with professionals, family members, or fellow patients in a support group. When people share their thoughts, they often find that they can make better sense of their struggles and gain new perspectives.

Our free services are designed for the whole family. We support families when a mother or father has cancer, as well as parents whose child has cancer. The services offered by the Cancer Society of North Rhine-Westphalia (NRW) are unique because many cancer counseling centers primarily serve adults. At all of our locations, we have specially trained systemic family therapists who can support children and adolescents.

However, our services are limited to counseling. This means we can support families and help them process their experiences effectively. We cannot, however, provide psychotherapeutic treatment, for example, for symptoms of depression or an anxiety disorder. In such cases, we are, of course, always happy to assist in referring families to an appropriate service.

Counseling continues for as long as families need support. Some families attend a single counseling session, while others receive our support for months or even years. Our counseling services allow families to seek help at any stage: Support is available as early as when cancer is suspected, during treatment, during follow-up care, or even years later if the experience has become a source of stress. We also support families who have lost a loved one and, upon request, can provide referrals to external grief counseling services.

Our counseling services are always free of charge, confidential, and available without a doctor’s referral. Affected families, as well as children and adolescents—who may contact us unaccompanied, depending on their age—can reach out to us in person, by phone, or online. No one has to prove how stressful the situation is. The only requirement is that the stress be related to a cancer diagnosis.

Even years later, many families tell us how much it helped them to be able to share their concerns with someone. That’s why I want to encourage everyone affected: Stay active and don’t hesitate to reach out. No question or concern is too small to bring to a cancer counseling center. Don’t hesitate to reach out. Talking to one another is the first step toward regaining stability and direction as a family.