Helping Children Cope When a Loved One Has Cancer
MADISON – When Nancy Klein was first diagnosed with breast cancer her two children were preschool-aged. While she was afraid of what the diagnosis meant, she also had feelings of sadness and guilt as a mother.
"My deepest need was finding ways to encircle my children with hope and love," Klein told the audience at the Seventh Annual Cancer Symposium on Oct. 24 at the Monona Terrace in Madison, Wis.
Like Ripples in the Water
Klein likened the diagnosis of cancer to a stone hitting water. The ripples it causes affect many people, particularly those closest. Families, especially those with young children, are faced with the challenge of learning about the disease as well as coping with the family's emotional experience of it.
"Children face the vulnerability of their mother and the fragility of life," Klein commented about the complex emotions with which children are confronted.
"Kids may experience guilt or fear, but they also have the potential to experience the joy of living in the face of cancer," she said.
An estimated one out of every four adults diagnosed with cancer is parenting a child younger than eight-years-old. Among women diagnosed with breast cancer, it's estimated one in three are mothers.
When her children were college age, Klein's breast cancer recurred. She shared that when one is diagnosed, life feels like scenes following a devastating tornado. Everything is torn apart, turned upside down, and the sense of loss is profound. And it's critical that parents help their children learn and cope with the experience.
"Children of all ages can sense a parent's anxiety and fear," said Klein. "Parents must have the strength to mirror strength."
Helping Children Cope
Stephanie Farrell, PhD, UW Health psychologist, explained that in order to help children, it's important to understand how their development affects their ability to comprehend and cope with what is going on. In many ways, dealing with cancer occurs along a continuum, from the immediacy of treatment to long-term survivors. And there are challenges for children living and coping along every step of that continuum.
"By understanding the interplay between a child's developmental stage and their experience of the world, parents can better appreciate children's worries," said Dr. Farrell.
Trust is Key for Infants
According to Dr. Farrell, infants are most affected by a family's emotional and physical state. They can easily sense parents' stress and are unsettled by a disruption in routine. They can also experience grief when separated from a parent.
"The basic theme for infants is trust," said Dr. Farrell. Tips for helping them cope include:
- Ensuring there is a small number of consistent caregivers who are "tuned in" to the baby's non-verbal cues
- Maintaining good communication between those caring for the child so everyone can provide consistency in care
- Taping a parent's voice, whether it’s singing songs or reading stories, and showing a picture of the parent to the baby will help him cope if a parent has to be away.
Toddlers and Control
For toddlers, the theme shifts to one of control. Like infants, toddlers are easily influenced by the reactions of others, and maintaining familiarity with surroundings and caregivers is important. When routines are disrupted it's important to provide them with simple reasons. Whenever possible, offer toddlers choices and a regular opportunity to play.
Pre-schoolers Find Comfort in Closeness
Energetic pre-schoolers are imaginative, communicative and helpful, often engaging in fantasy and "pretend" play. Dr. Farrell explained that they are very social and constantly exploring the world beyond the parent. They’re not yet able to think abstractly, and that shapes how adults need to help them cope. Some suggestions include:
- Providing clear and honest explanations in simple and concrete ways
- Providing emotional outlets, reassurance and comfort, such as engaging in "pretend" play, encouraging drawing or reading and telling stories
- Offering reassurance frequently and being clear that they are not the cause of the illness, they’re not at risk for catching it and they will be cared for.
"Pre-schoolers find comfort in security objects and physical closeness,: Dr. Farrell said. "They are important elements that can help children cope."
Family Still Important for School-aged Kids
During the school years, peers start to become important to kids. But for younger adolescents, home and family are still critical to their sense of well-being. Rules and order are important and it can be difficult for children to reconcile when seemingly unfair things, like an illness, occur. Having a support system of caring adults is important, even for the most independent of kids. Other suggestions include:
- Talking about feelings
- Encouraging the child to continue being involved with friends and activities
- Offering to help talk to their friends and friends' parents about what is happening
- Explaining what is happening so children can understand the connection between the illness, or treatment, and its effects.
"Asking questions like 'how was school today' or 'what did you do today' can help provide a sense of normalcy and show kids they are still important even with everything that is going on," said Dr. Farrell.
Friends Influential to Teens
The teen years are an awkward and often turbulent time for kids. Their bodies are changing rapidly, they may feel insecure, and are trying to establish their sense of independence and identity separate from their family. Friends are extremely important and influential, often replacing parents for advice and support. But, teens still need a safe space to find refuge for their sometimes chaotic world and parents, family and the comfort of home are important.
When helping teens cope, respect, privacy and honesty are important. Because teens can be emotional, it can be challenging for parents to find ways of connecting with them in productive ways. Some suggestions include:
- Allowing teens reasonable amounts of control and independence
- Finding ways to recognize and support a teen’s unique identity
- Providing clear, honest and direct communication about a family member's illness
- Avoiding pressuring or putting too much responsibility on teens, such as caring for the house or other family members
- Involving teens in some decision-making where appropriate
- Encouraging teens to be with friends
Dr. Farrell explained that parents should try "acknowledging [to teens] that it's hard to split time between family and friends. Teens can feel guilty, but they need to know it's okay to do so."
Parents Can't Protect Kids From Reality
Regardless of a child's age, parents can't protect them from the realities of an illness - even though they may try, by not discussing the issue in front of the child. But children are perceptive and will know something is happening. According to UW Health psychologist Joel Wish, PhD, kids' imaginations "can produce worse horrors than what is actually happening."
Parents don't need to be graphic in speaking with kids; instead, keep to the basic facts and use simple terms that are age-appropriate. And, above all else, be honest.
"If parents aren't honest from the start, children may doubt even when parents are being honest," said Dr. Wish.
In figuring out how to talk to a child, it's important to understand what their previous experience with cancer is. For example, if a friend's relative had it and passed away, a child may automatically associate cancer with death. Parents can more effectively support kids when they know how a child thinks about the disease.
Children Will React Differently
Parents also need to be aware that when confronted with a parent or family member's illness, children will react in different ways. Often they may not express feelings or show any recognition of what the illness means until it affects them directly.
"Sometimes it is only when a child has to miss a sporting event, or can't go to a sleepover that an illness becomes real for them," said Dr. Wish.
Parents need to help children be aware of feelings and give names or labels to emotions in order to help youngsters develop a vocabulary for what they are experiencing. Parents should also be aware that kids may express their emotions physically or behaviorally, rather than verbally. And they may have significant mood swings.
"Children may react in ways that are typical for them," explained Dr. Wish. "A child who is dependent may become more dependent, or clingy, for example."
Importance of Non-Verbal Cues
Dr. Wish recommends that parents pay attention to non-verbal cues in order to assess how a child is handling the situation.
"Look for words or absence of words, facial expressions, tone of voice, gestures, themes in the child's play," said Dr. Wish.
Other behavioral changes such as "acting out," nightmares, or even physical complaints like 'stomach aches' or 'headaches' can also be signs that a child is struggling with emotions.
Professional counseling or an organized support group can help children having difficulty coping, (such as withdrawing from activities or becoming depressed). Creating a circle of support with friends, teachers and relatives can also be beneficial.
Children have an incredible capacity for strength and parents need to provide them with ways to be resilient. Keep them involved with what is happening, ensure communication is open and honest while respecting their developmental levels, and allow them to work through their feelings without dismissing them or providing blanket assurances.
"If we provide a sense of hope for children," concluded Dr. Wish, "that's probably the most important thing we can do."
Date Published: 11/04/2008