Think of chats like jigsaw puzzles. Adding piece by piece. Kids, even teens, can’t take in too much information so keep it short and simple. Then be led by your child. Some kids want to know everything and other don’t.

The key thing is to tell them that you are always there for their questions, and if you don’t know the answers then you can find out and come back to them.

You can be creative and get a big piece of paper, or a jar, so when they think of a question they can write it on the paper, or pop it in the jar (questions and concerns often come up at random mad times so think of this as a management technique!) Once a day or every couple of days you can both discuss what was written.

Be led by your child. Start off light with detail (be honest obviously). Think about what your child will see (and feel). How will your cancer and treatment affect them? Tell them about side-effects you might experience (hair loss, weight gain, fatigue, irritability) so they are prepared.

Let them know dates of treatment, for example chemo cycles, so they know you might be too exhausted to do much parenting. Treatment days might also mean changes to your children’s routines, such as who will do the school run. Helping them manage their own expectations is important to ensure they feel secure about the changes in their lives.

Talk to the school. Make sure they know what is happening at home, and the extent your child’s life has changed (doing more chores, having more family responsibilities, possible impact of worries about your health on their ability to focus on schoolwork, etc.) School staff will know whether the exams can be deferred or not.

Talk to your child and ask them what they need: perhaps more time and space at school after lessons to revise for example. Ask how they are feeling.

Most children will ask this question. Little ones are likely to say it out loud, and older ones are more likely to keep it inside their heads. So, if you are able to, it is probably best to answer this question without being asked.

You can be vague and simply say ‘Most people think a person with cancer will die. This isn’t true, most people survive their cancer.’ The key thing is that you have opened up the subject, and the kids know it is not a taboo so they can come to you with their concerns or fears.

Always be honest because kids will sense if you are holding things back. In absence of information that is specific to your cancer, they may imagine the worst – which may not be relevant to your circumstances.

• You know your child best so be led by them. Here are some general guidelines about what children will understand:

  3-5 Years of Age

  Can understand something is wrong

  Have “magical thinking”- so may think a parent’s illness is their fault

  Struggle with verbal expression of how they feel

  Communicate emotions & feelings through play, drawings and behaviour

  Need information-but need repeated small chunks of information using simple techniques

  6-8 Years of Age

  May still show illogical or magical thinking

  Begin to anticipate death as illness progresses

  Need simple concrete information about the disease-its name, symptoms, treatments and causes

  9-13 Years of Age

  Use logical thinking to understand cause and effect

  More aware of long term implications

  Separation anxieties-school refusal

  Mood swings

  Feeling different

  Grow up or regress

  Wanting to care for the parent

  14 Years and Older

  More adult like maturity in thinking about death

  Philosophical questions about their own identity

  More mature status can be misread by adults- inside may be feeling “small” immature and scared

Denial is a fairly robust coping mechanism especially for teens. Sometimes using denial gives them a little more time to process what is happening, or it may be a sign that they need time before processing it. However, they can’t be in denial long term.

Be patient (as it can be extremely hurtful), let them know you are always there for their questions, worries or hugs, but try not to badger them - give it time.

If you have no obvious physical side effects of a cancer diagnosis, or treatment, then this can fuel their refusal to accept. Perhaps suggest to your child to take a visit to your clinic, to meet your CNS, or another member of your healthcare team.

Communication with older kids and teens can be tricky. If they won’t open up, express how they are feeling, or what is going on for them, it can feel very frustrating. You can’t force them to talk, in actual fact that can make them less likely to want to talk in the future.

Remember; they could be in denial, or they could feel that sharing their feelings will upset you, or they could feel confused about how they are feeling so are unable to articulate.

Perhaps try:

1) Introduce them to your healthcare team, ask them to visit the clinic with you (gives you stuff to talk about which might allow them to feel like they can open up)

2) Explain whilst driving/doing the washing up/walking together, that they can find someone else to talk to and perhaps give some suggestions of trusted people (friends, parents of friends, family, teachers etc)

3) Try using open questions starting with when, what, how, and allow for big silences. Do this whilst driving/doing the washing up/walking together etc so you are not staring at them (this can feel confrontational).

4) Sometimes sharing your feelings with them can work. For example tell them how the cancer diagnosis impacting on you, and what your are scared of. This can help to break down their barriers.

3) Maybe think of creative ways to help them feel comfortable in showing their emotions (try the ‘share a feeling’ or ‘what is important in my life’ family activities)

4) Suggest a pizza night on Thursday at a local café just the two of you (or something similar) – don’t talk about big stuff but let them know that Thursday nights is a space and time just for you two and that if they want to talk you are there.

Remember, they might already be talking to someone and not have told you. It might be somewhere you haven’t thought of like their online gaming community.

Little kids tend not to have much of a filter, are super curious, and love learning. Jump on this opportunity to tell them everything. Use resources that they can understand and ask if they can come into the clinic and meet your CNS.

They don’t have the same fears around medical health stuff because they have little reference to draw from, and do not link it to negative experiences.

So show them your port, stoma, or drain. Make their teddy have one too or play hospitals with them. This is all positive as it is normalising what is happening, removing any fears they may begin to have, and understand that they can talk to you about everything.

Absolutely. Obviously ask your CNS or healthcare team beforehand just in case there is some safeguarding or risk element (if there is, ask for an alternative like attending a well-being day in the hospital).

Introduce them to those who look after you. Allowing them to ask your healthcare team questions is both comforting and empowering.

Showing them where you lie or sit during treatment can help them visualise where you go when you go to the hospital. They no longer need to rely on their overactive wild imaginations!

If you can’t take them into hospital, how about Facetiming/WhatsApp video calling instead.