Why they need to be told
Almost every parent's first instinct is to protect: "better they don't suffer". But children read faces, hushed phone calls and absences, and fill the gaps with their imagination, which is usually worse than reality. And if they find out from someone else, or discover it was hidden, they lose trust just when they need it most. Telling them does not take away their childhood; it gives them a safe place to ask.
Ideas that apply at every age
- Use the word "cancer". "I'm poorly" or "a little lump" leaves room for them to think it is like a cold, or to hear the word at school and panic. Name it and explain simply: "some cells in my body are growing wrongly and the doctors are treating them".
- It is not their fault. Young children think in circles around themselves: "was it because I was naughty?". Say it even if they do not ask.
- It is not contagious. They can hug you, sleep next to you, drink from your glass.
- What will change at home: who will take them to school on hospital days, that you will sometimes be tired, that your hair may fall out. Concrete things are reassuring.
- Routines stay as far as possible: school, activities, timetables. They are the children's solid ground.
- Any emotion is allowed: crying, being angry, or carrying on playing as if nothing happened. That does not mean they do not care.
- Both parents together if possible, at a calm moment, unhurried, ready for the conversation to last two minutes and be picked up again days later. It is a conversation that repeats, not a one-off speech.
Ages 3 to 6
They need short, repeated sentences and above all to know who will look after them. "Mum has an illness called cancer. The doctors are giving her very strong medicine to make her better. The medicine makes her tired and sometimes she won't be able to play, but Grandma will come on those days." They may slip back to earlier behaviour (wetting the bed, not wanting to be apart); it passes. Play and stories are how they process things: there are picture books specifically about a parent's cancer.
Ages 7 to 12
They now understand illness as a process and ask direct questions, including "are you going to die?". Answer truthfully without closing off hope: "It is a serious illness and the doctors are doing everything to cure it. I will always tell you what is happening." They need to know they can carry on being children: going to parties, getting cross about silly things. Some will want to help; give them small, real tasks, but do not turn them into carers. Watch school: falling marks, withdrawal, tummy aches.
Teenagers
They will look things up themselves; better they hear it from you, with accurate facts and reliable websites. They may react with distance, irritation or apparent indifference: that is how they protect themselves, not a lack of love. Do not burden them with the adult's role or with confidences that are not theirs to carry. Respect their privacy and social life: going out with friends is not abandoning you. Offer, without pushing, the chance to talk to someone outside the family (psycho-oncologist, a trusted teacher).
Telling the school
Inform the class teacher or school counsellor. No medical details are needed; it is enough that they know the situation so they can understand changes in behaviour, be flexible with exam dates if necessary and let you know if they notice anything. Ask your child what they want their classmates to be told, and respect it.
Signs they need more help
- Sleep problems, nightmares or new fears lasting weeks.
- Frequent headaches or stomach aches with no medical cause.
- Withdrawal, a clear drop in school performance, persistent aggression or apathy.
- In teenagers: risky behaviour, substance use, self-harm, talking about not wanting to live. Seek professional help without waiting; in a crisis, call 024 (Spain's suicide-prevention line) or 112.
The AECC offers free psycho-oncology for children and teenagers and has downloadable guides and storybooks; hospital psycho-oncology units and child and adolescent mental health services can also help.
When the prognosis is poor
It is the hardest conversation and also the one it is least wise to postpone. Children who have been prepared step by step cope with loss better than those who find out at the end. Go in stages: "the medicines are no longer working as we hoped", then "the doctors can no longer cure it, but they can make sure there is no pain", and only at the end "I am going to die". Use real words ("die", not "go away" or "fall asleep"), let them ask, allow them to say goodbye in their own way and reassure them about who will look after them. A children's psycho-oncologist can support you through these conversations; ask for one.
What to ask at the appointment
- Is there children's psycho-oncology at the hospital, or somewhere I can be referred?
- Which visible physical changes will I have (hair, weight, line, stoma bag) so I can prepare them?
- What will the next few months look like in terms of admissions and hospital days, so I can organise who cares for them?
- Can the children come to see the day hospital or come with me one day?
- If things get worse, will you give me enough warning to prepare them?