How to tell your kids a loved one has cancer

As Amber Pywell watched her children enjoy a carefree afternoon splashing around the pool, she ran through how she was going to break the news to them that she has thyroid cancer. Do I tell them how scared I am? Do I tell them I might not see their next birthdays? How will I hold myself together?

Pywell, who lives in Cobble Hill, BC, had been diagnosed that morning, and she wanted to have just one more normal day with her daughters, eight-year-old Kaylen and six-year-old Hannah, and two-year-old son, Carter, before telling them that their world was about to change.

Pywell figured that she would have a better chance of maintaining her composure if she told her kids without her husband present. Before bedtime, she sat down with Hannah and Kaylen and asked them what they remembered from past conversations about loved ones who had cancer. Pywell reminded them that all cancers are different and some can be cured. She then explained that the doctor had discovered that the lump in her neck was thyroid cancer. She pointed it out and let her daughters touch it. Lucky for her, she said, it’s an easy cancer to treat: The bad cells are in a “suitcase,” and the doctor is going to take it out.

The idea of their mom’s neck being cut open worried the girls, so Pywell told them that their aunt had a C-section to deliver their cousin and she is now fine. There were a few questions (“Can kids get cancer? Are you going to die?”) but no tears. “I thought I would start bawling and freak them out, but I found a quiet peace within myself and tried to be open, positive and truthful,” says Pywell, tearing up now as she recalls one of the most surreal days of her life. “It was heartbreaking, but I was also bursting with pride that my girls could be so articulate and have a conversation about cancer.”

As she tucked them into bed, Pywell asked if they had any other questions. Kaylen was quiet (she usually takes time to process things), but Hannah was upset, saying that she wanted to punch the cancer and make it go away. She drew a picture of her mom with a lump on her neck and a smile on her face. Finally, she asked if she could catch cancer by hugging her. Extra cuddles helped answer that one. Pywell told her son as he was falling asleep in her arms, unsure of what he heard or understood. When she was certain that Carter was sleeping, she cried quietly, thinking about how unfair it was that, at 34, she had to tell her two-year-old that she has cancer.

Every child will react differently upon learning of a loved one’s cancer diagnosis, but all children can benefit from hearing the truth early on and having opportunities to ask questions and share their feelings, says Andrea Warnick, a registered psychotherapist and former oncology nurse based in Guelph, Ont. “It’s never too early to talk about cancer, but it can often be too late,” she says. “Lots of parents hesitate to tell the truth because they think it will be too hard for the kids. The best way to protect kids is to establish an environment where they know that you will be honest with them during the hard times in life.”

A study published in the Journal of Pediatric Oncology Nursing in 2013 found that children who share their feelings with their family are three times less likely to experience anxiety. In the absence of information, children will fill in the blanks themselves. “As hard as the truth can be, kids often imagine it as worse,” says Warnick, adding that even children as young as two can benefit from having discussions about cancer.

Unfortunately, given the national rates of cancer (about half of Canadians get some type of cancer, and roughly one-quarter die from the disease), chances are that most kids will have a loved one with the disease at some point. Warnick suggests that parents open up the conversation and let the child take the lead in how much information they want. If you’re worried about getting emotional, just let your child know that you might cry and that it’s OK for them to cry, too. Explain cancer in simple terms, point to where it is in the body and address common concerns. Warnick says that many children fret about the four Cs: Did I cause it? Can I catch it? Can I cure it? And who is going to take care of me? It’s important to note that kids may not ask these questions, but parents should try to address these concerns.

About half of the children that Warnick sees think they’re responsible for the disease in some way. One child was convinced that his dad got throat cancer from yelling at him to clean up his room. Another boy made a pact with a higher power to keep his little sister cancer-free by promising to never fight with her again. Of course, the siblings squabbled after that; when the girl relapsed and died, her brother was convinced that it was all his fault. A couple of months after her mom’s diagnosis, Kaylen asked her if she caused the cancer because the lump first appeared soon after she was born. “Let them know that they’re not responsible in any way and it’s totally out of their hands if the cancer is cured or not,” says Warnick. It can be really helpful to let kids know that the disease isn’t punishment, she says, and that it’s just part of nature.

Using the correct language and avoiding euphemisms is also important, says Warnick. Rather than saying “Mommy’s sick,” use the C word. Otherwise, children may think that the illness is contagious, like colds and flus that sweep through their classrooms. If someone is dying, telling kids that they’re “going to sleep” can make bedtime confusing and frightening, she adds.

It’s important to let children know that there are no bad questions, and check in regularly to see if they have any new concerns. Warnick suggests inviting children to the doctor’s office or chemotherapy clinic so that they can ask experts about any medical questions they have and see what’s happening. She warns that some children stay silent because they don’t want to upset their parents by asking the big questions, like the dreaded “Are you going to die?” so continue to open the conversation, but never force it. If a child seems withdrawn or has ongoing behaviour changes or a prolonged disinterest in normal activities, Warnick suggests that parents seek out extra support, such as a counsellor or psychotherapist.

You won’t always have answers, and it’s OK to say “I don’t know,” says Geoff Eaton, executive director of Young Adult Cancer Canada (YACC), an organization that brings together many parents who are grappling with cancer. Eaton, who lives in St. John’s, Nfld., had leukemia twice before his three children were born, and “cancer” has always been in their vocabulary. Now 11 and 9, his daughters have been asking more complicated questions about his treatment and the likelihood that they’ll get cancer, too. Nine-year-old Mira and six-year-old Kane have also shown interest in another way: by shaving their heads for the YACC’s Shave for the Brave. “When your kids want to do something like that, it opens the door for you to have some conversations about why they’re doing it and what kind of impact they’ll have,” he says.

As Pywell went through treatment and recovery, the initial conversations she had with her children helped foster an environment where they could ask questions and express their emotions. At times, both girls struggled with the fact that they couldn’t do things like play in the pool or go to birthday parties because their mom wasn’t feeling well, but they carried on with their lives as usual.

Parents are often worried that news of a cancer diagnosis will devastate their child, but Warnick says that kids have an incredible ability to balance deep sorrow and joy. “Let them know that it’s OK to be happy,” she says.

Read more: 18 books to help kids cope with death What life is like when you have breast cancer—and kids