How to tell a child they have blood cancer

Regardless of age, children are usually aware when their health causes their parents concern. Your child may experience a variety of emotions, such as anger, guilt, fear, anxiety, and sadness, all in quick succession.  

Sometimes parents want to shield their child from information about the illness and its treatment. Keep in mind that your child will use their imagination to fill in perceived gaps of information.  

Talk with your child about the illness and its treatment. Listen carefully to what your child is saying (or not saying) and then answer their questions. Be sensitive to your child’s body language and other reactions. These conversations are key to building trust. Your child is more likely to let you know when something is scary or worrisome if they trust you. You can take this opportunity to address some of those fears and concerns. 

Introduce your child to treatment team members who provide psychosocial support, such as a psychologist, nurse, social worker, and child life specialist. In addition to helping you explain the illness and its treatment to your child, they can help your child better understand their disease through play or other activities. 

When speaking with your child about his or her illness, keep these talking points in mind: 

• Give your child information that's age appropriate—a level that matches their ability to understand. You may need to give your child information more than once. Older children may want to know more about their illness and treatment.
• Explain that all cancers aren't the same. Many children, especially older ones, have heard of cancer and may know of someone who has died from cancer. Explain to your child that cancers affecting older adults are different than childhood leukemia or lymphoma.
• Encourage your child to talk about fears and concerns, and answer their questions. Acknowledge your child's behaviors and emotions as they arise.
• Let your child know you'll stay with them as much as possible. If you'll be separated from your child, explain this in advance and show other forms of support in your absence, such as phone calls and photos.
• Help your child recognize that the doctors and nurses are working to help them get well, even though they may have to do things that cause pain. Explain the reasons for tests and treatments.
• Understand that at times your child may act as if there is nothing wrong. You may wonder if they understand what's happening. Children commonly process information in small amounts, which helps them cope at their own pace. 

Age-appropriate conversation 

Keep the discussion age appropriate when you talk to your child about their diagnosis. Consider the following guidelines by age.  

Baby/Toddler (0⁠–3 years)  

• Children this young do not have an understanding of illness or cancer. However, they are aware of changes to routines and the feelings of people around them.
• Children in this age group may be afraid of the medical staff and medical procedures
• Children may be afraid of abandonment or being left at the hospital. Offer physical and verbal reassurance.  

Preschool/Kindergarten (4⁠–6 years)  

• Children may have some understanding of an illness, such as a cold, but not grasp the implications of a serious illness
• Children’s primary focus will be the symptoms they are experiencing in any specific moment
• Children in this age-group may be afraid of pain, so explain tests or treatments to them in advance
• You may see signs of regression in a child’s behavior, such as thumb sucking, bed-wetting, or tantrums
• A child may use play to process the information, such as play-acting doctor/patient scenarios,
• Assure your child that they did nothing wrong to cause the cancer  

Elementary/Middle school (7⁠–12 years)  

• Children in this age group may have a better understanding of serious illness, but not specifically cancer
• They may have heard things about cancer at school, from friends, on TV, or they may have found information online. Ask your child what they know and correct any misunderstandings, especially those that cause distress.
• Explain tests, treatments, and other medical procedures in advance. Your child may be afraid of pain and resist some tests or procedures. Be honest: If a procedure might be painful, work with the healthcare team and decide how to explain what will be done to lessen your child’s pain and why the procedure is important.
• Talk to your child in advance about possible changes to their physical appearance
• You may need to discuss fertility preservation with your child. Some cancer treatments can affect fertility. Fertility preservation, such as egg or sperm banking, may be an option for children who have begun puberty, though it needs to be done before treatment begins. Enlist members of the healthcare team to help with this sensitive discussion.
• You may see signs of regression in a child’s behavior, such as thumb sucking, bed-wetting, or tantrums
• A child may use play to process the information, such as play-acting doctor/patient scenarios
• If the cancer treatment will result in any changes to the child’s daily routine, explain the changes ahead of time so that the child knows what to expect 

High schoolers/Teenagers (13–18 years)  

• Teenagers understand more about cancer and may want to know more. You may still need to correct any misinformation your teenager has heard about cancer from school, friends, TV, movies, or has found online.
• Teenagers may want to participate in decisions about their treatment. Include them in discussions with members of the healthcare team, as appropriate.
• You may need to discuss fertility preservation with teenagers. Some cancer treatments can affect fertility. Fertility preservation, such as egg or sperm banking, needs to be done before treatment begins. Enlist members of the healthcare team to help with this sensitive discussion. High schoolers and teenagers may also be very concerned about changes to their physical appearance, such as hair loss and losing or gaining weight, as well as how their peers will react to the changes.
• As teenagers struggle to find independence, a cancer diagnosis may feel like a setback that can lead to feelings of frustration and anger. They may try to test their boundaries or engage in risky behaviors, such as drinking, drug use, or sex.