Children’s reactions and needs at different ages

Children’s understanding of illness and the implications of bad news varies depending on their age and family experiences. These charts give an overview of children’s different needs, which can be helpful when working out what to say to children and how you might respond to lessen the impact of the news on them.

Newborns, infants and toddlers

Understanding of illness

They have little awareness of illness.

Infants are aware of feelings that parents show, including anxiety

They get upset when the presence of a physical and loving parent is missing.

Toddlers may react to physical changes in their parent or relative or the presence of side effects (eg. vomiting)                                                          

Possible reactions

Newborn and infants:

  • unsettled, especially if weaned suddenly
  • may want to increase breastfeeds for emotional comfort
  • fussy and cranky
  • clingy
  • change in sleeping or eating habits
  • colic
  • toddlers: tantrums, more negativity (saying ‘no’)
  • Return to thumb-sucking, bed-wetting, baby talk, etc.

Suggested responses

Provide consistent caretaking by maintaining baby’s or toddler’s schedule

Give plenty of physical contact (patting, hugging, holding, extra breastfeeds) to help them feel secure.

Ask family members and friends to help with household tasks and care.

Observe play for clues to their adjustment.

Use relaxation tapes, music or baby massage.

Express your feelings and fears with others.



Preschool and kindergarten 3-5 years

Understanding of illness

They have a beginning level of understanding about illness

Children may believe that they caused the illness, eg. by being naughty or thinking bad thoughts ― this is called magical thinking.

Children are egocentric and think everything is related to them.

Children may think cancer is contagious.

Possible reactions:

  • thumb-sucking
  • fear of the dark, monsters, animals, strangers and the unknown
  • nightmares
  • sleepwalking or sleep talking
  • bedwetting
  • stuttering or baby talk
  • hyperactivity or apathy
  • fear of separation from significant others (especially at bedtime and going to preschool)
  • aggression (eg. hitting or biting)
  • repeated questions about the same topic, even if it has been discussed several times.

Suggested responses

Provide brief and simple explanations about cancer. Repeat or paraphrase when necessary.

Talk about the illness using picture books, dolls or stuffed animals.

Read a story about nightmares or other problems.

Assure them that they have not caused the illness by their behaviour or thoughts, nor will they catch cancer.

Explain what children can expect; describe how schedules may change.

Reassure them that they will be taken care of and will not be forgotten.

Encourage them to have fun.

Listen and be alert to their feelings, which they may express through speech and play.

Continue usual discipline and limit setting.

Let children get physical activity every day to use up excess energy, get rid of anxiety and to provide a positive outlet for any aggression.


 

Primary school 6-12 years

Understanding of illness

Able to understand more complex explanations of cancer and basic information about cancer cells.         

They may feel responsible for causing illness because of bad behaviour.

Younger children may be starting to understand that people, including parents, can die. Older children tend to understand the finality of death and its impact. If a child has been exposed to illness or death at a young age, they may have a more mature understanding of dying.

Possible reactions:

  • Irritable
  • sadness, crying
  • physical complaints: headaches, stomach-aches
  • sudden worry about health of the well parent
  • separation anxiety when going to school or away to camp
  • regressive behaviour
  • hostile reactions like yelling or fighting, including towards the sick parent
  • poor concentration, daydreaming, lack of attention
  • poor marks
  • withdrawal from family and friends
  • difficulty adapting to changes
  • fear of performance, punishment or new situations
  • sensitivity to shame and embarrassment
  • trying to be extra good, with the risk that their distress and anxiety is not identified by parents ― this is more common in girls.

Suggested responses

Listen and be alert to their feelings, which they may express through speech or play.

Use books to explain the illness, treatment and potential outcomes.

Assure them that they did not cause the illness by their behaviours or thoughts.

Reassure them about the care and schedules.

Tell them that their other parent and other relatives are healthy.

Let them know how you care about their feelings.

Address the issue of dying even if children do not bring up the topic.

See also ideas for younger children.


 

Secondary school 13-18 years

Understanding of illness

They are capable of abstract thinking they can think about things they have not experienced themselves.   

They are starting to think more like adults.

They are able to understand that people are fragile.

They are able to understand complex relationships between events.

They are able to understand causes and effects: relating to symptoms and illness or between actions and outcomes.

They are more likely to deny fear and worry in order to avoid discussion.

Possible reactions:

  • want to be more independent and treated like adults
  • anger and rebellion
  • critical of how adults react to or handle the situation
  • depression or anxiety
  • worry about being different
  • poor judgement and risk-taking behaviour (eg. alcohol abuse, smoking, staying out late, unsafe sex)
  • withdrawal
  • apathy
  • physical symptoms from stress (eg. stomach-aches, headaches)
  • more likely to turn feelings inward (so adults are less likely to see reactions)
  • regression: some lapse into previous behaviours such as watching children’s TV shows or being insecure and dependent on parents.

Suggested responses

Encourage them to talk about their feelings, but realise they may find it easier to confide in friends, teachers or other trusted people.

Provide plenty of physical and verbal expressions of love.

Talk about role changes in the family.

Provide privacy as needed

Encourage them to maintain activities and friendships.

Set appropriate limits.

If there are problems, provide opportunities for counselling.

Don’t rely on them to take on too many responsibilities.

Provide resources for learning more about cancer and getting support.

Make agreements that you don’t always want to talk about cancer: you still want you and your kids to talk about homework, sport, friends, boyfriends/girlfriends, their part-time job etc.

Reprinted with permission from Cancer in the Family: helping children cope with a parent’s illness, American Cancer Society 2001

Here are some ways you can encourage some expression and discussion in children or teens:

  • encourage physical activity and sport
  • run, jump, play, dance, walk to get stored-up energy out
  • talk about what’s happening:
    • with young children, using a doll house, puppets, stuffed animals or a phone
    • with teens, maybe while driving or taking a walk somewhere. It can be helpful doing something as you talk.
  • drawing, painting
  • clay, play dough
  • take photos, make videos
  • music – write songs, play songs, listen to music or dance to music
  • storytelling and reading – see the booklist at the end of this booklet
  • writing – stories, poems, a journal, or a letter.

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