Child Cancer & Emotional Support

The shock of a cancer diagnosis is understandably devastating for parents and children old enough to understand the nature of the disease. Both parents and children must deal with emotional turmoil in order to focus on the healing process.

In time, families come to terms with the reality of the cancer diagnosis. Support groups, family counseling and psychological therapy may help parents and children deal with their fears and concerns.

Emotions and the Stages of Grief

Emotions arising from a cancer diagnosis often follow the same path as the stages of grief:

1. denial
2. anger
3. grief
4. acceptance.

Parents have to confront, deal with and experience the stages of grief as much as their sick child — perhaps even more, if the child is too young to fully understand how serious the illness is.

However, even young children are very sensitive to their parents' emotions, and need parental support while parents are dealing with the stages of grief. Parents' intense emotions may frighten or upset a sick child.

Stages of Grief and Parental Emotions

The stages of grief are similar to those felt at the loss of a loved one:

1. Denial: Denying the reality of a cancer diagnosis is the first stage of grief for many parents. Parents want to believe that the doctor made a mistake. During the first stages of grief a parent may demand a second medical opinion. This is a valid precaution, but some parents continue to demand even more opinions, lengthening the time between diagnosis and treatment.
2. Anger: Angry emotions follow denial. Parents may be angry at the doctor, their spouse, themselves or even the child. Trying not to be angry at the child, a parent may lash out at a spouse or other family members. The need to allocate blame for the child's illness is very strong in the early stages of grief, and parents often blame themselves, leading to feelings of intense guilt.
3. Grief: Cancer is a frightening illness, and after anger the stages of grief often turn to sorrow and despair. While it's natural to express sorrowful emotions if a child is seriously ill, parents should remember that older children often associate cancer with death, and a parent's sorrowful emotions convince the child that treatment will not work. Support groups and therapy may help both parents and patients at this stage.
4. Acceptance: The last of the stages of grief, acceptance, allows parents to focus on their child's needs and the healing process.

Children's Emotions and Cancer

Children's emotions and reactions to cancer depend in part on their age. While younger children may not understand the seriousness of their illness, older children and teens often experience the painful emotions associated with the stages of grief. Support groups, therapy and family support can help older children deal with their emotions and allow them to become active participants in the healing process.

Children are particularly susceptible to their parents' emotions. As parents deal with the stages of grief, some sick children hide their own emotions from their parents, not wanting to cause their parents further pain. By not discussing fear and other emotions with parents, children may deny themselves their most important support group: their family.

Children, Blame and Guilt

Children with cancer, especially young children, may feel that their illness is a punishment for being "bad" and that they somehow deserve to be sick. Parents can help by explaining that no one knows exactly what causes cancer, but that it wasn't anything the child said, did or thought.

The older a child is, the better she will understand what cancer is, and why healing is so important. Different age groups will experience different emotions, and will require different levels of emotional support from their family:

• Infants and Toddlers: Very young children don't understand why they're sick, but are often scared of hospital visits, painful treatments and being abandoned by their parents during hospital stays. Parents should assure young children that they will come back for them and that, while treatments may hurt, they're needed for healing and for the child to get well. Telling a child exactly how long you'll be gone and when you'll return can help.
• Children Ages 5 to 10: Children in this age group often understand that cancer is a serious disease. Emotions may include fear, guilt and anxiety. Be honest with the child. Explain that cancer is serious, but that healing is possible, although the healing process may take some time. Support groups, counseling and therapy may help the child deal with his or her emotions.
• Children Over 10 and Teens: After age 10, children are old enough to understand most aspects of cancer and the healing process. The child may have learned from social messages to equate cancer with dying, so they must understand that healing is possible. Support groups and counseling can help older children deal with the stages of grief and meet peers going through the same process.Teens are likely to dislike the lack of independence they have during the healing process. Side effects of chemotherapy and radiation therapy may impact a teen's feelings of self-worth and cause worry about his or her appearance.

Social Support and Challenges

Children often find that cancer treatment disrupts their social, recreational and educational activities. Try though as parents may to maintain as normal a life as possible, hospitalizations, counseling sessions and healing treatments are enormous time commitments that affect a child's daily life.

When possible, provide opportunities for children to spend time with their friends and family members. If this isn't possible, group counseling and support groups offer opportunities to interact with peers and make new friends.

Schoolwork is a challenge during the healing process. Teachers, the child's principal, the school nurse and school counseling teams should be aware of physical limitations, medication requirements and the emotions and counseling needs of the child.

Stress to the child's teacher that the child should not be favored or singled out as "special" due to her illness: School life should be as normal as is realistically possible.

Resources

National Cancer Institute (n.d.). Young people with cancerA handbook for parents: Talking to your child. Retrieved September 5, 2007, from the National Cancer Institute Web site: http://www.cancer.gov/cancertopics/youngpeople.

Nemours Foundation (2007). Dealing with cancer. Retrieved September 5, 2007, from the Nemours Foundation Web site: http://www.kidshealth.org/teen/diseases_conditions/cancer/deal_with_cancer.html.

Swedish Medical Center (2005). Helping your child cope with cancer. Retrieved September 5, 2007, from the Swedish Medical Center Web site: http://www.swedish.org/18093.cfm.