Preschool (3-5)
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Engages in make-believe play, which may reflect some of the things they are going through (such as visits to doctor)
Younger children have difficulty distinguishing between reality and fantasy
Learning words to express emotions but may need help labeling different emotions
Often afraid of bodily harm and pain, may be anxious and distressed during medical procedures
Afraid of being alone in scary places (like the hospital)
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Starts to show a independence from parents
Plays cooperatively with other children, rather than just side-by-side
Learns to take turns and share
Imitates others
Appreciates being close to parent(s) and other well-known adults for comfort in new, unknown, or scary places
Often has only 1 person who really calms them down
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Asks lots of questions
Can understand simple explanations
Has trouble with multi-step directions or elaborate explanations
Obeys rules to avoid punishment; May believe that he/she was “bad” and that is why he/she is sick
Knowledge of cancer is limited
Knowledge of death is limited – does not understand that death is permanent or not reversible
Has some understanding of time – mostly in terms of routine rather than hours/minutes and months
Is unlikely to understand why treatments often make you feel bad to get you better
Physical comfort and soothing is important.
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Let your child know that he or she didn’t do anything wrong to get sick.
Use simple words, books, pictures, or objects to explain what will happen to your child.
To prepare your child for a procedure or task, you may tell them when in their routine it will occur (after this TV show is over, after you wake up in the morning)
Provide limited choices you can allow:
Do you want water or juice? Be careful not to offer a choice that your child does not have, especially with medical care (kids almost never say yes, they want that medicine).
Be a “secure base” for your child. Have a trusted adult (you, your spouse, other family member) stay with your child as much as possible.
Make a consistent routine, if possible.
Encourage your child to play and engage in normal activities when possible, and offer comfort, distraction with toys and fun activities. Be soothing when your child has to have medical procedures.
To help deal with fears of being hurt or of the unknown, encourage play with safe medical supplies and play to express feelings.
Keep your usual expectations and limits in place. You can still have your child put their cup in the sink or expect him or her to share toys with siblings when they visit in the hospital.
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School-age (6-12)
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Common fears include monsters and the dark in early years, replaced by school and social performance/rejection in later years
Developing a better vocabulary to describe emotions
Attached to primary caregivers when placed in challenging situations
While some may withdraw if depressed or unhappy, others may resort to aggression, lying, or teasing. Depression and withdrawal are more likely in children who are sick.
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Friendships become increasingly important but attachment to parents is still strong
School is an important part of socialization and learning
The transition from elementary to middle school is often difficult for kids, given that there are several changes at once (changing schools, puberty). This may be hard for kids who are out of school due to illness – they may feel left out and behind in terms of making friends and being a part of the school community.
Competence in athletics is important to many kids. Illness may interfere, causing kids to feel left out.
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Has knowledge from TV and other life experiences (such as grandparents and other family members) that cancer is a serious, scary disease
Knowledge of death developing; younger children usually understand that it is permanent, but lucky people escape it or that young people and their families don’t usually die. Older children usually understand that death is permanent and happens to everyone at some point.
Starting to understand the link between actions and consequences
Has a better understanding of time
Attention span gets longer as children get older, but kids may still have trouble understanding multi-step directions and explanations
Usually thinks in concrete, literal terms and has trouble thinking abstractly
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It may be helpful, especially if another family member has died from cancer, to explain that cancer is a word to describe many different diseases. You can use simple explanations about your child’s specific disease and let them know that many childhood cancers are very treatable. Pictures, books, and games might be useful. Encourage questions and help your child get answers from doctors or nurses if you cannot answer a question.
Encourage your child to interact with friends, do schoolwork, go to school, play with their siblings and go to team sports events (even if just to watch) when feeling up to it
Provide simple explanations about treatments – what will happen and when.
Encourage play with safe medical supplies (to help deal with fear of bodily harm and fear of unknown) and play to express feelings and/or for diversion.
Put up a calendar on the wall that marks the phases of treatment (or just the days in the current phase) marking things to celebrate. (i.e. day 5-ice cream to celebrate that chemo is over, day 7 comic books to read after biopsy…. Or use stickers at the end of each day of chemo, and other stickers to note radiation days etc.
Keep your usual expectations and limits in place. You can still expect your child to do some chores at home or finish homework while in the hospital. This conveys a positive message of keeping your child on track for when he or she is done with treatment.
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Teens (13-18)
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Usually have a good vocabulary for emotions
Confide more in peers and less with parents
May try to protect parents by not sharing their own emotions
May form close relationships with staff or may respect staff advice over parents’ advice
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Being accepted by, and involved with peers is particularly important
Likely to be concerned about changes in body and physical appearance, and how these may affect acceptance by peers
May have or seek serious relationship with significant other. Maintaining the relationships may be a primary focus and may have concerns about appearance and sexuality.
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Likely to focus on how cancer will interfere with daily activities, such as school, sports, spending time with friends
May want to be involved in making treatment decisions (link to 10-point rating system piece)
They have developed abstract reasoning and are able to think more deeply about the impact of cancer on self now and in the future
While they have developed thinking, they do not have a long track record of handling complex issues—so it is important for parents to remain highly involved in decision-making and following treatment recommendations
Teens usually understand that death is permanent and happens to everyone eventually. They likely had imagined what their life would be like before being diagnosed, and may struggle with how cancer may interfere with their goals and dreams. Teens have likely developed ideas about death and may be particularly worried about leaving their mark on the world before they die.
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Be honest with your teen about treatment and possible side effects when they ask.
Encourage your teen to interact with friends (email, phone, text, etc.) and his/her significant other when he/she has the energy.
Encourage your teen to complete his/her school work.
Help your teen’s friends and significant other to feel comfortable visiting home and hospital.
Encourage your teen to talk with you or a trusted friend or healthcare professional regarding feelings about cancer and body. If your teen doesn’t usually talk with you or others about these types of things, encourage him or her to express their feelings through writing, art, or music. Websites for teens with cancer may also help.
Give your teen privacy to the extent that you can – ask doctors and nurses to do the same.
Focus on the most important things—like medication adherence—and allow your teen to be in charge of other things that just don’t matter as much (the kind of music they listen to, time with friends, etc.)
Be open to talking with your teen about life and death. Correct any misperceptions your teen may have. If your child is worried about their legacy, work with your child to develop a plan for leaving their mark.
Keep your usual expectations and limits in place. You can still expect your teen to do some chores at home or finish homework while in the hospital. This conveys a positive message of keeping your teen on track for when he or she is done with treatment.
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