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Information central for parenting with breast cancer.

Setting the Foundation

Understanding Your Children

Adapted from “Resource Guide on Children and Grief,” Lois Pearson, M.Ed., Certified Life Specialist, Children’s Hospital of Wisconsin.

Each child is unique, and each child has a unique experience with his mother’s illness. Understanding your children’s coping skills can help you better meet their emotional needs as you progress through treatment and recovery. Click here to see this information in a chart format.

Newborn to Age 3

What They’re Thinking

When a family encounters a crisis like major illness, even the youngest children can sense that something has happened. They observe change. They notice that activity in the household is different, that Mommy is crying or sad or nervous, that the house feels frenzied or unusually quiet, that more or fewer or different people are around, that something is wrong.

How They Behave

Very young children sense that something is different, but don’t know what to make of it or how to ask questions about it. Kids may feel confused, fearful, anxious, and frustrated. They may not know what to do with these feelings. This can lead to changes in their behavior.

Parents might notice changes in their children’s eating or sleeping patterns, irritability, increased clinging, difficulty separating from parents or caregivers, regressive behaviors such as increased dependence on a transitional object like a blanket or doll, and even regression in toilet training.

How You Can Help

Be sensitive and aware:

Simply understanding why their kids are behaving differently makes parents more sensitive to their children’s needs. Parents are more understanding when they realize that regression in toilet training is related to the changes their child sees in the home. Parents are likely to be more understanding than if the potty training mishaps are attributed to laziness.

Talk to your kids:

Just because very young children can’t talk about their fears, ask the right questions, or articulate their concerns doesn’t mean you shouldn’t address them. Even 2- and 3-year-olds can understand your illness-and your feelings about it-when you use age-appropriate terms.

Some parents are afraid that bringing up the issue of Mommy’s illness will upset their kids. On the contrary, not talking about it makes kids more anxious and fearful, not less. They notice that something is wrong even if they don’t say so or act as if they notice. By ignoring the subject, your child begins to wonder, “What’s so terrible that Mommy won’t even talk about it?”

Maintain normal routines:

Parents should also do their best to maintain normal routines or to establish new routines. Consider bedtime. Continue your normal bedtime routine of reading stories, singing songs, turning on nightlights, leaving the door open-whatever your child has come to anticipate as part of his daily routine.

Sometimes maintaining a normal routine is not possible. In that case, try to establish a new routine. If cuddling your child while you read to him at bedtime becomes physically challenging for awhile, have your husband or a sibling cuddle him while you do the reading. Maintaining a pattern is more important than the pattern itself.

It’s also important to have consistent and familiar caregivers. They do more than feed your child, play with him, and change his diapers. They also help your child feel safe and protected. When you are battling a serious illness, your child needs to feel safe and protected more than ever. You’re likely to need extra help during your treatment. Try to limit the number of additional people taking care of the kids.

Age 3 to 5

What They’re Thinking

Preschoolers believe in magical thinking. They might believe that their own thoughts, wishes, or behavior caused your illness. They also might believe they can make your illness go away if they can only do the right thing or wish hard enough. Preschoolers also worry that other people they love might get sick. They feel more vulnerable in general and more fearful in other parts of their lives. They might become fearful of thunderstorms, going into the basement alone, or sleeping in their own bed.

Magical thinking also makes kids more resilient. Three- to 5-year-old kids often believe bad things are both temporary and reversible.

How They Behave

A preschooler whose mother is ill may reveal his concerns through his behavior. He might withdraw from others, limiting his conversation or preferring to play alone. He might show some regression in his skills, by reverting to baby talk or forgetting how to tie his own shoes.

Preschoolers might also show concern for their own well-being. A child who loves to swim might become fearful of the water, and a child who is always ready for adventure might be fearful of trying new things. Sickness themes might pop up during imaginary play where they’re the patient or the caregiver. Kids this age might also act confused or guilty.

How You Can Help

Identifying Feelings

Parents can help their preschoolers identify the feelings being expressed in their behavior. If your child bursts into tears as you leave for a doctor’s appointment, you can help your child understand recognize his feelings. He may be sad that you’re leaving and angry that you can’t play with him.

Setting Milestones

You can help by giving your child milestones for managing his fear. You might say, “I know you’re afraid because Daddy is leaving. Try to remember that Daddy always comes home from work. He’ll be home at dinnertime just like last night and the night before.”

Sickness Themes at Play

You can also help by including sickness themes during playtime with your child. Show your child how Thomas the Tank Engine can fall off the track but get right on again, how a mechanic can repair a bad part in a car made of Legos, and how Barbie can play soccer again after the doctor fixes her broken leg. Playtime is an excellent opportunity to help your child understand that your illness is temporary and that you will recover.

Ages 6 to 9

What They’re Thinking

Children of this age begin to develop a more realistic understanding of sickness and cancer. The older they get, the more detailed explanations they may require. They may worry that you might die or that others in their lives might get sick or die. They can be uncomfortable expressing these feelings and fears, even to a parent. Kids this age can make connections between their mom and other people they have known who have been sick, recovered, and sometimes died.

How They Behave

Your child might cover up his concern, trying to appear brave and unaffected. He may be okay inside, but he might also be very upset. Some kids this age cope with fear by using denial, telling themselves or others that you’re really not so sick. Sometimes they act out in school or at home. Kids who are usually well-behaved can begin bullying other kids or refusing to do their homework. You might notice regressive behavior. Your child could rediscover his favorite teddy bear, return to sucking his thumb, or throw tantrums to get his way. Kids of this age might also express their fears verbally, telling you outright that they’re worried and fearful.

How You Can Help

Listen and watch

Listen carefully to your child to determine exactly what kind of information he’s seeking. He might ask you to explain how chemotherapy works, but he really just wants to be reassured that you’ll be okay. Some kids this age might want to hear a lot of details. Others may feel overwhelmed or grossed out by too much information. Listen and watch your child’s reaction to know what-and how much-to say.

Help identify feelings

When your child tells you he’s upset-either outright or through his behavior-help him identify his feelings. If he yells at you for burning his toast every morning of his whole life, he may really be angry that you got sick. If he can’t fall asleep at night, he may be worried about your prognosis. You can help your child by helping him de-code his feelings.

Stress-reducing behavior

Encourage your child to do things that will reduce his stress. Physical activities are particularly effective. Ask him to go for a walk with your or to play soccer with his sister. Creative activities are also good for reducing stress. Kids can express feelings through drawing, painting, and writing that they may not be able to express to you verbally.

Ages 9 to 12

What They’re Thinking

At this age, kids have an even better understanding of what cancer and sickness mean. They also have a broader perspective, and they can put illness into context. They will likely know and remember other people, perhaps family members, who were seriously ill or died. These kids begin to have a personal understanding of sickness and death as well. They realize that they can become seriously ill and even die. Kids at this age may want very graphic and detailed descriptions of the events surrounding your diagnosis and treatment.

How They Behave

Your child might cover up his feelings by trying to appear tough. He might try to be funny and make jokes because he’s not sure how to handle his feelings. Some kids are able to discuss their feelings, while others demonstrate their anger, sadness, and fear through their behavior. They might show their anger through rebellious activities like using curse words or stealing candy from the store. Kids this age may also try to act like an adult but then show regressive behavior as well. Your child might offer to cook dinner for the family one night but then ask to be cuddled later in the evening.

How You Can Help

Encourage communication

Explore your child’s feelings with him. Ask him what he’s thinking and how he’s feeling about your illness. If he’s reluctant to talk, you can let him know that it’s normal to feel angry, confused, and fearful. Also let him know that you’re available if he wants to talk.

Find outlets for feelings

You can help your child find outlets for his negative feelings about your illness. Physical activities, like sports and exercise, are particularly effective for working out stress and fear. Kids can also benefit from activities like art and music, which allow them creative expression of their feelings.

Offer routine

Kids (like their parents) often find comfort in routine, particularly during times of stress. Maintain your normal routine as much as possible, particularly routines that involve the whole family, like attending religious services and having a family movie night.

Seek support

At this age, kids might prefer to explore their feelings among peers. You might find opportunities for peer support groups or peer-to-peer counseling services.

Adolescents

What They’re Thinking

Adolescents can understand the concept of sickness the way adults do. But their ability to cope with the information varies by child, based on experience and personal development. Some kids have more experience with illness and are better able to put your disease into perspective. Other kids with less experience might find the situation more difficult to handle. Kids who are easy-going and mature for their age might be better able to cope with their mom’s illness than kids who are more emotional.

Adolescents are egocentric. They are focused on themselves and on the present. They are concerned with their own world and how your illness affects them. Your daughter may worry about how she’ll get clothes for school if you’re too tired to shop with her. Your son might worry about how he’ll get to soccer practice if you have a doctor’s appointment.

Preteens and teens also see things as black and white, and they form strong opinions. This is the age when some kids become vegetarians because “eating animals is bad.” Many will remain lifelong vegetarians, but many will also develop a more complex understanding and choose to eat meat again. Your kids might develop a similarly dogmatic view of breast cancer. They might become passionate crusaders for a cure and become impatient with others who don’t share their passion.

Your adolescent, regardless of gender, is likely to feel embarrassed by your breast cancer. It’s a perfect combination of factors that adolescents find most embarrassing: appearance, the human body, parents, sexuality, and disease.

Boys may be particularly embarrassed. An adolescent boy is beginning to associate breasts with sexual stimulation. Just thinking about his mother’s breasts is likely to be embarrassing. But having his mom’s breasts as the focus of attention may be overwhelming.

Girls will likely be embarrassed, but they may also be fearful. An adolescent girl has anxiety about her developing body because the physical changes are profound and noticeable to others. She may become even more anxious to see her mom being treated for a disease of the breast, and she may become ambivalent about developing her own breasts. She may be afraid of developing breast cancer herself.

How They Behave

An adolescent whose mom is battling breast cancer may withdraw, preferring to hang out alone in his room instead of watching TV with the family. He may act out, arguing with teachers or bullying younger kids at school. Adolescents can act on their negative feelings by engaging in risk-taking or reckless behaviors. They may drive too fast without a seatbelt, drink alcohol with friends, try drugs, or vandalize someone’s property.

Some adolescents might try to appear mature and independent, as if they no longer need you and can handle life on their own. They may take on the role of caregiver to you by making meals for you or listening to your own fears and concerns. Adolescents may seek support from their peers. They may spend more time in the company of their friends instead of the family.

How You Can Help

Allow for informed participation

Your adolescent may want to be involved in your treatment, accompanying you to a chemotherapy treatment, for example. They may be afraid to ask and may feel unwanted. You can help by offering open-ended opportunities for them. You might say,

“I thought you might be curious about what happens when I have my chemo treatments. I’m going to give you an open invitation-if you ever want to keep me company, you’re welcome to come along with me.”

Keep lines of communication open

Most adolescents are not interested in communicating with their parents. When you throw breast cancer into the mix, they might become even more reluctant out of fear or embarrassment. (See “Maintaining the Dialogue.“)

Maintain rules

Your adolescent might push the boundaries, either intentionally or unintentionally, while you’re distracted by your illness. It’s important to maintain the rules you had before you became sick. This helps kids stay safe and healthy, which is why you had rules in the first place. Also, keeping the rules in place shows your kids that you’re involved and that you care. Despite their complaints, rules make your kids feel safe.

Maintaining the rules is complicated. Parents feel appropriately sorry for their kids because breast cancer affects them in many negative ways. Parents may also feel guilty because so much of their time and effort goes to battling breast cancer instead of taking care of the kids.

With this in mind, unity between parents can help prevent the erosion of rules. Make sure that you and your partner work through your disagreements about the kids in private. Your kids will see an opportunity for rule-bending if they hear or see discord between parents. You might find your kids going to the second parent with a question if they didn’t like the first parent’s answer.

Keep in mind this guideline: When your adolescent seeks permission, ask yourself, “Would I have allowed this before I got sick?”

Encourage peer support

Some adolescents may prefer to discuss your breast cancer with their peers instead of with other adults. You may find peer support groups or peer-to-peer counseling services in your community. Kids can also find peer support informally by talking about their feelings with their friends. Encourage your child to seek support either formally or informally, with peers or with other appropriate adults.

Click here to see the information above in a chart format.

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