Talking to kids about cancer can feel overwhelming. Your first reaction may be to keep the news from children or to delay telling them. Even though it can be difficult, research shows that being open and honest helps children cope with the cancer diagnosis of someone close to them.

When someone is diagnosed with cancer, adults are sometimes hesitant to discuss the situation with children. Parents and other adults can feel overwhelmed by their own anxiety and fear, and their first reaction may be to protect children from those same strong emotions. They may be concerned about their children's reactions or worry the diagnosis will disrupt their children's school performance or friendships.

However, there are many reasons why a straightforward and honest discussion can help children.

You are the expert

To help you discuss the difficult subject of cancer with children, these pages offer evidence-based, practical strategies that can build upon your existing strengths and knowledge. Sometimes it may take a few attempts before you find an approach that suits your family. Use your understanding of your children's individual personalities and needs to guide you.

Secrecy can make things worse

Children who are told about the illness of someone important to them tend to cope better than children who are kept in the dark. Trying to keep the diagnosis secret can be difficult. It can add to your stress – you may worry about whether you should tell, or feel guilty if you don't say something. You may need to change your daily routine without your children knowing why, which can be confusing for them.

Keeping secrets teaches children that it is okay for family members to lie to each other if a good reason exists. In turn, children may keep information from their parents if they think it will upset them.

You can't fool kids

Children are observant. No matter how hard you try to hide a cancer diagnosis, most children will suspect something is wrong. Even if it's not a parent who has cancer but a close relative, such as an aunt or grandparent, this can cause stress that kids will usually pick up on.

They will notice changes at home, such as your sadness, whispered conversations, closed doors, an increase in the number of phone calls or visitors, and possibly changes to family schedules. These signs may be more obvious to older children and teenagers, but even young children can pick up on change. They will work out that a secret exists, but that it should not be discussed. Not knowing the reason for the secret may leave them feeling powerless or disconnected from everyone else, without knowing why.

Cancer in different cultures

You may be reading this because you work with children who have been affected by a cancer diagnosis. Before talking to someone else's child about cancer, it is important to understand and respect the wishes of the parents.

Cancer can have a range of meanings for different groups of people. Some cultures believe that cancer is caused by bad luck or that it is contagious or always fatal. Others may believe that the cancer has been sent to test them.

It is important to respect different ways of coping. If a family wants to keep a diagnosis private, organisations such as Cancer Council 13 11 20 or CanTeen may be able to provide a way for children and other family members to discuss their feelings and concerns in a confidential setting.

Honesty can build trust with your child

Children can feel hurt if they suspect or discover they have not been told something important that affects their family. Sharing information shows you trust and value them, which can boost their self-esteem and ease their concerns. Hearing bad news is better than the worry they feel when they don't know what's happening.

The diagnosis may also be a chance for children to learn from their parents how to deal with complex feelings. Together you can all find ways to bounce back from difficult situations (resilience).

They might find out from someone else

Ideally, children should hear about a cancer diagnosis from their parents, guardian or a trusted family friend, particularly if it is the parent, a relative or close friend who has cancer.

If you tell friends and relatives about cancer in the family, but you don't tell your children, there is a chance your kids will learn about the cancer from someone else or overhear a conversation. Children often listen to adult conversations even when it seems like they are busy with their own activity and not paying attention. They may also look for a way to listen without being noticed.

Overhearing the news can make your children feel upset and confused. They may think the topic is too terrible for you to talk about, or that they are not important enough to be included in family discussions.

Children may also misunderstand information and think a situation is much worse than it is or make up their own explanation to fill in what they don't understand. They may feel afraid to ask questions. They might worry in silence or spread incorrect information to other children in the family. Teenagers, and even young children, may pick up on a few key words and search the internet for answers, which can lead them to unreliable websites.

Kids can cope

When a family is affected by cancer, it can be a challenging time for kids. You may wonder how they will get through it, but with age-appropriate information and good support, most children can bounce back from this difficult situation.

Children and young people learn about emotions and how to express them by watching others – especially their parents. A key factor in helping kids get through difficult times is to role model how to recognise, talk about and manage a range of emotions, e.g. "I'm feeling sad about Grandma's diagnosis and I think I need to go for a walk".

It is okay to admit to your child that what you are telling them is upsetting – let them know it's natural to have strong feelings. We can't stop kids from feeling sad, but if we share our feelings and give them information about what's happening, we can support them in their sadness.

Children need a chance to talk

Talking to your children about cancer gives them the chance to ask questions (see some suggested approaches). Encourage your kids to share their thoughts and feelings, but don't be surprised if they don't want to talk when you do, and don't push if your kids prefer not to talk. Suggest that children keep a journal to write down questions or thoughts that come up.

Sometimes kids, particularly teenagers, may feel guilty about burdening a sick parent or taking up a healthy parent's time. So they will open up to an adult who is not their parent. That person may be a grandparent, an aunt or uncle, a family friend or their best friend's parent.

When you can't talk about cancer

Some parents don't want to tell their children at all and try hard to keep the diagnosis secret. People have their own reasons for not sharing the diagnosis with their children, including cultural differences, family circumstances, or an earlier death of a close relative from cancer. Sometimes you may want to wait to find out more about what the diagnosis means before telling your kids.

If you want to share the diagnosis with your children but your fear of saying or doing the wrong thing is keeping you from having this difficult conversation, talk with a psychologist or social worker, who may be able to help you develop a strategy. Keep in mind that talking about cancer often becomes easier over time.

Key points

• Start with questions to check what your kids know about cancer.
• Offer basic information and provide more details if they ask.
• Practise your response to potential questions before talking to kids.
• Explain that the cancer is not their fault and is not contagious.
• Assure them they will always be looked after, even if you can't always do it yourself.
• Stop and listen to your children so you know how they really feel.
• Share your own feelings to help show children that it is okay to feel strong emotions about the situation.
• Children may react with different emotions. They may feel angry, sad or guilty. Reactions can also be physical, such as bedwetting or a change in sleeping patterns.
• Teenagers may find it hard to talk to you or show how they feel.
• Continue daily routines as much as you can. Talk about your children's own activities as well, and let them know that it's still okay to have fun.