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Helping Children Deal with Treatment

14736689Head and neck cancer treatment is difficult for everyone, but children can feel particularly panicked and vulnerable. Treatments can change their parent’s appearance and mood. An active parent may suddenly be bedridden. The other parent may be distressed and overwhelmed, having very little time for the children. Children can be quite sensitive to these changes. You may not even realize your children are feeling distressed. In one large study, parents reported that their children were not exhibiting anxiety about a parent’s cancer treatments; but the children in the same study said exactly the opposite, indicating that they were very distressed.1 Welch AS, Wadsworth ME, Compas BE. Adjustment of children and adolescents to parental cancer. Cancer.1996;77:1409-1418. This shows that parents can underestimate the impact of cancer on their children’s lives and emotions and thereby overlook signs that the children might need comfort or help.

During the most intense treatment period in a parent’s illness, children are very likely to experience temporary behavioral problems.2, Kroll L, Barnes J, Jones A, Stein A. Cancer in parents: telling children. BMJ.1998 March 21;316(7135):880.3 Huizinga GA, van der Graaf WT, Visser A, Dijkstra JS, Hoekstra-Weebers JE. Other problems children of a parent with cancer commonly experience include anxiety, problems sleeping and compulsive behavior. An orderly family environment helps children to cope better than if family life is chaotic. A family that has close relationships also helps children to adapt better than one that is disengaged. Finally, having home health care helps teens to feel less burdened as caregivers.3 Huizinga GA, van der Graaf WT, Visser A, Dijkstra JS, Hoekstra-Weebers JE.

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Young children

Young children may need comfort and plenty of reassurance. It’s hard to imagine too much affection and comfort for a child in distress. If you or your loved one is going through treatment, it can be very challenging to provide that type of comfort. This can cause tension and stress for everyone in the family. Your children might think you’re mad at them when really you’re just in pain or not feeling very well.

Keep in mind that young children are less capable of understanding abstractions, medical concepts and even time. Six weeks of radiation therapy feels like an eternity to you, but it can feel equally long for children.4Psychosocial consequences for children of a parent with cancer: a pilot study. Children are used to illnesses, such as a common cold or strep throat, lasting just a few days. The idea of being sick for weeks is very confusing and frightening to them. It can be helpful to have a countdown calendar posted so they can feel like they know what is going on.

Young children can also be extremely fearful.2 Kroll L, Barnes J, Jones A, Stein A. Cancer in parents: telling children. BMJ.1998 March 21;316(7135):880. Some patients we talked to mentioned that their children refused to kiss them or get too close to them during their radiation treatments because they were frightened that they might get sick, too. Try to remember that your kids or grandkids are probably not trying to hurt your feelings. Explaining to them that cancer is not contagious can help, but it may not always put them at ease.

Actions you can take to help your young child cope with the treatment phase of head and neck cancer:

  • Try to maintain a sense of normalcy about your home and family routines.
  • Establish a routine. Predictable days give your child something to look forward to.
  • Talk about the future and encourage dreaming. Treatment can feel endless. A sense of future can be spirit lifting.
  • Find ways to incorporate play, laughter and learning into your child’s days as much as possible.
  • See if your child can befriend other children their age who are going through a similar experience. Cancer is less scary with company, and children may be more comfortable sharing their fears with others their own age.
  • Look into seeking a child therapist or counselor who can help them find a place to voice their concerns. It may also be helpful to let your child’s teacher know your situation so they can observe your child for any changes in behavior.

Adolescents and teens

Teens and adolescents want to do things on their own, and acknowledging their dependency on others—especially their parents—is hard for them.5Cancer Nurs. 2003 Jun;26(3):195-202. Head and neck cancer treatment is a long and difficult journey. Teens may not know how to handle it and may shut down or lash out.6 Droit-Volet S. Time perception in children: A neurodevelopmental approach. Some teens may despair and become fatalistic. Others might withdraw and get even moodier.6 Droit-Volet S. Time perception in children: A neurodevelopmental approach. Other teens may amaze you by taking on household chores like an adult to fill the roles that Mom or Dad used to fill before treatment started. Just be sure to pay close attention to your teen’s behavior and ask them frequently how they’re really feeling. A teen might be trying to be perfect in order to avoid adding to your stress. Being perfect all the time is impossible, and the pressure your teen is putting on himself or herself isn’t healthy either.6 Droit-Volet S. Time perception in children: A neurodevelopmental approach.

Some teens may not be self-aware enough to know what to ask you for in terms of support. But there is evidence that regular conversations with the well parent in which information about the ill parent’s treatment is shared have a direct positive effect on the teen’s relationships with his or her peers.6 Droit-Volet S. Time perception in children: A neurodevelopmental approach.

Everyone experiences the head and neck cancer journey differently. It isn’t unusual for some teens to drop out of activities at school so that they can be around the house more to help out. It also isn’t unusual for some teens to start spending more and more time away from home because they’re having a hard time dealing with the fact that a parent is sick.5Cancer Nurs. 2003 Jun;26(3):195-202. There is no right or wrong way for teens to deal with a parent’s head and neck cancer treatment. Try to be understanding of your teen’s efforts to cope.

Here are some tips for helping your teen cope with treatment:

  • Listen to your teen and try not to correct him or her. At the same time, share your own views and offer support.7Neuropsychologia. 2012 Sep 20. doi:pii: S0028-3932(12)00395-8.
  • Encourage your teen to research and understand the treatment and side effects. Let him know you’re happy to answer any questions he or she might have.
  • Be supportive if your teen wants to be with and talk with other teens.
  • Simply asking your teen how they feel they can help can yield surprising information.
  • Check in with your teen to make sure that they feel comfortable with any responsibilities they offer to take on.
  • Emphasize the future.
  • Ask if they would like to speak with a therapist or counselor, or join a support group.
  • Let your teen continue with his or her regular activities as much as possible. A sense of routine and being with friends doing something enjoyable will help your child to cope.5Cancer Nurs. 2003 Jun;26(3):195-202.

When treatments are completed

When you are finished with your treatment and you are declared cancer-free, have a family celebration. Not many events create as powerful a bonding moment and sense of overwhelming relief and gratitude for a family as the day cancer treatments end and you are officially a cancer survivor.

Don’t underestimate your children. They’re a lot more mature than you probably think or care to admit.David S. (son of tonsil cancer survivor)

References

1 Welch AS, Wadsworth ME, Compas BE. Adjustment of children and adolescents to parental cancer. Cancer.1996;77:1409-1418.

2 Kroll L, Barnes J, Jones A, Stein A. Cancer in parents: telling children. BMJ.1998 March 21;316(7135):880.

3 Huizinga GA, van der Graaf WT, Visser A, Dijkstra JS, Hoekstra-Weebers JE.

4 Psychosocial consequences for children of a parent with cancer: a pilot study.

5 Cancer Nurs. 2003 Jun;26(3):195-202.

6 Droit-Volet S. Time perception in children: A neurodevelopmental approach.

7 Neuropsychologia. 2012 Sep 20. doi:pii: S0028-3932(12)00395-8.

8 When someone you love is being treated for cancer: talking with family and friends. National Cancer Institute. http://www.cancer.gov/cancertopics/coping/when-someone-you-love-is-treated/page6. 2012 Jan.

9 When your parent has cancer: a guide for teens. National Cancer Institute. Publication No. 12-5734. 2012 Feb. http://www.cancer.gov/cancertopics/coping/When-Your-Parent-Has-Cancer.pdf.

10 Sieh DS, Dikkers AL, Visser-Meily JM, Meijer AM. Stress in adolescents with a

11 chronically ill parent: inspiration from Rolland's Family Systems-Illness Model.

12 J Dev Phys Disabil. 2012 Dec;24(6):591-606.