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Family Support GuideCrossroads4Hope’s3 Crossroads Drive, Bedminster, NJ 07921 | 908-658-5400support4families@crossroads4hope.org | crossroads4hope.org | @cr4hope

At Crossroads4Hope, we understand that receiving a cancerdiagnosis can feel overwhelming and acknowledge thechallenges of sharing this news with your children and lovedones. This comprehensive guide contains tools and insightsinto how to have these conversations, addressescommon questions children may have, and providestailored considerations based on their developmentalstages. It is designed to help you understand how a childmight be processing the changes in their body or in thosearound them. The goal is to empower you with knowledgeon how to best support the children in your family at anystage of the cancer journey.This guide is relevant for understanding an initial diagnosis,changes in treatment, changes in diagnosis, or evenchanges in daily routine. While the Family Support Guideuses language addressed to a parents or caregivers, theinformation can be relevant to anyone who needs to explaincancer to children or teenagers. We know that it takes avillage to raise children, and we believe that the whole villageshould be able to access support. This guide is intended as ageneral resource and we encourage you to seek outpersonalized support and assistance.Remember, you are not alone. Crossroads4Hope is here toprovide you with information, support, and guidancespecific to your circumstances. Please don’t hesitate to reachout for additional needs for yourself or your child.908-658-5400support4families@crossroads4hope.org

Often, children are able to sense when others around them are feeling more stressed or sadthan usual. They may assume things are worse than they actually are or blame themselves forbeing the cause of the problem. Talking to children about a cancer diagnosis creates a safe spacefor them to express their thoughts openly and truthfully throughout the cancer journey. Itincreases trust in your relationship and allows open conversations to take place.When children know what to expect, it can be easier for them to cope with challenging situations.The more a child understands, the less scary things will be for them. Knowledge is power!Older children have access to technology and other information from peers. In order to preventmisinformation, talking to them directly is your best opition.Why should I talk to my kids about cancer?Why should I talk to my teens about cancer?Teens have access to a lot of information about cancer. They may be misinformed about whatcancer is from TV and movies. It is important to remind them that not all information on theinternet is accurate related to your specific cancer diagnosis.At this age, teens may want to take an active role in your cancer journey. Ask your teen if theywant to be involved in decision making. Give them choices and opportunities to support you,while ensuring they don’t feel overwhelmed.Your teen may only want to talk to other's about the cancer journey. Having open conversationswith your teen ensures that they have a trusted adult to confide in and ask questions, even if itisn't you.Talking to your teen about the emotional aspects of a cancer diagnosis is extremely important. Lead by example, demonstrating through both your words and actions that it is okay to expresstheir emotions.Talking to Kids and Teens About Cancer

Involve others in the conversation for emotional support. It is okay to reach out for help.Choose a quiet space for this conversation that doesn't have many distractions. There is noperfect space or time, but you have the power to control where and when you share yourdiagnosis with your child.Allow your child to have a break to process the information you provided about cancer beforediscussing it further. It is normal for them to want to get up and leave.How to Approach Sharing a DiagnosisTips for How to CommunicateDepending on your child's age, temperament, and previous experiences, their reactions to aconversation about cancer may differ. Even siblings may react differently from each other. Remember that for many young children, "cancer" is just a word. It does not have the samenegative connotation that it does for adults. Using the word cancer is not a bad thing and canreduce confusion and misunderstanding. Be mindful of your tone of voice, body language, and environment. It's best to have calm andreassuring behavior. It is okay to show your emotions as they arise.Ask your children what they want to know. Younger children may ask repetitive questions. Olderchildren may be distant when processing. It is okay to not have the answers to all of theirquestions.Children may wonder how this will affect their daily life and routine. Share with them how youknow it will affect them.Talk about what they can do to help you when you are undergoing treatment or experiencingside effects. This could be as simple as making their bed!Sharing a DiagnosisEach family's situation is unique and no two conversations about cancer will look the same. Whilethere is no "right" way to talk about cancer with your child, below are a few different approachesthat you can use when talking about cancer.

Many children are satisfied with the answer that cancer is an illness or sickness. Other childrenwant to know more. When explaining what cancer is, keep it simple, while being honest. Childrenneed to understand cancer is a different kind of disease than a cold or the flu.Be honest and open. It is okay to say "I don't know". If you do not know the answer, try to find theanswer and follow up with your child.It is okay to use scientific or correct medical terminology when talking about your body andillness. It is okay to say the word cancer.Share details that are appropriate to your child's age and developmental level.Many parents hope their child does not ask this question. A parent’s natural instinct is to tell thechild that everything will be fine. Instead, parents should balance hope and reality. You canacknowledge that people with cancer do die sometimes, but at the same time many people whoget cancer do get better. Everyone's cancer is different and needs different kinds oftreatment/medicine. Parents can explain that treatments are improving constantly and this leadsto greater odds of survival. Children may believe that cancer can spread from person to person. Cancer is not spreadthrough air or any bodily fluids like some other diseases. Cancer occurs in our bodies themselvesand cannot be shared to another person’s body.Common QuestionsKeep these tips in mind when answering questions from your child:What is Cancer?Am I going to Get Cancer?Is the Person with Cancer Going to Die?

Tumor:A tumor is a ball of cancer cells.Cells:Cells are like the building blocks that make up our body, they are super super tiny, youcan only see them with a microscope. Humans have over 75 trillion cells in their body.That is a lot of cells!Diagnosis:Diagnosis is the word for what is making us sick. For example, when we have a runnynose, our diagnosis could be a cold or the flu.Cancer:Cancer is a disease that happens when some cells grow faster or different than thehealthy cells in the body. Cancer is not contagious, so it can not be spread like a cold.Chemotherapy:Sometimes people shorten this long word to chemo. Chemotherapy is a very importantmedicine that helps get rid of cancer by fighting cancer cells and stopping them fromgrowing any more.Intravenous Line:Also called an IV line. This is a special straw that is put into the arms or hands to helpput medicine and water into our bodies.Oncologist:An oncologist is a doctor that works to treat cancer.Scan:A special machine takes a picture of the body and lets the doctors check for any cancercells. There are a few different types of machines used for scans, MRI and CT scans aretwo of them! These machines both look like big donuts with a bed that slides right insidethe donut.Radiation Therapy:This is a way to treat cancer that uses an invisible beam almost like a laser to get rid ofcancer cells! The laser comes out of a big machine, but you can’t see or feel it!Port:A port an IV line that is placed on the inside of the body to help carry medicine directlyto our heart. The port looks like a little button that has a tail coming out of it. The tail iswhat goes towards the heart. Since our heart’s job is to move the blood all over thebody, our port is helping to get medicine to the whole body nice and quickly!Cancer Dictionary4Kids

Supporting Children and Teenagers atVarious Developmental StagesWhile everyone is unique, we can better understand a child'scomprehension when we are aware of some common developmentalresponses to challenging circumstances. Children at each stage willprocess and cope in different, but often predictable ways. Theway a child reacts will depend on many factors, and while every child willhave unique needs, the following section of this guide offersinformation on their potential experiences and offerssuggestions for supporting them.This resource covers all stages of childhood development, allowing youto understand how children of different ages might understand andrespond. This may helpful as not every child will be on the same timelineand may display behaviors that fall on a different page than theirchronological age. It is also important to note that since cancertreatment can sometimes be a lengthy process, a child's knowledgeand coping may evolve throughout the course of treatment andeven beyond it. If you have concerns about your child, please feel free tocontact us so we can work together to ensure your child is getting all ofthe support that they need.908-658-5400support4families@crossroads4hope.org

Children at this age will not quite understand illness or a concept as big as cancer.However, they will notice if an important person in their life is sick and absent dueto treatment. Children on the older side of this age will begin to understandsickness and some basic information about illness. Children at this age are likely tobe affected by changes in their routine and how the cancer diagnosis affects them.Supporting Children Ages Birth - 18 monthsUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Displaying increased fussiness or irritability compared to normalHaving trouble following their typical routineExperiencing increased separation anxiety or clinginessFacing difficulty sleepingStruggling with eating habitsExperiencing challenges with toiletingShowing excessive clinginessDemonstrating excessive cryingHaving more frequent temper tantrums than usualShowing overall distressMaintain typical and consistent routinesMake sure familiar caregivers are consistently presentContinue to take care of basic needs (ex: regular feeding, diaper changes, etc.)Provide physical comfort (ex: rocking, hugging, holding, etc.)When possible, try to stick to their normal routine (i.e., nap time, bedtime story,snack time)Tips for Helping Them:

Maintain typical and consistent routinesProvide comfort when neededProvide reassurance when they show signs of distressProvide opportunities for them to process their feelings and emotions throughplayWhen you are comfortable, show your emotions. Even at a young age, it is okayto expose children to actions such as crying. When you do show those emotions,talk to the child. (i.e., "I am crying right now because I am sad."). While the childmay not respond, learning to associate emotions with reasons helps the child'semotional and language development.Answer questions as honestly as possibleProvide simple, but doable choices (ex: do you want to wear the red or blue shirttoday?)Supporting Children Ages 18 months- 3 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: Children at this age will not quite understand illness or a concept as big as cancer.However, they will notice if an important person in their life is sick and absent dueto treatment. Children on the older side of this age will begin to understandsickness and some basic information about illness. Children at this age are likely tobe affected by changes in their routine and how the cancer diagnosis affects them.Exhibiting increased irritabilityHaving more frequent or intense temper tantrumsShowing anxiety when separated from caregiversDisplaying relatively brief outbursts of emotionDemonstrating excessive clinginessSeeking out more physical contact than normalCrying uncontrollablyDemonstrating developmental regression (ex: may begin wetting the bed againeven though they have been toilet trained)Asking the same questions over and over

Explain the diagnosis in a simple, concrete language such as the words cancer Provide reassurance and validation- they need to know that they are being listen to,that they are safe, and that their feelings are valid.Be honest and transparent with them about what may affect them or they mayexperience.Answer any questions they ask, even if the questions are repetitive. If you do notknow the answer, tell them you don't know.Offer them to have control as much as possible by giving choices.Offer physical and emotional comforting and nurturance. Give comfort items thatthey can bring when they are not with you.Encourage them to play, this is how children process big feelings.Keep as much routine as possible. Speak about their feelings with them, providing words for their experiences whennecessary.Supporting Children Ages 3- 5 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: Children at this age are beginning to understand what illness or sickness is, but oftenassociate the words with illness or sickness that they may have experienced such as acold or the flu. They tend to think that changes in their life or anything that impactsthem, are caused by them (i.e., "I didn't eat my vegetables, so I got cancer"). Becoming uncooperative, irritable, or displaying misplaced anger, hostility, orfrustration.Having nightmares or developing new fears.Demonstrating developmental regressions (i.e., bed wetting once already pottytrained).Showing signs of separation anxiety.Being overly sensitive or emotional (i.e., having tantrums when they may usually not).Facing difficulties with transitions, new activities or new people (i.e., school drop off,new teacher).

Having difficulty focusing or performing tasks (i.e., cleaning room, completinghomework, needing comfort items they had given up).Becoming uncooperative, irritable, or displaying misplaced anger, hostility, orfrustration.Starting to withdraw from friends and family.Having nightmares or developing new fears.Hiding or suppressing their reactions for fear of upsetting others.Supporting Children Ages 6 - 10 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: In this age group, children begin to understand the concept of illness, and canunderstand the difference between a cold and cancer. Children at the younger sideof this age still tend to think that an illness is caused by something that they havecontrol over. Children may think that their loved one's illness is caused by a badaction (i.e., "They were mean so they got cancer). Children may also think thatpeople or objects caused the diagnosis. For example, they may say that someone"caught cancer" from sources like a friend, an animal, food, or germs. Children mayalso think that cancer is something that you digest and catch (i.e., "I ate a bad appleand now I have cancer"). Children at this age may also begin to have otherexperiences or associations with the word cancer. Explain the diagnosis in a simple, concrete language such as the words cancer,chemotherapy, radiation.Provide reassurance and validation- they need to know that they are beingheard, that they are safe, and that their feelings are valid. Be honest and transparent with them about what treatment may look like. Answer any questions they ask, even if the questions are repetitive. If you do notknow the answer, tell them you don't know. Offer them to have control as much as possible by giving choices. Allow for opportunities to speak about the diagnosis, openly and as often asthey need, Be an active listener. Offer physical and emotional comforting and nurturance. Give comfort items that they can bring when they are not with you. Encourage them to play, this is how children process big feelings. Keep as much routine as possible. Speak about their feelings with them. Inform the people in their life that may interact with them regularly (i.e.teachers, friends, friends parents, etc.), and allow the child to be involved inmaking choices about who and how people are informed.

Provide reassurance and validation- they need to know that they are being heard andfeelings are often big and complicated.Be honest and transparent with them about the diagnosis, treatment plan, and sideeffects.Avoid blaming the body for treatment responses. Provide specific compliments (Instead of "You are such a brave girl/boy" try "You didan excellent job of holding still").Allow for opportunities to speak about the diagnosis, openly and as often as theyneedBe an active listener. Remember that you do not need to try and make it better. Being there for them iswhat they need most. Talk with adults who have authority in their life who they spend time with (teachers,coaches, group leaders, etc.) about providing support and leeway where appropriate.Open conversations about how to share the news of the diagnosis with their peersand friend groups. Ensure that they are an active member of that conversation andoffer to support them in whatever ways they would like.Supporting Children Ages 10 - 12 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: Children at this age will begin to transition from thinking the cause of the illness is aperson or object to thinking the cause of the illness is a germ (i.e., I caught cancer froma germ). Children may deny that they are sick. If your child is diagnosed, they may beginto blame themself or their own body for becoming sick.Having difficulty focusing or performing tasks (i.e., cleaning room, completinghomework).Becoming uncooperative, irritable, or displaying misplaced anger, hostility, orfrustration.Starting to withdraw from friends and family.Having nightmares or developing new fears.Hiding or suppressing their reactions for fear of upsetting others.

When appropriate, include the teens in medical conversations. Provide space for theteens to contribute their own thoughts on the treatment plan and ask questions. Even teenagers crave reassurance and for parents to ease their fears and providecomfort.Model healthy coping behaviors to show them know that is OK to express bigemotions outwardly. If possible, help them find ways to cope (i.e., painting,exercising, talking).Remind them that you are available to talk to them about thoughts, feelings andemotions; however, do not force them to talk if they are not comfortable doing so. Make sure there is someone in their life to talk to even if that is not you. They mayfeel more comfortable talking to peers or other adults.Engage in conversations about how to share the news of the diagnosis with theirpeers and friend groups. Ensure that they are an active member of that conversationand offer to support them in whatever ways they would like.Supporting Children Ages 13 - 18 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: At this age, teens are able to understand more abstract concepts. This means that theywill understand that there are many causes of illness and cancer. Teens are likely to askmore questions regarding the specifics of the diagnosis and treatment and understandthe effects and outcomes of the treatment and illness.Becoming more dependent on adults.Having difficulty focusing or performing tasks (i.e., cleaning room, completinghomework).Becoming uncooperative, irritable, or displaying misplaced anger, hostility, orfrustration.Starting to withdraw from friends and family or feeling left out of their friend group.Having nightmares or increased fear of death.Becoming anxious or depressed.Feeling insecure in their body image, sexuality, or identity.

Include them in medical conversations and decisions. Allow them to ask questionsand be involved in creating a treatment plan, even if they are not physically present.Remind them to make themselves a priority. It is important for young adults toengage in their own self-care (i.e., painting, exercising, talking, spending time withfriends, etc.).Encourage them to keep up with their usual activities and routines as much as theycan (i.e. social life, school, job).Give them room to react without judgment. Let them know that you care about theirsafety and tell them how much you appreciate contact with them.Advocate for them to seek support. They may feel more comfortable talking to peersor other adults. If they are living away from home, encourage them to seek supportwhere they live (i.e. college counseling center, local cancer organization , therapist intheir area, etc.). Offer to help connect them to other young adults who may be experiencing similarcircumstances ( support group, 1x1 connection, cancer support organizations). Supporting Teens and Young Adults Ages18 - 25 years oldUnderstanding of Diagnosis and Illness:Common Reactions for Children of This Age May Include: Tips for Helping Them: Young adults are able to understand what cancer is, what causes it, and what theoutcomes of the illness and treatment are. Young adults also have access to find theirown information from both reputable and non-reputable resources. Feeling pressure to take on a caregiver role for their parent or siblings. Starting to withdraw from family and friends, or display misplaced anger towardsthem.Experiencing feelings of guilt.Becoming angry, anxious or depressed.Sensing a loss in their independence at a time when they recently gained it.Seeking out constant change as a method of distraction.Engaging in risk-taking behaviors such as binge drinking, drug use, or unsafe sexualactivity.Experiencing shifts or loss in their sense of self or identity development.

Join our network of support by scanning the QR code to enrollin Crossroads4Hope’s MyGo2Support (MG2S) complimentary,mobile support program.If you or someone you know is impacted by cancer,Crossroads4Hope is here for you.Our network of support is available to anyone; thediagnosed, their loved ones, and the community thatsupports them. All free of charge. 3 Crossroads Drive, Bedminster, NJ 07921 | 908-658-5400support4families@crossroads4hope.org | crossroads4hope.org | @cr4hopeContact Us!