It is normal for a child diagnosed with cancer to be scared and even depressed, at least for a while. They may not want to talk much to their parents or the doctors. Hopefully, older kids will maintain some communication with their friends, at least a best friend or boyfriend or girlfriend; but this can be hard too, since the concerns are so different from what they usually talk about. This can be challenging for parents. It is best to be reassuring and offer to listen when your child is ready to talk. You can also tell them it is normal to feel scared. At the same time, it is important to offer reassurance that there are good doctors working on getting the best treatment for your child and that they, and you, believe they will provide good treatment.
It is relatively rare for sick kids to do things to physically hurt others. They might, however, throw something or destroy something because of feeling angry that they have cancer. This may be different from their usual behavior, but this may be the worst thing that has ever happened to them – they have a right to be angry. Rather than focusing on the action, it may be helpful to ask what they are feeling and how you can help. If this behavior or other similar acts persist, it may help to talk with the mental health professional on your child’s care team.
While fighting is unusual, it is more likely to occur in later stages of the cancer journey, perhaps when a child returns to school. You may want to seek help from the mental health professional at the hospital or talk with similar professionals at the school if fighting becomes a problem.
Fighting between siblings may reflect the siblings’ anger at the attention the sick child is receiving or the sick child at the sibling for being well. Don’t be too quick to decide whose fault it is. Try to sit with both kids to talk about how hard it is as families change around a serious illness. Siblings may want reassurance that the focus will not always be on the sick child and that it is OK to be jealous or angry, but need to be told not to take it out on the sick child. The sick child may need to learn that this is not easy for their siblings either and that the siblings care about them but may feel like the balance in the family has shifted over the course of the illness. The sick child may not have considered the view from the sibling’s position.
This is usually a serious call for help. If any of your children are cutting themselves, seek help from a mental health professional immediately.
Risk Taking or Boundary Pushing
Adolescents who have had cancer may feel like they have to make up for lost time growing up. Sometimes, this takes the form of wanting to show too quickly how independent they can be once they are home from the hospital or through their treatment by taking unnecessary risks or pushing boundaries, such as by coming home late or not saying where they’re going. Try to approach your adolescent as you typically would, to set firm limits, and to have them understand the consequences of their behavior for themselves and others. If this is not successful in getting them to cut back on their upsetting and unhealthy behaviors, seek help from mental health professionals. If your child refuses to go for help, it may be useful for you and your spouse or co-parent to get help initially about how to manage the behavior.
Drinking and/or Using Drugs
Adolescents who have had cancer are less likely to drink or use drugs than other kids, given what they have been through. However, it does happen, especially as they try to be “normal” like other kids in school or to be “cool” instead of sickly. Siblings might also turn to drugs or alcohol for some escape from the worrying environment at home. Deal with these the same way you would have before, trying to intervene directly with your children and, if unsuccessful, getting them help from trained professionals.
Doing Poorly in School
For some children who have had cancer, school performance may not return to its former level or may become worse over time. [See School Support for more information.] This is especially true for children who have had radiation of the head. It is also true that emotional issues or fatigue can interfere with school performance. Talk to your child’s doctor about what might be contributing to school performance, and talk with school personnel about ways they might accommodate your child’s learning needs. This may be a long-term adjustment. Many children do return to their previous level of performance and go on to college and beyond. There are also some college scholarships for pediatric cancer survivors – your child’s social worker will be aware of these as many are state-specific.
For some children, especially some who have brain tumors, their disease or treatment may affected how well they pick up and use social cues, which can affect their friendships. Others may not be as physically strong or active as they used to be, which can affect what they do with other children their age. There are many things to help your child to make better connections with friends, and your child’s ability to talk about his or her experience may also make it easier for other kids to know what to say and not to shy away from them. Socially active children before cancer usually keep or regain a close circle of friends. A child who struggled socially or who had cranial radiation may need more help to make social connections after cancer.