When you have a young family, this is the conversation people dread most.
Most parents want to protect their children from all of it, and the instinct to say nothing is a loving one. The difficulty is that children almost always know something is wrong long before you tell them. They hear the phone calls, they notice you are upset, and what they imagine is usually worse than the truth.
There's no script for this, but the following tips might help
Tell your kids before it starts
If you can, have the conversation before your hair goes rather than after. Hair loss usually starts two to three weeks into treatment.
Being told in advance means the change is something they were expecting rather than a shock they walk into. It also means they learn it from you rather than working it out alone or hearing it from someone else.
Use the actual words so they know what they mean
Say cancer. Say chemotherapy. It feels brutal but it helps.
Children fill gaps with guesswork, and vague language like "poorly" or "not very well" leaves too much room. A child who's told you're poorly may worry every time anyone in the family gets a cold. Obviously, this one is very dependant on the age of your child, but naming it gives them something they can ask about. You can't ask questions about a thing that has no name.
Explain hair loss simply
The version that works for almost any age is that the medicine is very strong. It's good at attacking the cancer, and it also affects other fast-growing things in the body, and hair is one of them.
Three things worth saying out loud, because children commonly worry about them without mentioning it:
- It doesn't hurt. Losing hair looks dramatic and children often assume it's painful.
- You can't catch it. Younger children in particular worry cancer is contagious.
- Nothing they did caused it. Children can quietly conclude they're to blame, especially if they'd been in trouble recently.
Conversation guides by age group
Take these as rough guides. You know your child better than anyone else.
Under five need very little. Something like "the medicine will make Mummy's hair fall out for a while, and then it will grow back" is plenty. Expect them to be more interested in whether you'll still do bathtime.
Five to ten want more detail and will ask direct, practical questions. Will you look different? Will people stare? Can I tell my friends? Answer them plainly. This age often copes better than anyone expects when given the facts.
Teenagers are the hardest, because they understand what cancer can mean and they often go quiet rather than asking. Be honest, don't over-reassure with promises you can't keep, and leave the door open. Many teenagers would rather talk to someone outside the family, which is normal rather than a rejection.
Let them be part of your chemo journey
Children cope far better when they've got something to do. A lot of families find the hair itself becomes the thing that helps. Let them help choose your hats and scarves, or pick the colours. Some parents let their children be there when they have their hair cut short, or make it into an occasion rather than a loss.
You could also let them feel a soft hat or a scarf before you wear one, so it's familiar rather than strange.
Let them see, when they're ready
Don't force it, and don't hide either. Most children want to look at some point and feel awkward asking.
Offer it lightly. "Do you want to see?" gives them the choice. Some will want to touch your head, and many find it far less frightening than they'd built up in their mind.
If a child gets upset, that's not rejection. It's a big change to a face they've known their whole life, and they'll come round.
Expect the unexpected
Children rarely process this in the conversation. They process it three weeks later at bedtime, or through behaviour.
Watch for clinginess, tummy aches, trouble sleeping, going backwards on things they'd mastered, falling out with friends, or a sudden dip at school. None of it means you handled the conversation badly, it just means they're working it out.
Tell the school
This is the practical step people forget, and teachers consistently say they wish they'd known sooner. The school can keep an eye out, go easy on a bad week, and know why a child is tired or tearful. Many schools have a pastoral lead who does this well.
Ask for help, because it exists and it's free
You do not have to do this alone, and there are people who do it professionally.
- Macmillan have a free booklet on talking to children and teenagers when an adult has cancer, and their support line is free on 0808 808 00 00
- Fruit Fly Collective produce free resources built specifically for families where a parent has cancer, including tools for these conversations
- Riprap is a website made for teenagers who have a parent with cancer, with real stories from other young people
- Your clinical nurse specialist can often refer you to family support, and many hospitals have a psychologist attached to the team
- Maggie's centres offer free support to families, no appointment needed
If the worst happens and you need bereavement support for children, Winston's Wish are the people to call.
If you're finding it hard yourself
Most parents cry during this conversation, and your children will not be damaged by seeing that. They learn that hard things can be talked about and that upset isn't dangerous.
You also don't have to get it right first time. This isn't one conversation, it's dozens of small ones over months, in cars and at bedtime and while you're doing something else entirely. You'll have chances to add things, correct things and answer what they've been sitting on.
They mostly want to know that you're still you and that somebody's got them. Everything else is detail.
If other people in your life are struggling to know what to say, our guide to helping a loved one cope with hair loss may be useful to pass on.
Frequently asked questions
Should I tell my children I have cancer? Most professionals working in this area say yes. Children usually sense something is wrong, and what they imagine tends to be worse than the truth. Being told by you is easier than working it out alone.
When should I tell my children about hair loss? Before it starts if you can. Hair loss usually begins two to three weeks into chemotherapy, so telling them in advance means the change is expected rather than a shock.
What should I say to a young child about chemo hair loss? Keep it simple. The medicine is strong, it makes hair fall out for a while, and it grows back. Add that it doesn't hurt, they can't catch it, and nothing they did caused it.
How do I talk to a teenager about my cancer? Be honest and avoid promises you can't keep. Teenagers often go quiet rather than ask questions. Many prefer talking to someone outside the family, and Riprap is a website built for them.
Where can I get help talking to my children about cancer? Macmillan's free support line is 0808 808 00 00 and they have a booklet on this. Fruit Fly Collective produce free family resources, and your clinical nurse specialist can refer you to local support.
Not medical or psychological advice. Your clinical nurse specialist can refer you to family support, and Macmillan's support line is free.
