The first few years of your child's life are a time of significant growth and development when the foundation for their social, emotional and learning skills is laid. A cancer diagnosis and treatment can disrupt the safe environment and routines that foster your child's development. This can create stress, affect behavior and cause important growth to be temporarily delayed or reversed.
Dr. Emily McTate, a Mayo Clinic pediatric psychologist who specializes in oncology, explains how actively supporting a child's development through cancer and cancer treatment can help them continue to thrive and reduce distress.
How cancer affects child development
Cancer and cancer treatments can affect your child's development at any age. The effects on development will vary depending on your child's age. According to the National Cancer Institute, treatments such as radiation therapy, chemotherapy, and other medications can have long-term effects on memory, learning, concentration, and problem-solving abilities.
For young children, the demands and expectations of cancer treatment add an extra layer of stress and confusion to learning how to navigate the world, says Dr. McTate. “Two- and three-year-olds should be exploring their world and learning how to tolerate and regulate their emotions. They're in the midst of exploring their autonomy, so they want to be able to make their own choices and do things for themselves,” says Dr. McTate.
But the hospital environment can limit a child's opportunities to develop their newfound independence, confidence and skills, which can frustrate them. Behavior is often the biggest indicator of how a young child is feeling. “Changes and disruptions in behavior, sleep and mood are common,” says Dr. McTate. “We see the same in older children, but they can tell us how they're feeling rather than acting out.”
Dr McTate says that while regression to developmental milestones is common for toddlers, it can still be hard: “For example, potty training is a big achievement and boosts a child's self-confidence, but during cancer treatment it's common for children to become incontinent because they're taking in so much fluid to expel the chemotherapy. Suddenly they're in nappies – that can be really hard for a three-year-old who is so proud of who they are.”
If your child is older, they may have to rely on you more than usual and may struggle to spend time with friends or enjoy their favorite activities. As they become more aware of their body, they may start to feel anxious about the physical changes caused by cancer and cancer treatment.
Prepare for your child's changing needs
Working with pediatric psychologists, child life specialists, social workers, and others can help you prepare for possible disruptions to your child's development before and throughout cancer treatment.
Dr. McTate says this is an important first step after diagnosis at Mayo Clinic: “All newly diagnosed patients meet with a pediatric psychologist within the first month or so, and we do an extensive evaluation and provide a lot of teaching. We want to know where your child is developmentally and understand their temperament.”
Part of pediatric mental health care involves educating parents to provide information appropriate to their child's developmental stage. “The more information a child has, the better they're able to deal with unpredictability and uncertainty, even if that information is really hard to hear,” says Dr. McTate. “We want children to trust that their doctors and parents will be honest with them about what's going to happen, and that includes being honest about the fact that there are some things they don't know.”
As your child's main support system, you may need extra help to cope with this difficult time, so it's important to plan for your needs and know what to expect as their caregiver.
“Caregiver support is really important and it's different for every family,” says Dr McTate. “Some carers have anxiety or mood issues that may be exacerbated by this major life event. Carers who didn't have any worries before may suddenly have problems. It's not surprising that the human brain doesn't feel the same way it normally does in the context of a cancer diagnosis.”
Restoring normalcy during treatment
Dr. McTate says routine is not only important for a child's development, but maintaining consistency and structure during cancer treatment creates a sense of normalcy and helps children cope. This includes maintaining regular expectations and discipline. “It's not going to look 'normal,' but I always teach families that there need to be some expectations and demands because you don't want your child to completely miss out on skill-building opportunities,” she says.
Social interactions with peers are an important part of child and adolescent development, but missing daycare or school or having limited time with siblings can reduce children's opportunities to experience these connections.
If your child is school-age or older, it's important to keep them connected with friends and classmates, as this will help ease the transition back into daily life. “Sometimes children develop incredible skills at speaking with adults because they're used to interacting with nurses and the medical team, but struggle to interact with kids their own age,” says Dr. McTate.
If your child is immunocompromised, it may be more difficult to provide in-person interactions. “We're trying to make sure they have safe social interactions and stay connected,” says Dr. McTate. Depending on your child's age, if your care team agrees it's safe and your child is well enough, they may be able to text, use social media, connect with friends over video calls, or invite visitors.
Helping your child deal with difficult emotions
Children of all ages can experience difficult emotions as they battle cancer, but the types of emotions and the reasons behind them vary by age. “It's normal to see changes in behavior and changes in mood — these are expected,” says Dr. McTate. “What we've found is that when people engage in what we call active coping, they do much better.”
For older children, helping them cope positively means giving them the space to talk about their feelings, encouraging them to talk to health professionals, family and friends, and teaching them ways to reduce stress and anxiety.
Cognitive behavioral therapy (a type of talking therapy) and biofeedback (mind-body techniques used to regulate stress and anxiety) are often used by cancer care teams to help children with cancer cope with fear, anxiety and other difficult feelings.
Explaining the procedure and making sure your child understands possible pain can also help manage fears during treatment, which also includes working with the medical team to familiarize your child with the equipment and how to use it.
It's natural to worry about your child's emotional well-being and development after a cancer diagnosis. Dr. McTate emphasizes that while it's important to pay attention, behavioral changes, growth regressions, and other concerns are likely temporary challenges rather than long-term obstacles. “In most cases, children will get back on track with their development.”
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