It’s impossible to shield children from all of the stressful parts of life, and following your natural desire to protect children will usually not make things more pleasant or secure for them in the long run. Even if you don’t discuss your cancer with your children, they will have a sense that something is wrong. Children may incorrectly determine that your silence means that whatever is happening is too terrible to be talked about. This may cause them to imagine all kinds of frightening things. Another risk of keeping cancer a secret is that children will know you are being vague and are trying to conceal something from them. They may end up feeling isolated and uncertain about whether they can trust the information you share with them.

Children grow to understand what is happening in their world by observing their parents’ reactions and views. So how a child reacts to a cancer diagnosis will very much depend on how his or her parents or other adults are handling the crisis. The responsibility for setting a healthy tone for coping with cancer can contribute to parents’ stress, as they are dealing with their own powerful feelings of fear and uncertainty. However, parents and their children can and do learn to cope with breast cancer and its treatment.

Parents often want to protect children as long as possible from harsh "adult" realities. But if children aren’t given an honest explanation of a situation, they will arrive at conclusions that spring from their imaginations and immature intellects. Information demystifies cancer for children as it does for adults, and it helps children feel less helpless. Thus, the first and most important step in helping children deal with your diagnosis is to immediately offer children appropriate information about your breast cancer.

Be truthful with your children about the disease and its effects, to the extent that is appropriate for their age and comprehension. Be the first one to tell them you have breast cancer. If children hear about your cancer from someone else—for example, a curious neighbor or a classmate who has heard other people talking—it can harm the child’s trust in you. It’s best for you to communicate information about cancer truthfully, in a way that allows a child to understand and have a role in what is happening in his or her life.

Young children (up to age eight) will not need a great deal of detailed information, while older children (aged eight to twelve) and adolescents will need and deserve to know more. Adolescent daughters of women with breast cancer will have different concerns than a five-year-old who needs his or her parent for basic caregiving.

When talking to children, use simple, age-appropriate language based on what is really happening. Begin by asking what they understand or think about the illness. Using dolls or drawing pictures can help. Explain the effects of the illness and the side effects of the treatment—such as fatigue, hair loss, weight loss, surgical alterations, and moods—so that the children are not left to fantasize about why these things are happening. Remember that children are familiar with being sick, but be careful about saying things such as, "It’s like when you had a sore throat and had to go to the doctor." Young children might conclude that the next time their throat hurts, it means they also have cancer.

Adolescents may have a range of complicated reactions to a parent’s cancer. They may feel very ambivalent about their sick parent, wanting to help and yet feeling angry and guilty about wanting to flee. Their reaction can be especially difficult if they were not getting along with the parent before the illness. Teens are also aware of cancer news in the media and are more developmentally able to think of the future than younger siblings. They may be frightened. They may feel alone and abandoned.

Older adolescents may feel overwhelmed by the parents’ pain and their own helplessness in dealing with it; as a result, some may become aloof, others may become anxiously overinvolved in the parent’s care. Some teens may act out aggressively and destructively or abandon their social outlets, whereas others may begin to fail in school. They may even start developing headaches, rashes, and other psychosomatic problems. More mature teens may cope as adults do, seeking and evaluating information and turning to friends and counselors for help.

All children need to know the following basic information: the name of your cancer (you may simply tell them "breast cancer"), the part of the body where the cancer is, how the cancer will be treated, and how their own lives will be affected by the disease and treatment. The guiding principle should be to tell the truth in such a way that the child is able to understand and prepare him or herself for the changes that will happen in the family. Keep in mind that communicating with young people about cancer is not a one-time event; it is a process that will continue over time. If the illness goes into an extended remission or continues as a chronic problem, children will require updates tailored to their own changing understanding and emotional needs.

When life becomes unpredictable, kids will need help in adjusting to the changes. Children, especially very young ones, need continuous reassurance that they’ll be safe, secure, and loved. Because cancer and its treatment necessitate frequent absences from home, and/or leaving them in the care of others for periods of time, you will need to reassure them that they are not being abandoned and that they will always be taken care of no matter what happens. Let them know that their daily needs and activities will still be addressed: They’ll still get their favorite sandwiches for lunch, go to Little League, play with their friends, and so on.

While children do worry about breast cancer itself, they also develop other concerns. At some point, most children believe that something they did or didn’t do may have caused their parent’s illness. Children regularly engage in "magical thinking"—that is, they believe that they can make all kinds of things happen. They can also believe that bad things happen because they have been angry with their mom or dad. It is also important to let children know that your illness is not their fault. Small children dwell at the center of their universes and often think that bad things happen because they were naughty. So when a parent is diagnosed with cancer, children often feel guilty and think they are to blame for the cancer. Kids usually won’t express this fear, so go ahead and bring up the issue, then reassure them about it. You might say something like "The doctors have told us that no one can cause someone else to get cancer—none of us did anything that made me get breast cancer."

Children also worry that cancer is contagious and that they or their other parent will get it. It’s a good idea to correct these ideas before the child has a chance to worry. Children can become confused about how people get sick, and one of their common worries is one person can get cancer from another, like "catching" a cold. Parents can explain that cancer is a different kind of illness and the child doesn’t have to worry that someone passed it on to their mom or that the child will develop cancer. Parents should also reassure the child by saying that it would be very unusual for the other parent to get sick too.

Another worry your child may have is that everyone dies from cancer. Parents may want to tell their children that years ago people often died from cancer because doctors didn’t know much about how to treat it. Many advances have now been made and the outlook for many cancers is much more hopeful.