Facing the fact that you or someone you love has cancer is difficult. Deciding what to tell your children is even tougher. While parents may want to shield children, especially younger ones, from such distressing news, it's best to be open and honest about the illness and its treatment.

Even very small children will know that something is terribly wrong when their families' normal routines are altered because of cancer. Parents' anxieties and an atmosphere of secrecy are just as apparent to children as the more obvious signs of the illness, such as frequent bedrest, physical changes, or hospitalization.

When children receive no explanation for the changes in their lives, they will make up their own. Because of their immaturity and self-centered view of the world, they often blame themselves. They may feel that they have been "bad" or that their parents don't love them anymore. Adolescents and teens may feel helpless in dealing with a parent's pain and frightened at the prospect of death and loss. Silence merely fuels their anxieties.

As difficult as it may be, children should be given accurate, age-appropriate information about a parent's cancer as soon as the diagnosis is given. Tell children the name of the disease and where it is located, such as the breast or lungs. Explain how it will be treated. Above all, assure children that the disease is not their fault.

Telling children about cancer is not a one-time event. Ongoing discussion is important because children need continuous reassurance that they will be safe, secure, and loved. Describe both what is happening now and what is likely to happen in the near future. Also explain side effects, such as fatigue, hair loss, weight loss, surgical alterations, and mood changes.

When a child asks about death, respond as honestly and optimistically as possible. If recovery seems unlikely, acknowledge the uncertainty and say that the family will face whatever happens together. Children's response to the information they receive about a parent's cancer will vary. They may need time to absorb what they have been told, so be willing to answer questions and listen to concerns whenever they arise.

Because cancer causes considerable disruption in family life, watch for signs of stress, such as trouble sleeping, nightmares, loss of appetite, physical complaints, unusual quietness or fearfulness, or behavioral problems at home or in school.

Giving children as much attention as possible and expressing your love usually helps them get back on track. Maintain normal discipline, and don't let the illness become an excuse for children to violate their established limits. Allow children to follow as normal a routine as possible at home and in school. Let them continue their usual activities and spend time with friends; allow adolescents and teens their privacy. Reach outside the family as well. Inform children's teachers there is cancer in the family. Teachers can keep track of how children are performing and report any problems.

If you need additional help with the consequences cancer is having on your family, contact school counselors, hospital social workers, or your local chapter of the American Cancer Society. Support groups for children of parents with cancer may also help relieve the pressure.