Even very young children know when something is wrong. Pretending that everything is normal only increases their fears. It is much kinder to share what you know in a way that they can understand.

A very young child can be told that your breast was sick and you had to have an operation, and now you have to take medicine that makes you very tired. This gives the child a chance to help you, for example, by playing quietly while you rest. It also gives the child an opportunity to talk about his or her own fears that you are sick, and that you may go to the hospital. This kind of talking makes it easier for both mother and child to be able to admit to being frightened and uncertain.

Younger children often worry about two things:
1. Who is going to take care of me? They need to feel safe and protected. They need to know somebody will take care of them.

2. Is mommy going to die? Be honest with your children and don't make promises that you aren't sure you can keep. Be hopeful and realistic: "I can't say exactly what will happen to me, but I'm taking medicines that can help me get better, I'm working with the doctors to get better as soon as possible."

Why being honest is important
Try to maintain some of your normal routine and create the sense of safety and caring that will help them adjust. Tell them honestly about the changes that may happen to your appearance. Encourage them to express their feelings by drawing or singing. older children may be angry, or may withdraw. But often, when they know what the problem is and that they are safe, they feel free to talk about their fears.

They may also be able to help out around the house, which can help them feel they are contributing to your recovery. If they don't feel comfortable talking about their fears with you, they can talk to someone else.

How to talk to your teens about your diagnosis
Cancer is now so common that many children and teens are able to get information and support from friends who have experienced cancer in their own families. Your child's teachers, a school nurse, or cancer centre support groups may have information about support services for children. You may find it helpful to talk to your oncologist about your children's reactions to your diagnosis. Often the oncologist can bring a member of your treatment team, such as an experienced nurse or social worker, to talk with your children about cancer.

Breast cancer and adult children
If your children are adults, they may have concerns about their own health. Daughters in particular may be worried about their risk of developing breast cancer. Teenage daughters, for example, may express anger and resentment toward a sick mother. Encourage your daughters to read this book and to find out more about their own risk

Encourage your adult daughters to do breast self-examinations and, when appropriate, to get routine mammograms. In some cities, breast cancer support groups offer support and information for adult children of people who have had cancer.

Excerpted from What You Need to Know About Breast Cancer by Pat Kelly and Dr. Mark Levine (Key Porter Books).