Mothers often find it very difficult to talk about breast cancer with their children, especially breaking the bad news. It is understandable to be worried about the effects the diagnosis will have on your child/children.

Why tell the children?
Children are often very sensitive to a change in their environment, they can easily detect a change in the home atmosphere especially if it is fraught with emotion. Additionally, children over hear conversations both on the telephone and in the home. If these changes are unexplained, they may feel confused, insecure, and alone with their fears. It is worth remembering that children are very resilient when faced with difficult news, and generally cope very well if they are kept informed. Being open and honest with children is usually the best approach. Below are some guidelines to help you talk about breast cancer with your children and aid their coping and your own.

Manageability.
It is important to try to make the illness manageable for the child. Children often find it better if the news is given a little at a time gradually building up a picture of your illness. Give a realistic and limited picture, try and avoid giving a sad reflection of your feelings.
The message ought to include the following:
The illness has been discovered, treatment will be starting, and that the family are facing this together.
If you can handle your own emotions, it will be better breaking the news yourself if you can manage it.
Children are often curious and come up with questions. Try and answer them as honestly as possible.

Giving information.
Give information according to the child's ability to understand. For instance, the message of loosing a breast, or going into hospital, is for the positive purpose of getting well. For small children communicate this message using dolls and toys, stories or song. For the older child or adolescent use straight forward non alarmist language.

Responses.
Some children will need to hold this news at a distance, as if it were happening to some one else. Other children may ask for the explanation all over again. Often children will make no response at all, or become moody, or have tantrums. Try not to feel to disturbed by these responses, children need time to take on board the news they have received, and will find different ways to cope with it.
Children sometimes respond by giving their own solutions to difficult situations. It is important to listen to these and respect them, whilst at the same time letting your child know about the treatments and solutions which are going to help you get better.
Occasionally, children may feel that mummy is ill because of something they have done. It is important to reassure the child that the illness is not their fault.

Routine.
Keep life as normal as possible for your child/children, as this increases feeling of security.
Expand your own support network with family and friends, as this will help you cope both emotionally and practically. Your child's behaviour may be affected by your diagnosis, it is important to inform the school or nursery of your circumstances. Such places are usually very understanding and sensitive to your child's situation and often become a further dimension of support. In the case of infants, it might be a good idea to let your health visitor know about your circumstances. She may be able to offer you additional help and advice.

When you go into hospital for treatments it is important to tell your child/children a couple of days in advance so they have time to adjust to your forth coming absence. For younger children who cannot measure time in days of absence leave a small gift to be opened each day while you are away. Also leave a photo of yourself. Older children may appreciate a tape recorded message prepared before your admission to hospital. Your child/ children will be able to visit you on the ward in most circumstances, direct contact is always reassuring. These days hospital stays are very short and other treatments such as radiotherapy and chemotherapy are performed on an out patient basis.

Reactions.
How your child/children react will depend to some extent upon your own reactions and coping. The age and temperament of the child/children, along with the degree of changes in family life, as well as the amount of support from family and friends will influence how well your child/children cope.

The cancer charity BACUP do a free useful booklet, ''What do I tell the Children''. Tel 020 7613 2121 ( from London ) or Freeline ( Outside London ) 0800 181 199.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885