Talking to children about your breast cancer diagnosis

Talking to your children about your breast cancer diagnosis can be tough. Being open and honest can be reassuring during this difficult time of change.

Research shows that children of parents diagnosed with a serious disease such as cancer are at much higher risk of distress and mental health issues than their peers. Often parents are not aware of the level of their child's distress.

There are many supports available to help you support your child.

As a general rule, the way children respond to a parent’s illness and cope with something like breast cancer depends on their age and maturity level.

Early childhood

Up to the age of about eight, children usually can’t appreciate anyone else’s point of view or understand how their behaviour affects other people. Adults encourage young children to believe in magic with talk of Santa, the Easter Bunny and making a wish as they blow out birthday candles. Unfortunately, children’s belief that they can make things happen by wishing for them has its down side when things go wrong. Children can also believe they cause bad things to happen by thinking certain thoughts or misbehaving.

If a parent becomes ill and a young child believes she or he may have caused this, they might feel guilty and distressed, or even afraid of other disasters. It’s important for parents to make it very clear that the cancer is not the child's fault – that it’s nobody’s fault. It also helps to explain that they cannot ‘catch’ cancer like you can a cough or cold.

Very young children usually express their distress through behaviour rather than by what they say – and this may mean behaving badly. When parents are tired, sick or anxious, it can be hard to see beyond a child’s behaviour to the message behind it – that it’s the child’s way of saying ‘I’m scared’.

Sometimes children respond to anxiety by being extra good, as though this will magically put things right. The danger here is that, while the good behaviour might be praised, the child’s distress may not be acknowledged.

Middle years

From approximately 8 to 12 years of age, children start to appreciate how other people might be feeling, although it’s still hard for them to consider abstract concepts and things that are merely possible.

Having opportunities to play and exercise are important. At this age, children start to look for acceptance from others and, if their family is different for any reason, they will be acutely aware of this. For instance, they may hate having a mother with no hair.

Children in this age group often try to be brave and can feel overwhelmed by their feelings as they struggle to be grown-up. This may be in the face of confronting and distressing comments from other children, such as ‘Your mum has cancer. She’s going to die.’ Well-meaning family and friends may tell them to be brave and grown-up, which isn’t helpful and may discourage them from expressing their feelings.

Adolescence

From approximately 12 years of age onwards, children are able to think in abstract terms, although their ability to think logically often fluctuates. It’s a mistake to assume that, because they can cope with complex maths at school, they will grasp the significance of breast cancer.

The rapid physical changes during early adolescence are not always matched by emotional maturity; it’s easy to expect too much of young people. For instance, it may seem obvious to a parent that adolescent children should do more around the home if their mother is unwell, but it may not be obvious to the adolescent. They may be very happy to make a contribution but still need to be asked, and often reminded, to do specific jobs.

Being accepted and part of a group is important at this age, and self-esteem can be very fragile. Adolescence is also a time of developing a sense of self and identity, and thinking about adult roles, relationships and responsibilities. Adolescents may need to feel separate from the family while still needing support and reassurance.

It’s common for adolescents to have wildly fluctuating and conflicting demands and expectations from their family – if the parent doesn’t ask, they’re selfish and don’t care; if they do, they’re nosy. Emotions can be felt very intensely, and it’s easy for adolescents to feel isolated. An adolescent whose mother has breast cancer may feel on one hand that no one else understands how different his or her life is and, on the other, that he or she doesn’t want to be treated any differently. Their reflections may also be focused on what impact the cancer diagnosis will have on them and their lifestyle.

Adolescent girls may also have questions about their own breast cancer risk if their mother has been diagnosed with breast cancer. It may be helpful to know that 90–95 per cent of all breast cancers have nothing to do with family history and your diagnosis does not mean that others in your family will also develop breast cancer.

What you can do to help your children

It’s tempting to feel that keeping the situation secret from your children will protect them from worry. In fact, children are quick to pick up on atmosphere and mood and, if they’re not told what’s happening, they may fear the worst and become distressed.

• However upsetting, talking is essential, and it’s important to help children feel that their needs and concerns will be addressed.
• Information should be adapted to the age and maturity of the child. For young children in particular, it may be better to give information in stages rather than all at once.
• Remember, too, that young children don’t have a good concept of time. When you are four years old, ‘three big sleeps’ till your birthday seems like forever.
• Avoid telling children ‘everything is okay’, but reassure them that you’re getting the best possible care.
• For adolescents, providing an invitation to talk and then spending quality time together may help.
• Even though it can be difficult, it’s better to tell your children what’s happening to you, using language they can understand. This gives them the opportunity to ask questions and talk about their fears. If you don’t tell them, it’s inevitable that they will hear the news from someone else. A common concern for parents is what, how and how much to tell children.
• Children of any age who are using the internet should be directed towards reputable online resources and away from ‘Dr Google’.
• You may also like to discuss the situation with your child’s school and teachers and access the school counsellor if available.