Telling children about a breast cancer diagnosis

If you are a parent, one of your biggest worries after a breast cancer diagnosis may be how to break the news to your child or children.

You’re not alone. About 1 in every 5 people who receive a new cancer diagnosis have children under 18. Over time, you’ll find that there are many sources of support: books, websites, support groups, professional counseling, and organizations designed for kids of parents who have cancer.

When you’re first diagnosed, take some time for yourself.

• Take a few days to move through the initial shock, understand your situation, consider your treatment options, and possibly seek a second opinion. During this time, give some thought to how you will share the news with your family.
• Discuss what lies ahead with your doctor, your spouse or partner, and/or someone else very close to you. If you have early-stage breast cancer, your treatment will have a beginning, a middle, and an end. If you have metastatic breast cancer, treatment will likely be ongoing, although there can be breaks in between treatments.

You’ll be better prepared to share the news with your child or children once you understand your situation and how your treatment plan will impact you and your family. It’s best to talk with your children before telling loved ones outside your household and immediate family, if possible. This helps ensure they don’t hear the news from someone else.

The information below is for parents, and it may also be helpful if you are a grandparent, aunt, uncle, or other relative who needs to share your diagnosis with a child.

Why kids need to know about breast cancer

It’s better for children of all ages if you tell them you have breast cancer instead of keeping it secret.

Children — even very young ones — can sense that something is wrong when you’re under stress and family routines change. Children will​ notice changes in body language and​ pick up on conversations you’re having with other adults in the home or over the phone.

For example, they may see adult family or friends with red, puffy eyes from crying or experience a stop or hush in conversation when they enter the room. It’s natural for children to try to fill in the gaps to try to make sense of what they are seeing when they don’t have enough information. As a result, they might imagine something more terrible than what you’re trying to keep hidden.

Even if you’ve asked others not to share your diagnosis, it won’t take long before your child hears about your medical situation from someone else. That secondhand information may be inaccurate or frightening.

Children will notice changes in your appearance or energy levels due to surgery or other treatments, and wonder why you decided to keep the truth from them. Parents tend to withhold information in an effort to protect their children from hurt. Very commonly, however, children of parents who have decided not to disclose feel angry and upset, and that they cannot trust their parents in the same way going forward — at the same time that they are trying to process their feelings around your diagnosis.

By telling your child, you get to choose what to say. This lets you communicate a reassuring, supportive, and hopeful message. It builds trust, promotes ongoing discussion, and protects your child emotionally. Including your children in your cancer experience can be an opportunity to teach them healthy coping strategies they can use for the rest of their lives.

Guidance for sharing your diagnosis

It’s normal to be nervous about breaking the news to your children. Remember that you know your own child best. You’re the best judge of how much information they can handle, and what might need to wait until later. This is just the first of many conversations that will happen throughout treatment.

The guidance below is intended to help you talk with children of any age.

Prepare for the conversation

There are several different ways you can prepare for the conversation to go well:

• ​​Think ahead about what you want to say. ​Keep it short and consider writing it down first, like a script. This can help prevent ​becoming flustered in the moment. ​​​ ​​​​
• ​​​​Rehearse the conversation in advance.​​ Thinking about what you plan to say is different than saying it out loud. Practice in front of a mirror to be aware of your expressions and make changes if needed. It’s OK to show emotion or cry, but you’ll want to keep the focus on your child.​​​​​
• Ask your partner or another adult family member to be there when you share the news. Ideally, it should be someone who will be available to you and your child throughout your treatment.
• ​​If you have more than one child, consider whether to tell them one at a time or in a group. ​Telling children at the same time can create a shared experience, reinforce the ​strength of the family unit at a difficult time, and prevent children from feeling that they “found out last.” This works best if your children are relatively close in age. If there is a large age gap, or significant differences in ​​temperament​​ or learning styles, meet with them individually to adjust the news to each child’s level or understanding. If you have separate conversations, be sure to come back together as a group so that everyone can support one another. ​​​ ​​
• Plan for a day or time when your child is typically well-rested and not busy with other activities and schoolwork. Consider the rhythm of your family’s weekly schedule and what the best time might be.
• Keep your explanations simple. You don’t have to talk about everything at once. Younger children will require less detail than older children and teens.

Some other tips

Think about how you’ll reassure your child as you share the news. Sitting close, holding, or hugging can express support and give comfort to some children, especially younger ones. Others may benefit from a quick touch, eye contact, or simply being on the sofa together. Do whatever makes sense for your relationship.

If your child has experienced cancer through another relative, a friend, a friend’s parent, or a family friend, think about how to address that. They may assume that all cancers are the same, and that you will have a bad outcome if another person did. You might have to say directly, “I know Grandpa died of cancer, but my cancer is not the same as ​​his.”

Be ready for a range of reactions. Children might not react in the way you expect them to, and that’s OK. Some might immediately express sadness and concern. Others might not seem that affected by the news. They might not want to get close to you or talk about their feelings. No matter how they react, let them know they can come to you whenever they have questions.

​​Give children time to wrap their heads around change. “Kids need time,” says Eliza Park, MD, MSc, a psychiatrist who specializes in helping people with cancer. “When someone’s illness impacts a child’s life, they may have a reaction of disappointment. They may be mad or anxious at first. It’s important to leave space for that reaction.”​​​

​​​​Revisit the conversation.​​ Children tend to process information in chunks. They may not have heard everything you shared at first, and may have questions as time goes on. Be sure to offer plenty of opportunities for ongoing dialogue.

What to talk about

Below, you can find information that can help support your child when you are letting them know about your diagnosis. Talk with your child in a way that suits your child’s age, personality, and emotional readiness. You know your child better than anyone, so you are the best person to decide what is going to work well.

• Tell your child that you have breast cancer. Explain that there are many types of cancer that can happen in different parts of the body. Tell them cancer is not contagious, and reassure them that they can’t catch it from you.
• Emphasize to children, including teenagers, that cancer is not their fault. Nothing they did or thought caused you to develop breast cancer.
• Tell them what treatments you will have, if you know. Provide general background and keep the information simple and straightforward.​​​​
• Let children know what physical changes they might see as a result of treatment. For example, after surgery, they will see you with surgical drains (temporary tubes that help drain extra fluid from the surgical site). If you are having a certain type of breast reconstruction surgery that involves using your abdominal tissue, they might see you sleeping in a propped-up position or recliner as you heal. If you are having chemotherapy, it might cause hair thinning or hair loss, nausea, or fatigue.
• Prepare children for how their daily lives will be affected when you are getting treatment. Explain who will stay with them, make meals, pick them up from school, or take them to team practices or other activities.
• Reassure them that it’s OK to focus on school, friends, activities, and fun. They shouldn’t feel guilty about living life as normally as ​​possible.
• From time to time, ask children to explain back what you’ve said. This lets you quickly correct misunderstandings and respond to questions or worries they might have.
• Let children know who else is being told, so they can turn to those people for support. Talk about when it will be OK for them to tell their friends and classmates, and let them know they can ask for your help with what to say. (Keep in mind that many children, especially younger ones, will spill the news right away.)
• Answer any questions that children ask. When you don’t know an answer, it’s OK to say, “I don’t know, but I’ll find out and tell you.”​ Be sure to follow up with them ​later so they know you are taking their question seriously and not withholding information.​​ Tell them they can always ask you ​​additional questions going forward.​​
• Follow their cue at the end of the conversation. If a child can’t listen anymore or cuts the talk short to go play or do homework, that’s normal. You can continue another time once the basics have been covered.

School-age children and teens often will ask, “Are you going to die?” Be prepared for that question. With early-stage cancer, you can reassure them that treatment will likely have a beginning, a middle, and an end. Most people will live a normal life afterward. Share whatever positive information your doctor has given you about your ​prognosis.

If you have metastatic breast cancer, it’s important to balance the seriousness of the diagnosis with the reality that there are many good treatments that can keep cancer under control for years at a time. Let your child know that you have a healthcare team that is working with you toward that goal. For more guidance, visit Talking with family about metastatic breast cancer.

If you have metastatic breast cancer

If you’ve been diagnosed with metastatic breast cancer, your situation is different from those who have early-stage breast cancer.

As with any conversation about illness, how you talk to your children about your diagnosis also depends on their age. No matter how old they are, it’s important to be as honest as possible, and to resist making promises that may be difficult to keep. Here are some things to keep in mind:

• Children of all ages want the security of knowing they will always have someone to care for them and love them. Having a support network during treatments will show them how your partner, relatives, and/or other adults in their life will be there for them. Let your children know which family members and friends will be there at times when you are not as available.
• Older children and teens are likely to ask questions about death and dying. Be prepared for those questions. You can let them know that yes, metastatic breast cancer is serious, but your healthcare team has many treatment options to help you live as long and as well as possible.
• Let your kids know there will always be a plan, even if a treatment stops working. Explain that, while your doctor and healthcare team can’t cure the cancer, they likely can keep it under control for long periods of time.

As a parent, it’s natural to be concerned that sharing this information might mean that your child will always be worried about you. But most of the time, this is not the case, according to Eliza Park, MD, MSc. “Kids can compartmentalize — often better than adults, and live happy, healthy, busy lives despite knowledge of a parent’s serious illness,” she says.

For more guidance, visit Talking with family about metastatic breast cancer.

Supporting your child’s mental health

After learning that a parent has breast cancer, children can have many different kinds of responses and feelings. Different children will have different reactions depending on their age, how much they are able to understand.

While some children may be comfortable with the information you give them, others may be anxious or become clingy, or they may argue more. Other children may show little emotion or withdraw.

There are many ways to help your child feel supported as they adjust to your diagnosis. Visit Supporting your child’s mental and emotional health to learn more.

Resources for talking with children about breast cancer

LBBC offers these resources for you and the children in your life:

• Our Breast Cancer Helpline volunteers are available to help you think about how to communicate breast cancer diagnosis news to children.
• Our Reading for Reassurance program offers free books for children aged 4-17 with a parent who has been diagnosed with breast cancer within the last 6 months.

There are also organizations that offer educational resources and support for parents and kids:

• Pickles Group provides free peer-to-peer support and resources for kids and teens with a parent or guardian who has cancer.
• Bright Spot Network offers resources for younger parents and guardians caring for young children at the time of their cancer diagnosis.
• Kesem offers free programs for kids ages 6-18 who have a parent with cancer.
• Wonders & Worries provides free, professional support to children and teens when a parent faces a serious illness or injury.