Talking to children about your cancer can be a very difficult thing to do, and may be upsetting for both you and the child. However, involving children in the situation and letting them know what is happening can be very supportive to them and can help them (and you) to cope better with the illness.

• Cancer affects the feelings and emotions of the whole family and a child has a right to know about anything that affects the family.
• Children can sense when something is wrong, because they are very sensitive to tension and stress. If you try to protect them by saying nothing, they may fear that something even worse is happening.
• Not talking about cancer may suggest it is a subject too terrible to be discussed, and can make children have an exaggerated fear of cancer or illness later on.
• Children may find out the truth from someone else, or get misleading and frightening information from TV, the internet or other sources.
• Children can feel isolated if they are not told. They might feel they are not important enough to be included in an issue that affects all the family.
• Children are good at noticing things but may be mistaken in their interpretation of what they mean. For example: 'Grandad died in hospital. Now Dad has to go into hospital. He is going to die too.' Or 'I was cross with Mummy when she told me to pick up my toys. Then she was ill. Maybe I made her ill.'
• Children who know the situation can be a comfort to you. You won't need to watch what you say all the time or feel secretive and isolated in your own family. Openness can help all of you to feel closer.
• Children have an ability to deal with the truth that adults often underestimate. Not knowing things can make them feel anxious. Even very sad truths will be better than the uncertainty of not knowing what is happening. We cannot stop them feeling sad, but if we share our feelings and give them information about what is happening we can support them in their sadness.
• Dealing with cancer in the family can be an opportunity for children to learn about the body, cancer, treatment and healing. They can learn about how strong people can be during hard times and how to deal with difficult feelings.

As a parent or carer, if you feel able to tell the children, it is usually best for you to do it. This is a very difficult thing to do and there is no easy way of saying it. It is all right to get upset or cry. Seeing you cry gives your children permission to cry too, and crying together can feel very supportive as you are sharing your feelings. You will know if you can be the one to tell them.

If you do not feel able to tell the children, your partner or a close relative such as a grandparent could do it. A nurse or your doctor or a member of the professional staff looking after you can also be involved. It is important that you know what has been said to your children, and it may be helpful for you to be present when they are told.

After being diagnosed, it is helpful to explain what is wrong. You don't have to tell everything at the same time. You can give a bit of information at a time.

Before treatment begins and when you are being treated, you can explain the treatment and how it is given. You can also talk about the side effects and about any changes in treatment, whether things will be different at home or how you feel. Some treatments such as chemotherapy or radiotherapy can make you feel very tired and possibly irritable. It is helpful to explain this to your children so that they know that the treatment may affect how you behave and relate to them.

Try to keep information relevant to the current situation. It can be best to give children warning that something is about to happen, such as a scan or treatment, shortly beforehand, but not too far in advance.

After you finish treatment, explain to your children that you will tell them about your health and about any changes.

Be willing to talk whenever your child asks questions or seems concerned about your condition.

There may be particular places where you feel more able to talk to your children, or they may be more likely to discuss things with you. An example is when they are in the bath.

Often, children may talk about things or ask questions when they are in bed and settling down to go to sleep. It is very important to answer any questions that they ask at this time. However, this may not be a good time to start a conversation that could be difficult, as the child may then have a long time on their own to think about the situation or may not be able to sleep. If they do ask questions at this time and you talk to them, it is important to spend time with them to make sure that they feel supported before they go to sleep.

You can talk to your children as a group, or individually (if they need to know different things because of differences in their ages or how grown up they are).

You may want to practise what you will say and anticipate the questions that the children will ask. It is important to talk in a language and at a level that each child understands.

It is helpful to create an environment in which your children feel safe and in which they feel able to ask questions, even if they feel sad and upset. Set aside plenty of time, when you know that you will not be interrupted, and let the children know that you have plenty of time to discuss the situation with them.

Children need to be told information in a way that they can understand.

• Tell them what has happened, such as some details about the cancer.
• Explain what will happen next, such as how it will be treated.
• Leave them with feelings of hope that even though you are upset now, there will be better times.
• Assure them they will still be loved and cared for. Tell them who will look after them, if necessary.
• Listen to them – it lets you know what they can cope with.
• Answer their questions simply.
• Ask them what they think cancer is. Explain it as well as you can.
• Ask them if they are worried about anything in particular.
• Correct any misunderstandings they may have.
• Be honest.
• Let them know how the situation affects your feelings and emotions, as well as giving factual information about the cancer and treatments. An example is that you can say you may feel more sad than normal, or may be more easily irritated.

• 'I have an illness. It is called cancer. The doctor is giving me medicine to help me get well. Sometimes I will feel ill or tired and sometimes I will feel fine. Dad/Mum will help me to take care of you until I feel better.'
• Simple and straightforward language is the most helpful, for example: 'Some of the cells in my (tummy) are growing too quickly and have made a lump that is sore. The doctors will take the lump out during an operation.'
• 'Being ill makes me feel sad. You are a help. But it's all right for you to feel sad (or angry or happy or whatever). Our feelings change but Mummy/Daddy and I will always love you.'
• 'A lump was growing in my body that wasn't supposed to be there. It is called cancer. The doctors took it out in the operation I had. Now I will have treatment so that it doesn't come back. If you have any questions about cancer, you can ask me. Sometimes you hear frightening things about cancer, but there are lots of different kinds of cancer. I will tell you what we know about my cancer.'
• 'The cancer is trying to grow again. That makes me angry and sad, too. I have to take very strong medicine (or have another operation or radiotherapy) to try to get rid of it. Doctors know a lot about taking care of people when this happens. They think that this treatment will help me.'

Sometimes it can be helpful to use books about cancer to help you to describe it. See the patient information guide for details of helpful books written for children.

• It is best to avoid words for cancer, such as 'the big C', or 'breast mouse' for breast cancer, or 'a nasty tree growing inside me' as this can give children the wrong idea which can be very frightening. Just say 'cancer'. 
• Don't lie.
• Don't trouble them with complicated medical details, money problems (except when it will affect them), or your worries about waiting for the results of tests, etc.
• Don't make promises you may not be able to keep. (Say 'I think I will be able to...' or 'I'll try to...')
• Don't be afraid to say 'I don't know'.
• Don't push children to talk if they do not want to.