[This story was originally published on October 12, 2020. It has been updated.]

Telling children that a parent has cancer is one of the most difficult things a newly diagnosed parent must face. There’s no one or “right” way to have this conversation. Every family copes with life’s challenges uniquely.

As a two-time cancer survivor, wife and mom of three children, here is what learned about telling kids about a parent’s cancer diagnosis, based on my experiences.

At first blush, a parent’s instinct may be to avoid telling the children in order to protect them. My parents never told me that I had cancer when I was a teenager diagnosed with Hodgkin’s disease as it was called then; it left me bewildered every time I had radiation therapy in a hospital filled with very sick children. So, when I was first diagnosed with breast cancer four years ago, my husband and I decided that we would tell them when we had all of the relevant information—diagnosis, treatment plan, prognosis—so that we would be on the same page and could deal with the news together.

My children were ages 19, 15 and 10 at the time—a freshman in college, a freshman in high school and a fifth-grader. Despite our best intentions, it didn’t work out as I’d hoped; our college-aged daughter felt betrayed and hurt when my husband told her that I had breast cancer when I was one hundred miles away from home at a swim meet with my high school son.

In retrospect, my plan to share the information at one time made a difficult and stressful time much harder. In fact, according to the American Society of Clinical Oncology, parents should consider sharing the information with children in multiple, brief conversations to allow them to digest the information. If I had it to do over again, instead of trying to control the narrative, I would have shared the information as I received it, particularly with my college-aged daughter and teenage son.

It may be hard to keep cancer a secret. Once treatment begins, children will see the side effects. But even before cancer manifests itself physically, children, and particularly teens, know when secrets are being kept. They’ll pick up on their parents’ worry, anxiety and hushed voices and wonder what is being kept from them. Understandably then, kids might believe that whatever is happening is too awful to talk about, which in turn might make them feel isolated from the very people who are supposed to care for them.

Another concern is what happens if children hear about your diagnoses from someone else, by mistake. A classmate or a neighbor might say something, not knowing that the news hasn’t been shared. The children may then find themselves in the bewildering space of not knowing what to believe.

Before having these painful and hard conversations, take some time to plan what to say. Talk to a spouse, partner, therapist, a health care professional, or member of your faith community. Consider writing down important points so you can pay attention to your children’s reactions.

Know that there may some difficult questions to answer from your children— for example, be prepared for your children to ask whether you will die. It was the first question my younger son asked. In response, I explained that my cancer was caught early, that I would have surgery and chemotherapy to get better, and that I had great doctors taking care of me. Also, don’t be afraid of being emotional—it may help the children to process their own feelings. It’s okay to cry together.

How much information to share depends on the children’s ages. Parents know their children the best and what works for one family may not work for another. However, according to the American Cancer Society, at a minimum, children should be told the following:

  • The name of the cancer (e.g. breast cancer, lung cancer, lymphoma)
  • The location of the cancer in the body
  • The type of treatment
  • A simple explanation of side effects
  • How their lives might be affected

When naming the cancer, it may be helpful to use a doll, stuffed animal or drawing to show or where the cancer is. For older children and teens, parents also may want to explain what cancer is—a family of diseases caused by abnormal cells that divide rapidly and over time can grow into tumors—and how it’s treated—typically with surgery, chemotherapy or radiation therapy.

Being honest about the day-to-day impact that treatment will have on children’s lives also is essential.

Children need to know that the parent might be away from home for several hours a day for chemo or radiation therapy or may be hospitalized. The parent may be too tired to cook, attend school events or may need more help with household chores. The parent might lose his or her hair or experience weight changes. Teens, in particular, might worry about how their parent may look once treatment starts and become apprehensive about “being seen” with their sick parent. The first question my teenage son asked me was whether I’d lose my hair. I told him I would, but that I’d wear a wig or baseball cap whenever I was out of the house.

Parents need to give their children time to absorb and process this news and therefore should be prepared to have more than one cancer conversation. Keep the lines of communication open and encourage children to ask questions and share their concerns. If parents don’t know the answer to their children’s questions, tell them that and follow-up later with an explanation.

Finally, parents should assure their children that cancer isn’t contagious and let them know that it’s okay to hug and show affection for each other. Tell the children that they didn’t cause the parent’s cancer—it’s not their fault—and that the family will work through this time together.

And above all else, remind children and teens that they are now and always loved. Cancer will never change that.