One of the most emotionally painful aspects of breast cancer is how it impacts our children. We worry about our condition affecting their present lives and we dread that our cancer may be passed onto our daughters. With so much intensity, it can make us feel insecure and confused as to the best way to help our children through our experience. My training as a psychotherapist has provided me with a great deal of knowledge about effective parenting, but the tool I draw from the most is remembering what it was like to be a kid. Since my mother also had breast cancer, I often ask myself what I would have liked or needed as I was growing up. Sometimes my insight come from the helpful things my parents did for me, but often it comes from remembering my own unmet needs.

Before I needed to have my explant surgery (removal of breast implants), my daughter had already been told that I had had my breasts removed to prevent breast cancer. The information came out in the process of explaining her adoption. She was told that we chose to adopt a baby so I wouldn’t pass on breast cancer to a daughter. When it was time to talk to my daughter about my explant surgery, my husband and I sat down with her and told her that I needed to have surgery. We reviewed my medical history to make sure she understood what she had been told before. We told her I was very sick because my implants had ruptured and we hoped I would feel better after having them taken out. I explained that I would no longer have breasts, but I would wear artificial breasts inside of my bra. Because she was at a delicate, developmental age with regard to her female body, she appeared a little embarrassed, so I kept the details brief. We finished our talk by asking her if she had any questions. She asked if the surgery was dangerous and if I could die. We were honest and said the surgery was considered very safe but any time someone is put to sleep, there is always a chance that they could die. Because kids often are not very good at identifying their feelings, we asked her, “What are you feeling? Are you scared?” She said she was scared and started to sob. We asked if she wanted to be at the hospital with her dad or go to school on the day of surgery and she said she wanted to go to school.

Looking back, I realize we should not have placed the weight of the decision to go to school or to come to the hospital on her. In retrospect, I realize I was trying to overcompensate by including her in the process to spare her all the pain I felt as a kid. Whenever we overcompensate, we often find that we end up with the same result we were trying to avoid. As an only child, going to school kept her isolated and gave her the message that she couldn’t or shouldn’t have to deal with the situation. Many years later she was ill prepared to handle her father’s hospitalization when he had back surgery. The choice also implied that school performance was more important than family, which is not at all our family value. I realized after the fact that she was too young to try to make a decision like that on her own. She had no experience to draw upon and as difficult of a situation as this was, this would be a valuable life experience for her to go through with us.

As you attempt to help your children cope with your breast cancer, remember it is also happening to them. Make them feel included by explaining what is going on. Listen to their questions. Anticipate how they may be feeling and help them find words to express their feelings. Try to match your explanations to their developmental age. Young children need to know that there will always be someone there to take care of them. Don’t be hurt if the first thing out of your young child’s mouth is, “who is going to take care of me?” instead of, “I hope you are okay mom.” It’s merely a sign of his/her developmental age. Older children will have more sophisticated questions and reactions that should be answered honestly without unnecessarily scaring them.

Several months before my mother’s mastectomy, she showed me her bleeding breast when I was ironing in her bedroom. I found myself in a role reversal situation trying to talk her into seeking medical attention. I felt scared and powerless to see her diseased breast, knowing she was doing nothing about it. Your children should be allowed to provide you with emotional support but not carry the load. On a regular basis, ask how they are doing and give them updates, so they come to expect that its ok to talk about what’s happening and how they feel. If there is another adult who you and your kids are close to, you may want to ask that person to be available to talk with your kids.

The decision to include your kids in the trip to the hospital the day of surgery should be based on their age and the amount of additional stress it will cause for your other family or friends who will be waiting for you. No one will benefit from trying to manage several small children running around the waiting room. If your children are young, it might be best to leave them home with someone close to them who can comfort them and provide them with updates.

Your children will be curious and want to know about your treatment. Some may want to go with you for a chemotherapy treatment to see what it is like. Show them your postmastectomy products. I offered to show my daughter my chest but did not insist on her seeing it. She chose not to see it. When Carly was in high school, I talked with a couple of her close friends who went on vacation with us to let them know I had a double mastectomy. When talking about cancer, try to give a complete picture. This means that sometimes cancer is successfully treated, sometimes it becomes a chronic illness with recurrences, and sometimes it causes death. Give your children hope by explaining that breast cancer is likely to be curable in the near future through such things as genetherapy. If your family practices a faith, pray together.

If your children show signs that they are not functioning well, such as, their grades significantly drop or they are isolating themselves - you should have them professionally evaluated for depression and complicated grief. Many communities have support/grief groups for cancer patients’ children. The American Cancer Society is one of your best resources. There are no perfect parents. When you don’t have an answer, don’t just make something up. Say you don’t know. Your children will be able to trust you more if you can admit to your limitations. And remember, the goal of life is not to spare our children their emotions. Instead, it’s to guide them and help them develop the coping skills needed to deal with all the situations life presents.