TELLING YOUR CHILDREN

As a clinical psychologist, Carolyn Ingram is an expert at helping people cope with life's challenges. But after she was diagnosed with breast cancer in 1994, she had to handle a problem that was new territory for her: deciding how she and her husband should best tell their daughter Leslie Ann, then 8, about the cancer.

More than 200,000 women will learn they have breast cancer this year, and more than 400,000 others will learn they have other forms of cancer, according to American Cancer Society projections. Many will still have young children at home.

So it's crucial to deal not only with the cancer, but with communicating information to your children. Here, tips from Ingram, who practices in Marin County, Ca., and others on how to do your best when you may be feeling your worst.

First, Pull Yourself Together
Being emotional and distressed after a cancer diagnosis is normal. But before you call the kids in for a meeting, pull yourself together, experts advise. "We're not saying a mother should never show irritability or tears," says Patti Brandt, Ph.D., a nurse practitioner at the University of Washington, Seattle, who has researched the topic. "But if she finds herself constantly sobbing or preoccupied with her own health, that's saying she needs to take some time out, to do some care taking of herself."

Call a Meeting
"Set a  time when the phone doesn't ring," says Leslie Gebhart, a  life coach in Palm Springs, Ca., and the sister of Carolyn Ingram. Or turn off the phone and other distractions. The sisters are both breast cancer survivors and together wrote "The Not-So-Scary Breast Cancer Book" (see their site, www.childvoice.com for more information) to help women cope, including tips on how to talk about their cancer with their kids.

"Include everyone who lives under your roof," Gebhart says. Decide on an age-appropriate length of time, Gebhart says, and set a timer in the kitchen to keep yourself on track.

Starting the conversation isn't easy; just remember to keep it simple. What works: "Mom's going to be taking special medicine to help the cancer go away." Let the children know it will of course affect the family and how the kids can help.

Keep the Goals in Mind
One point of the meeting, says Gebhart. is to ease tension. For you as the mother, it's also a way to practice asking for what you need. If you are like most mothers, you are not good at this.

You can be specific, telling the kids, "I might need you to make the beds." "I might need you to make sure the dog has fresh water."

If you will need outside help, pick and choose which chores you want to relinquish, Brant suggests. "Keep your personal connection with the kids," she says. So, hire someone to do laundry, but not to pick up the kids from soccer practice.

Talk positively to set the tone. "Say, 'We are going to get through this," Brandt suggests. Be brief and to the point. "You don't want to overload them with details about how often you will see the doctor, how many treatments you will have."

Picking a Good Setting
Use whatever environment you have used in the past to deliver news, good or bad, Brandt suggests. "Sometimes it works [to talk] after a favorite TV show," she says. Maybe you want to order in a favorite dinner, and talk when you are done.

Don't schedule a meeting when kids have something important coming up on their agenda, such as a big school function or a test.

One Meeting Isn't Enough
One meeting won't do it all. Ongoing communication and discussion are crucial. How often you decide to meet to talk about your cancer depends on a lot of factors: the age of your children, the stage of your cancer, the personalities in your family.

Some experts suggest weekly meetings, but only you can decide how often is enough. Know that when children get no explanation for the changes swirling around them, experts say they are likely to make up their own explanation. And that could mean blaming themselves, especially in the case of young children, even if it makes no sense to you as a parent.

Between meetings, give your kids an opportunity to get their questions answered. Gebhart suggests keeping a sheet of paper on the refrigerator. Kids can jot down questions or concerns to be brought up at the next family meetings. Such as: "Sam's mother had this kind of cancer and she didn't have to have the treatment that made her go bald. Why not?"

Try to Understand Where Your Child Is Coming From
Leslie Gebhart recalls that her niece's first question to her mother after the initial news was delivered was: "Will anything bad happen to you?" At age 8, the question was really, "Am I going to be OK?"

While even young children are concerned about their mother having cancer, their life still revolves around themselves. In other words, it may be your cancer, but if you have young children, it's still all about them.

And that's normal, says  Ellen Zahlis, M.N., a researcher at the University of Washington, Seattle, who studies the impact of cancer on families. Young children, and even some older ones, are likely to ask, "Can I still go to my games?"  "Will I still get to have my birthday?"

It's OK, she adds, to say you don't know, especially if you don't know the toll treatment will take on you. It's Ok to tell your kids their events will go on whenever possible and you'll do your best.

What Do Kids Worry About?
When Zahlis interviewed 16 children whose mothers had breast cancer, she found some key worries:

• Worrying about death
• Worrying something bad would happen, such as the cancer spreading or an allergic reaction to one of the treatment drugs.
• Worrying about the family and how they would cope
• Worrying when the mom did not look good
• Worrying mom would never be her old self.
• Worrying that financial cutbacks would be necessary.
• Worrying about talking to others about the cancer
• Worrying that the child herself or himself would get cancer

As you discuss the treatment and progress with your kids, bear in mind that some of their questions may reflect these common worries.

Give Your Child Some Control Over the Situation
Leslie Gebhart recalls her niece's reaction when her sister said she would go bald. "She burst into tears."

Leslie Ann decided she didn’t want to see her mother bald, so Carolyn Ingram agreed to honor that wish, asking her little daughter to knock on the bedroom door before their morning cuddle session, giving her enough time to grab a scarf or a wig.

Weeks later, after Leslie Ann was used to seeing her mother in a wig or a hat, she changed her mind. "The openness with which my sister talked to her helped her change her mind," Leslie Gebhart says.

When Leslie Ann saw her mom bald for the first time, she told her, lovingly, "Mom, you look like a little baby."  And months later, as Carolyn's hair began to grow back, Leslie Ann told her she'd miss the bald head.

Allow your child to decide how he or she wants to handle feelings—Talk to another adult? Talk to you when they want to? Journal their feelings and keep it private? The feeling of control, however slight, will help them cope.

Avoid Role Reversal
Don't look to your child to nurture you, says Brandt. There's bound to be some degree of natural role reversal, but it shouldn't be a complete role reversal.  "Let them do nice things for you, like get you presents or bring you water when you are resting," she says. "A teen might stop by the video store and pick up a DVD that is your favorite, bring it home and watch it with you."

But remember, you're still the mom and you're still mothering, though understandably with less energy than before.  Get your emotional needs and caregiving mostly from other adults, not your kids.

Put It in Perspective
Unless the outlook is terribly uncertain, reassure your children that life will get back to normal. You might say, for instance, "Mom's treatment will be done by the time two more soccer games are over." Or you might plan something when treatment is finished—a trip to the beach or mountains, a day at the amusement park.

"Cancer is not something any of us would choose," Gebhart says. "As odd as it is to say this, this really is an opportunity to grow closer together."