How you communicate with family members as you are fighting cancer will depend on your relationship with them before you were diagnosed. Some women have very close-knit families that help them every step of the way through their treatment. Others have strained relationships and feel the need to share information about their illness only with certain people. How you handle family members is up to you; only you know your comfort level in handling these delicate relationships.

Children can bring up very different concerns, and this can be hard for many women. If you were diagnosed with cancer before you were able to start a family, the children of others may remind you of the reality that you are not able to have children of your own. This tremendous sense of loss is one of the most difficult feelings to handle. Working through the sadness and pain of this loss may involve connecting with other children in your life who need the special attention that only you can provide.

At this point, what you tell children and how you talk about cancer becomes central to your relationship with them. Most of us know children who are inquisitive and unafraid to ask the awkward questions that most adults would not. This behavior tells us that children notice and try to understand many of the complex issues around them. If you have lost your hair, or are feeling bad, children will notice and ask you why. If you look different than other adults who they know, or have a physical limitation as a result of your cancer diagnosis, they will ask you about that too.

It may help to know how most children process and understand the idea of cancer, especially when a parent has cancer, and how they cope with this knowledge.

The ability of a child to understand your illness and treatment is often based on age. Young children, such as those from ages 4- 7, only understand concrete notions -that is, what they see, touch, hear or have experienced. So their questions might be "What is that for?" (pointing to an IV) -or "Does your 'ow' hurt like mine does?" These children express feelings concretely also, often by taking actions. For example, a kindergartner brought her mother a band-aid after she was crying from a chemotherapy treatment. On the other hand, just because children of this age don't say they are upset, doesn't mean that they are emotionally unaware. Often distress is expressed physically, such as loss of appetite, bed-wetting, difficulty sleeping or nightmares, and hitting other children. If these problematic behaviors are consistent for over two weeks, a consultation with a child psychologist may be valuable.

School-age children, ages 6-12, can understand and identify with experiences that they have not directly participated in. They can also understand the meaning of events. For example, if mom goes to the hospital often, this pattern of events may mean that she is seriously ill. Children are also more socially aware at this age, and may hesitate to voice a concern for fear of upsetting the parent. It is good to ask kids of this age group if they have any questions or concerns, on a weekly basis. This shows them that talking about worries is appropriate. Although children of this age group who are distressed may show it in the same way as younger children, the most frequent change to watch for is poorer school performance.

Adolescent daughters and sons have the most complicated reactions to their mother's illness. Adolescence is a time when they want to become independent, yet out of concern for the parent they want to be closer to the family. Even though they are very involved with friends, they feel a pull or obligation to be at home. They are also, for the first time, able to identify with the same sex parent as an individual, and may be frightened of loss. On the other hand, adolescents are also capable of great intimacy, intensity and understanding. They understand the meaning of loss and can talk about it.

Children of all ages have some traits in common. First, they understand events in their lives in relationship to themselves first. This may be confused with being self-centered or 'spoiled' when it is a logical way of understanding. Second, children need to repeat the same questions until they have mastered a concept. The younger the child, the more repetitive. This can be maddening for the adult. For example, a 5-year-old may ask every morning for five days straight, "Where is mommy?" only to be told over and over again that mommy is in the hospital. Third, children ask questions and talk in small doses, often abruptly changing the subject when they have had enough. This is not insensitivity, but rather a method for coping with anxiety or cognitive "overload." Finally, children have different issues than adults, often dictated by limits in understanding. For example, adults may be upset over a threatened loss, which is beyond the imagination of many adolescents. On the other hand, children tolerate helplessness better than most adults, because it is a more common experience in their daily lives. Additionally, children often teach adults about joy in the moment and acceptance.

Some hints:

There is a universal rule when talking with children about serious subjects - answer only the question they ask, and don't assume that they are asking more than what they have actually said. If you can do this, you can help the children in your life understand the information you are telling them a little at a time, which is easiest for any child.

• Answer a child's question as honestly as possible.
• Reassure the child that it is not their fault that you have cancer.
• Explain the treatments, procedures and hospital visits you will have in the child's perspective. "When I have chemotherapy, my hair will fall out, and you will see me without any hair. Sometimes I will wear a hat or a wig, so that I can be warm and comfortable."

Adult children can present different challenges and concerns, which are no less important or emotional in nature, Many adult children of cancer survivors are very supportive and loving when a parent has breast cancer. For female children, however, dealing with their mother's breast cancer diagnosis can be especially difficult when they realize that their parent's diagnosis brings them increased risk. Often, female children will wonder if they are going to get breast cancer, and if they do, will it be like your experience with the disease.

Many women feel angry at the possibility that they might die before their children have fully grown, lived their lives, accomplished great things and started a family. Children often feel angry at the possibility that they might lose their mother sooner than they expected.

Dealing with these difficult feelings can be affected by where your children live, and whether or not they are close to you or far away. Many parents are emotionally closer to children who live near to them: this can affect how much you share with your children and how often.

This information is excerpted from Y-ME National Breast Cancer Organization's booklet, "I Still Buy Green Bananas." If you would like to request a copy, call the 24-hour Y-ME National Breast Cancer Hotline (800-221-2141) or visit www.y-me.org.