Yoshiko Sugihara, a color therapist, was shocked to learn she had breast cancer in autumn 2007 and was concerned about how she would explain the illness to her only daughter, Moeka, who was only 5 years old at the time.

Young children are often bewildered to learn a parent has cancer and what and how a child should be told is something every stricken parent struggles with. Experts point out the importance of being honest to ease anxiety and help reduce negative emotions. Speaking with someone who has dealt with this firsthand is an instructive experience.

"I was surprised at my child's awareness and sensitivity. I didn't tell her about my cancer, but she had already noticed it," said Sugihara, 50.

When she talked with her husband about how to tell Moeka about the disease, she was surprised by a birthday card Moeka gave her. Two round breasts were drawn on the front of the card. Moeka had picked up on the fact something was wrong with her parents, noticing the strange atmosphere and overhearing conversations.

Immediately after that, she told Moeka she had cancer, and if her right breast were removed, she would be able to take a bath with Moeka. She said Moeka silently listened to her story.

Many parents worry about whether they should inform their children of the disease, out of fear children would be concerned about the disease or they would not be able to understand it.

Kaori Osawa, representative of Hope Tree, a group supporting children with parents who have cancer, and a medical social worker at Tokyo Kyosai Hospital in Meguro Ward, Tokyo, stresses the importance of telling children the truth.

"Even if parents hide the cancer, most children notice changes and may imagine the worst. Some children may mistakenly think their parent has cancer because they were bad children," Osawa said.

According to experts, when parents explain the disease to children, there are three points to keep in mind:

• Parents need to clearly tell children what cancer is and the difference between cancer and other illnesses they know, such as colds. It is important for children to understand cancer is not easily cured and anticancer drugs have side effects, including hair loss.
• As children tend to think we contract illnesses through infection, parents should explain cancer is not an infectious disease. In addition, parents should tell children they can still have physical contact with them, such as hugging.
• It is not unusual for children to think they are to blame for a parents' cancer. Parents should clearly explain it is not their fault.

Experts also said parents should answer children's questions, such as what effect treatment might have on their lives.

Programs to help children cope

Children who know about their parents' cancer have differing reactions to the news, but it is important to let children express their emotions and relieve their stress.

Hope Tree offers programs to help primary school children cope with their various emotions. In the programs, which have been in place at cancer hospitals in the United States, children are sorted into several small groups to learn about cancer and make crafts and discuss how to deal with their emotions.

In one activity, children make dice called "ikari baibai saikoro" (dice to say goodbye to anger). Children fill the faces of the dice with pictures or phrases, while concentrating on how to soothe their anger. The crafts allow children to learn concrete methods to express their emotions with words or pictures--"Eating my favorite food" and "Yelling." From this, children can learn ways to not accumulate negative emotions.

Moeka took part in the program. Before, she had avoided the topic of cancer out of fear of hurting her mother. But having learned from the programs she can express any emotion, she had the confidence to ask her mother, "How long do you have to take the drugs?"

Sugihara tried to act healthy in front of Moeka, but sometimes she needed to lie down for a few minutes when the drugs' side effects kicked in.

"Support for children whose parents have cancer is just beginning, but various programs are spreading. One includes joining a support team at a hospital and another offers a hospital tour to help children understand cancer treatment," Osawa said.