For a long time it was considered bad news when a diagnosis with an unfavorable prognosis had to be communicated to the patient or the relatives, in this case the parents. Delivering bad news about a child’s illness to parents and families and involving the child in the communication process, is a complex and difficult task. The person receiving the news could broadly define bad news as any information that is unexpected and perceived as negative. The question of whether this “bad news” should be delivered by doctors at all arose time and again, as it was assumed that the recipients of the message would lose hope and the will to live, and that children as patients, should not be told anything about the low chances of recovery or even death. This is in many ways a paternalistic intervention, withholding important information from the patient’s family and assuming that children and young people do not have an age-appropriate understanding of health, health-related knowledge and skills, and illness. In this case, one of the main questions seems to be what are “bad news” and what does “breaking bad news” mean, especially for parents, sick children and adolescents? Bad news is first of all pure information for identifying and naming a disease and the associated treatment options; however, the meaning of this information only comes from the people involved, parents, children, doctors and regularly differs in many ways. A strict diet that offers hope from a medical point of view can be disastrous for the family. A prognosis that includes the child’s death can give parents a sense of direction in a situation of child suffering that they can no longer control. How such a message should be delivered, the framework for delivery, and the way in which clinicians should deal with parents are discussed and the implementation is illustrated with case vignettes. Shared decision-making or more generally participatory decision-making, should serve as a model for how doctors can involve children and parents in diagnostic and therapeutic decisions, so that almost all forms of treatment can be designed together. Decision-making for sick children is complex and challenging for parents as well as healthcare professionals. The model of shared decision-making should be more actively implemented in routine care. It takes a long time for patients, parents and professionals, perhaps it takes the total diagnostic and therapeutic process, to learn to communicate, develop trust and make decisions together. In The Lancet, Fallowfield described a reason for further development in this area: when bad news is insensitively broken, the impact can be distressing for both the bringer and the recipient.