Adults coping with cancer and treatment have their own challenges to face; those raising a child with cancer confront a unique set of issues.

Having a child diagnosed with cancer is among a parent’s worst fears. Many challenges will follow, ranging from emotional distress to the stress of caregiving. Adults coping with cancer and treatment have their own challenges to face; those raising a child with cancer confront a unique set of issues.

Honesty is the Best Policy

Experts advise being honest with your child about the cancer diagnosis and what to expect as far as treatment, side effects of treatment, physical limitations, and challenges related to school and outside play.

"When explaining your child's diagnosis to him or her, use the same medical terms that the doctors use," advises Jessika Boles, a child-life specialist at St. Jude Children's Research Hospital in Memphis. "Then, define those terms using words they understand. For example, for a younger child you might refer to a tumor as an 'owie' or 'hurt spot.' By doing this, your child will be better able to understand what the doctors are saying."

For an older child, call it what it is. "By calling it cancer, you will avoid the confusion that comes with euphemisms," says Abraham Bartell, MD, a child and adolescent psychiatrist at Memorial Sloan-Kettering Cancer Center in New York. "Otherwise, the next time someone has a 'boo-boo,' they will get very confused and concerned."

"Children understand a lot more than what we think," says Boles. "By being honest with them, they will gain information and grow their trust in you as a parent."

When Carol Fletcher learned that her son, Lance, 8, was diagnosed with osteosarcoma in his leg, she followed Boles' advice. "We never sugar-coated anything," says Fletcher, who took Lance to St. Jude, more than 800 miles from their rural New Mexico home. "We explained that this is how it is and this is how we're going to get through it. We found a happy medium."

If your child asks the question, "Why me?" Boles suggests this answer: "You didn't do anything to cause this to happen. A lot of people have been working to find out the cause of cancer, and right now we just don't know. But treatments are available and we are going to do our best to make you better."

Help Your Child Understand What to Expect

Talk to your child about what he or she might experience during treatment. Then create a coping strategy. For instance, let your child know that he or she may lose hair. Suggest going shopping for some hats or a wig.

If possible, have your child speak to another child who had a similar experience. "The other child can discuss their fears and concerns, such as what is was like to return to school after treatment and being labeled as different," says Paul A. Meyers, MD, Vice Chair, Academic Affairs, Department of Pediatrics at Memorial Sloan-Kettering Cancer Center.

Physical limitations during treatment and perhaps beyond are probable. You may find you need to tell your child that although he or she can still enjoy time with family and friends, there may be activities or events he or she may not be able to participate in the same way as before. For instance, some children won't be able to participate in events that draw crowds due to the risk of infection if their immune system has been weakened by treatment.

Children being treated for cancer will also need to take special precautions when playing outdoors, such as wearing sunscreen, a long-sleeved shirt, and a hat, because they are particularly susceptible to the harmful effects of sun exposure.

Be sure to replace activities your child can no longer do with new hobbies. For instance, Lance loved to play basketball. While he mourned having to give it up, he was happy that he was able keep his leg, and eventually discovered new hobbies such as playing guitar, swimming, and golf. If he couldn't participate in physical education class at school, Lance served as the referee.

Explain that some changes are temporary while others will be permanent. For example, hair will grow back after treatment, whereas if a limb is removed, that will impair physical abilities for life. However, with hard work during physical therapy, certain activities may be doable again despite many limitations.

Addressing Limitations

You should be careful not change the way you treat your child. "If you want the same child back at the end of treatment, do not spoil him and maintain the same discipline," advises Dr. Meyers.

Regarding schoolwork, however, you may have to revise academic goals that were set prior to treatment because of your child's hospitalizations, sickness, and/or lack of energy. Nonetheless, it is important to set goals, and be sure to praise efforts.

Help your child stay current with schoolwork as much as possible. Some schools and hospitals have programs to assist with this. To help him stay connected with classmates, Lance Skyped with them during his treatment. This resulted in an almost seamless return to school more than a year later.

When a child re-enters school, it is important that classmates are prepared for changes in your child's appearance and abilities, and that they know they can't "catch" cancer. Parents should work with guidance counselors and teachers to convey this and help avoid any unpleasant, potentially hurtful situations or bullying.

Babysitters must also be made aware of special needs, such as medications, allergies, or dietary considerations. Perform a practice run with a potential babysitter before actually leaving the child with her. Discuss possible scenarios and plans of action. Make sure anyone caring for your child has all contact information and clear, written instructions, and make sure they can reach you or another emergency contact at all times. Also, while it may seem obvious, have “911” written out next to the phone along with your child’s name, your address, and the closest major intersection in case the caregiver needs to call for emergency medical help. In these situations, it is not uncommon for anyone to panic and forget the basics.

Talking to Siblings

To avoid a sense of secrecy from developing, have conversations with the entire family present. Discuss any changes that might occur, such as shifting of parental roles and siblings having to reduce extra curricular activities due to parents' commitments to the sick child.

Siblings often have their own emotions about their sister or brother getting sick, and parents should be aware of this possibility. "It is extremely common for siblings to be jealous of the attention given to the child with cancer," Dr. Meyers says. Siblings may also have other, perhaps less obvious or expected, reactions to the experience. "Called 'magical thinking,' siblings may feel guilt that something they did caused their sibling's cancer.” Communication and sensitivity to how siblings are handling the situation is critical. “If parents don't address these issues, they can fester and become problematic. Again, honesty is critical."

Ideally, however, siblings will be able to maintain some sense of normalcy. Ask another parent or teacher to take the sibling to after-school activities or help with homework, and try to arrange play dates. Reassure siblings that they are still loved even though you will now be spending a significant amount of time with the sick child, especially if this requires you to spend a lot of time at the hospital. Whenever possible, spend some time with your other children, whether it is a short walk, an afternoon at the movies, or reading them a bedtime story.

Lance Fletcher’s parents can attest to this. "Our daughter had to take a back seat many times. When she was in the spotlight, we tried to focus on her." The Fletchers were able to arrange for one parent to stay home with their daughter so she could remain in school and the other to stay at the hospital with Lance.

Parents Need to Take Care, Too

Parents should take time to take care of themselves, too. "You need to be the best you can be because your child needs you," Dr. Bartell says. Caring for a youngster with cancer can be exhausting, emotionally and physically, and can be even more so if you have other children. Make sure you eat healthy, get enough sleep, exercise, and take the time to replenish your energy to be strong and keep your spirits up. Accept help when it is given, and don’t be afraid to seek it whenever necessary. No doubt many family and friends, and even others in your community, will be willing and eager to help. But know your limitations, too.

"We were thrilled to have many offers of help, but we only let people assist to the point that we were comfortable," Fletcher says. "Don't be afraid to say 'we're not ready for that' or 'we don't need that right now.' "

Local support groups are also good places to find help, information, and understanding. Ask your child’s doctor or inquire at the hospital for referrals.