While your child is being treated for cancer, this will obviously have a big effect on the whole family. Your child may be very frightened and may have symptoms of the cancer or side effects of treatment to cope with. They may become very clingy, argumentative and difficult. Maintaining normal discipline is reassuring for the child and can help them feel more secure. The child's whole routine is likely to change, with stays in hospital and going to hospital for appointments. The treatment may make them feel very unwell for a time and may cause changes in their appearance, such as weight loss or their hair falling out. These changes can affect their confidence – especially in older children and teenagers.

Perhaps one of the hardest parts of caring for a child with cancer is knowing how to talk to them about it. Answering questions honestly is best, and although some children do not ask questions, this does not mean that they do not want the answers. They will be frightened and uncertain of many things.

For younger children, separation from their parents is a major fear and they need reassurance that this will not happen. Older children are more frightened of pain. It can be helpful to reassure them that effective pain control is almost always possible. Doctors and nurses will be happy to explain how this can be managed and can help you to reassure your child.

Children with cancer often have gaps in their education: due to going into hospital; side effects from treatment; or generally not feeling well enough to fully take part in daily school life. Most children’s cancer hospitals have education departments, which can support your child while they are in hospital. The teaching staff at the hospital will contact teachers at your child’s school to make sure that they can continue their schooling whenever they feel well enough. It is even possible for children to take exams in the hospital if necessary.

As your child’s health improves and treatment allows, going back to school can be either a relief or a challenge. For many children, school is a refuge from the world of hospitals and procedures - a place for fun, friendship, and learning. Going back to school can be a sign that life is returning to normal.

Some children, especially teenagers, may dread going back to school because of temporary or permanent changes in their appearance. They may also worry that being away may have changed their relationship with their friends or affected their standing within their group.

If treatment has affected a child’s ability to learn, this can be a major frustration for them and may affect their confidence and self-esteem. However, the school can give extra help for children with learning difficulties. If you think your child may have problems, it is important for you to talk to the teachers at the school about the help that they can give.

It is important to keep the school in touch with how your child is doing. As soon as your child is diagnosed, let the head teacher know in writing about their diagnosis and the fact that they are in hospital. It is helpful to let the school know about the plans for treatment, so that the school can let the hospital education department know which work your child will be missing. This work can then be covered in the hospital.

It is helpful for the teachers at the hospital to let the school know if your child is emotionally or physically fragile. The teachers there can then take this into account. Your child should be involved in letting the teacher know which information they would like to be shared with their classmates.

Infectious illnesses such as chicken pox, measles, mumps, or flu can be dangerous to children who have a low immunity due to cancer treatment. If your child is attending school, it is important that the teachers are aware of this, and can let you know immediately if any child in the school develops an infectious illness. If your child has been exposed to chicken pox, and has not had chicken pox before, they should have an injection of varicella zoster immune globulin (VZIG) within 72 hours. The school can develop a system to let the classmates parents know that they should notify the teacher if their child develops an infectious illness.

• You could ask the children’s cancer nurse or social worker to talk to your child's class about what is happening to your child and how they will look and feel when they go back. This should include a question-and-answer session to clear up misunderstandings and reassure the children. Teenagers should be involved in deciding what information should be given to their classmates.
• Send pictures of your child having treatment to the school. Some families fill photo albums with pictures that are shared with the classmates.
• Encourage classmates to keep in touch by sending notes, phoning, texting, emailing, sending class pictures or making a scrapbook.

Whenever your child is able, keeping up with schoolwork is a priority. Learning can continue even outside school. It is important for you to speak regularly to the teacher, so that you know which subjects are being covered in school. Often, the teacher will send assignments and materials home with siblings, or arrangements can be made to collect them.

To help your child keep up in school, you may need to ask for a special education statement. This qualifies your child for extra help. You can get information about the education of children with special needs from the government website at: www.hmso.gov.uk/acts/acts2001/10010--b.htm#2

Many children diagnosed with cancer are very young and have not yet started school. As a parent, you may have to choose between having your child at nursery throughout treatment (with the risk of infection) or keeping your child at home. Keeping your child at home may mean that they have less chance for social growth and development. There is no ‘right’ decision – it is a personal choice. The following questions may help you to decide:

• Is your child already settled in well at nursery or pre-school?
• Can their social needs be met by siblings and/or other children?
• Is your child well enough to attend nursery or pre-school?
• Has your child already had chicken pox?