Cancer treatments almost always disrupt schooling. Depending on the severity of the disease and the schedule of treatments, a child could be out of the classroom for a week, or for many months. A child may return to school but need frequent absences to go to a clinic for continuing treatments. Or a child's physical condition and energy may fluctuate, meaning that he or she may be in school only intermittently.

If your child is too weak to attend school, or if he or she is especially vulnerable to virus and infection, homebound instruction may be needed. Finally, if a child is hospitalized for an extended time, an in-house teacher may be available to continue his or her lessons in the hospital.

As soon as your child's condition is known, you should get a note from the doctor explaining the diagnosis and the need for being off school so that teachers and school administrators can, as soon as possible, begin to prepare for sending work home or arrange for tutoring.

The best situation is if a child can return to his or her own classroom, and you should work toward this as soon as the doctor says it's medically feasible.

Not all of the changes that a child undergoes as a result of getting cancer are negative. By getting support from parents, teachers, and classmates, by facing and overcoming obstacles, and by learning to accept and process difficult news, many children can grow and mature socially and emotionally far beyond their years. Sometimes children even choose careers in health care as a result of undergoing cancer treatment.

Your goals are to:

• call for help if it is needed
• maintain as much normalcy as possible in your child's school life
• avoid problems at home
• get help from educators when it is needed

When To Get Professional Help

You should seek help from the hospital social worker or counselor if any of the following is true:

• Your child resists going to school. If your doctor has cleared it for your child to return to school and the child resists but won't talk about it, you may need to find the underlying reasons. A hospital social worker may be able to talk with your child and find out if he or she is upset about feeling different, about looking different, about losing friends because he or she has been away for so long, or a host of other reasons.
  
• If your child is having problems at school. If your child is having problems at school that he or she didn't have before getting cancer, you'll need to learn more about them to resolve them. Your child may be upset about missing so much school and feel that it's hopeless to catch up in the curriculum, or he or she may be facing annoying reactions to physical changes in their appearance from other students. A hospital social worker, the school nurse or guidance counselor, or a combination of several of them may be able to work out a solution, either for issues like arranging tutoring or for personal issues. Social workers, for example, can suggest responses that are appropriate to give to someone who makes fun of a child's appearance. See Prepare your child emotionally upon returning to school
  
• If the school system's bureaucracy is overwhelming and you can't seem to make any progress in getting what your child needs. Members of medical staff, as health-care professionals, are your best allies to accomplish something for your child if the school bureaucracy is an obstacle. Most educators are eager to accommodate your child's needs and, in fact, want them to be educated either in the classroom or through tutoring. While most children can resume learning in their regular classroom setting, keep in mind that federal law-Public Law 94-142-protects a child's right to an alternative education. While it is written primarily for handicapped individuals, its provisions mandating the development of Individualized Education Plans (special education) include health-impaired students, such as anyone with cancer. If you encounter attitudinal obstacles, persist until you find someone who can help. As an extreme and last resort, if you've run out of options, consider (by yourself or with a medical staff professional) going outside the administration and seeking help from an elected school-board member. An inquiry from a board member sometimes carries weight that one from a parent or taxpayer does not.

What You Can Do To Help

• Making arrangements with schools
• Avoiding problems at home
• Getting practical help from the school upon your child's return
• Prepare your child emotionally upon returning to school

Making arrangements with schools

• Make certain that school continues to be an important part of your child's life. If a child's disease requires extended hospital stays or frequent absences from school, it's easy for parents to give up, figuring that it will be impossible for the child to keep up with the rest of the class. It's also easy to fall into a negative trap of thinking, "If my child has cancer, she has no future, so why should I worry about school?" However, for both educational and social reasons, it's vital that children maintain contact with their school, teachers, and friends. It's also important because the routine promotes a child's sense of life being normal, or as normal as it can be under the circumstances. School is a child's equivalent of a "job" or "work." Without it, most children will feel as if they are lost or don't fit in, or are academically and socially inferior. One way to prevent uncertainty in your child's mind is to simply state, as early as possible and as early as you know details, that he or she will definitely be going back to school. If your hospital has in-house teachers who help children while they're staying there as an inpatient, make sure you let the child know about that and tell him or her what to expect.
  
• Establish a working relationship with school officials early. It's important to work together early on with teachers and administrators, letting them know what they can expect in terms of attendance and absences, and the child's general health. This is especially true if a child is having difficulty at school, either educationally or socially. One step you can take to help create the right attitude among school staff is to practice using and promoting the term student to refer to your child, rather than patient. This simple shift of terminology underscores what your child can do, not what he or she can't do. It also casts members of the school staff in their intended role as educators, rather than as teachers trying to play part-time nurse.
  
• When your child misses school, make sure that a hospital social worker contacts the school to arrange both continuity of schoolwork and continuity of social contact with the child's classmates. Hospital social workers, in particular, are trained in coordinating school needs and schedules with a child's medical treatments and serving as intermediaries. Social workers also can help arrange for a child to make a social visit to his or her school, even if it's not yet possible to return full-time. In addition, they can talk with not only teachers and administrators but also other students to explain the child's condition, what to expect of him or her, and what they can do to help the child and preserve the link between child and school. This might include arranging for your child's class to send cards, send videotaped personal greetings (and arranging a return video greeting from the child to the class), or even having the teacher visit your child in the hospital. Especially if your child will be in and out of classes over an entire school year, it's important to maintain that connection.
  
• If you need help from the medical staff in dealing with school rules, ask for it. Some school districts may have regulations that were written for situations other than chronic illness, and you may need help seeking flexibility. For example, some districts require a child to be out of school for two weeks before they will authorize tutoring or homebound instruction. You child may not be off school for two weeks at one stretch, but instead may miss two days here, four days there, accumulating much more than two weeks of absences in the course of treatment over a school year. The hospital or clinic staff can help explain this to school administrators, who usually are understanding and flexible. If a child is in and out of school, some districts even provide in-school remedial support to help him or her through the disruption.

Avoiding problems at home

• Pay attention to the doctor's recommendation on returning to school. Many families are cautious and want to protect the child who has cancer. When a doctor says it's OK for the child to go back to school, that doesn't usually mean it's optional-the meaning usually is that the child should go back to school for both educational growth and emotional well-being.
  
• If you have a job and have taken time off to care for your child, you should go back to work. Even if it's on a part-time basis, go back to work to demonstrate to your child that life goes on. If you stay home and keep your child home when he or she is capable of returning to school, it's unhealthy emotionally for both of you.
  
• Be sensitive to the needs of your child's siblings who may be in school. Make sure that teachers of your other children know what's going on with the child who has cancer, because it can affect both their classroom performance and their emotions. For example, if the child is having a hard time with treatment, is undergoing surgery, or suffers a relapse, teachers of the siblings should know. Also, siblings who attend the same school may grow weary of other students continually asking them about the sick child, never about them. They also may resent being constantly reminded of the situation. Siblings also may feel the loss of their identity if teachers rely on them to ferry books and homework assignments back and forth. One way to turn this around is to praise them, thank them, and remind them what an important job they are doing in helping the child with cancer.
  
  Some siblings have chosen to express their thoughts and feelings about a brother's or sister's cancer by doing a science report or project on the disease and treatment. You might consider suggesting this to a sibling, but gently, and with plenty of other alternatives. For more detail, see the homecare plan for Brothers and Sisters of Children with Cancer.

Getting practical help from school upon your child's return

• Prepare your child, and school officials, for the practical side of returning to school. If the child needs minor medical assistance at school (for example, in taking medications or maintaining a catheter), meet with the school nurse or other officials to see that someone at school can help handle these situations. Officials also should be alerted that a child with cancer is especially vulnerable to infection from common childhood diseases such as chicken pox. If your child can't move or walk as easily as before, make sure he or she can leave class five minutes early to get to the next class on time. If your child tires easily, make sure he or she knows it's OK to lie down in the nurse's office to rest. On the other hand, make sure school officials don't let the child abuse this privilege and skip out of class or work when he or she isn't tired. Similarly, school officials shouldn't be afraid and oversensitive by, for example, insisting on sending the child come home immediately if he or she is running a slightly elevated temperature of 99 F. Try to get the school to treat your child normally, as a student, and not as a patient.
  
• Pay special attention to maintaining continuity of learning for an adolescent. Children of any age benefit best from uninterrupted learning, but a practical aspect of attendance is that an older child stands to lose more from absences or missed homework than a younger child. An adolescent who is inadequately educated in 11th and 12th grades will be a poor candidate for college or a poor prospect for the job market. Ask educators to remember this as you seek their help in easing your adolescent back into the school routine.

Prepare your child emotionally upon returning to school

• Coach your child to be prepared for the reactions of others on his or her return to school. Things won't be the same when your child returns to school and he or she needs to understand that others may react unpleasantly to physical changes caused by treatment or surgery. Students or even teachers or school staff members may stare without saying anything. Other reactions might be pointing, or snickering. You should tell your child that when this happens, one of two things can occur. If your child feels comfortable talking about it, he or she could be ready to explain the reason for the changes. One opening might be: "I bet you're wondering why my hair is gone," or "Are you wondering why I don't have any hair?" A follow-up response might simply be: "I have cancer. I take medicine for it, and the medicine makes my hair fall out. My hair will come back when I'm finished with the medicine." On the other hand, if your child doesn't want to talk about it, such as might be the case if a stranger walks up on the street and asks about the lack of hair, he or she may simply wish to say: "I'd rather not talk about that." Either of these is better than a nasty retort, such as "None of your business" or "Buzz off."
  
  Physical changes may not be restricted to hair loss, which is the most widely known side effect of cancer treatment, but also can include puffiness from being on steroids, a gain or loss in weight, bruises, scars or amputations, limping, or a loss of energy. Also, these changes may mean the child will have to live with restrictions on activities like gym class, or contact sports or other outside activities. If you haven't already done so, ask a hospital social worker to coach your child in how to explain these physical changes to other students so they understand.
  
• Make sure your child doesn't use the disease as an excuse to take it easy or not work up to potential. Some children can be tempted to use the fact that they have cancer as an excuse to take it easy, to not work up to their potential, or to stay home from school. One good clue for you, as a parent, is whether your child tended to do this before the cancer diagnosis and treatment. Sometimes a child asks to stay home from school, saying that he or she just doesn't feel good but without identifying a specific pain or problem. You, the parent, have to make the call, but be aware that nothing may be wrong. Also, be aware that your child may be embarrassed to go to school for the reasons noted above-physical changes and a fear of others' reactions. If this is the case, consider asking the hospital social worker to arrange a school visit to explain the disease and its treatment and effects.

Possible Obstacles

1. "I'm so afraid of losing my child, I don't want to send her back to school. My highest calling as a parent is to stay home and take care of her."
   
   Response: If the doctor says a child is well enough to return to school, you should follow his or her directions. Emotionally as well as educationally, the most healthy situation is for a child to be learning among peers.
   
2. "The cafeteria aides at my child's school are saying that cancer is contagious and that other students shouldn't eat with him."
   
   Response: Misinformation and rumors can really disrupt a child's successful re-entry into school. A one-time comment is nothing to become alarmed over, but if this pattern persists and your child is being affected by it, try to arrange a school visit from the hospital staff.
   
3. "Kids at school are making fun of my child's bald head."
   
   Response: Re-read the section on preparing your child emotionally for returning to school and review the responses with your child to make sure he or she understands what to say to counter or soften attitudes.

Carrying Out and Adjusting Your Plan

Is your child's education going forward as well as can be expected under the circumstances? Are you successfully working with the school staff and hospital staff to make the transitions as easy as possible? Is your child readily going back to school, or reluctant? Is your child getting class work and homework completed? Are his or her grades about what they were before the diagnosis and treatment? If they're not, is it because of absence only, or because your child is discouraged?

If your plan doesn't work

Review the section When to Get Professional Help to make sure you haven't overlooked anything. Otherwise, call the hospital social worker and explain what you have done and why it seems not to be working.

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