Back to School For Cancer Kids

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For most children, the end of summer signals the transition back to school. But for children with cancers such as leukemia or lymphoma, back to school can happen at any time of the year. In fact, back to school can happen several times a year.

While parents might worry that returning to school after cancer treatment might overwhelm their child, it is important to return promptly when the time is right, for a variety of reasons.

Returning to school helps the child regain a sense of “normal life” and independence, escape from the world of hospitals and appointments, and sends them a message that there is life after cancer and that they have a future to invest in.

The Back-to-School Challenge

While returning to school may be important for learning and social development, it does present some challenges. The three main areas of concern are teachers and school personnel who likely do not have any experience with cancer, the child’s classmates that do not understand the condition, and the child’s own attitudes about going back to school.

Communication with School

While children with cancer have unique needs, the surge in recent interest in children with concussions and their return to school has generated some potentially relevant and helpful lessons: the team approach is key when it comes to return to school.

It may seem like the furthest thing from your mind when your child is being treated for cancer -- but planning for the return to school happens far in advance of the child's readiness to go back.

Early on in the diagnosis, you -- or a helpful friend or family member -- should contact the school principal or administrator to let them know what is happening with your child. It may be easiest to write a letter and let them know:

  • The type of cancer your child has
  • What kind of treatment you expect them to receive
  • How long you expect they will be out of school
  • Your plan to keep the school updated on your child’s progress

If you have other children that attend the same school, you will also want to identify this as well. Siblings will also be impacted by the changes in your family, and their behavior or performance at school may reflect this.

Closer to the return date you will want to cover more specific information with your child’s teachers. While it is very helpful to speak to them face to face to allow them to ask questions or raise concerns, you should also put some key points in writing so they can be referred to later and so that all the staff is getting consistent information.

This may include:

  • Any physical limitations that may impact activities your child can participate in such as phys ed classes, or recess. You may also consider requesting the option of additional rest periods for your child while at school, or starting out with half days instead of full days
  • Any medications or treatments your child will need to take while at school
  • Any behavioral or academic changes that are anticipated after therapy
  • Concerns your child has about returning to school
  • Problems that require your immediate notification, for example nosebleeds, injury, fever, or nausea and vomiting
  • Special consideration regarding exposure to infectious disease such as chicken pox (see more about this below)

Classmates

As with school staff, the best way to help your child re-integrate with his or her classmates is to keep them connected throughout school absences. Now that social media is a regular part of the everyday lives of kids, this can be made a little easier but good old- fashioned letters can also do the trick. Your child can post or send photos of his or her treatment and keep their friends in the loop with regular updates. At times when your child is feeling unwell, you or a sibling could keep the updates going.

This will help to take away some the scariness or mystery of what is keeping your child from school and may also help to prepare them for any physical changes, such as hair or weight loss.

When the time comes for your child to return to school, it may be helpful for a nurse or social worker from your cancer center come to your child’s class and do a presentation about their cancer and what to expect when they come back. Allowing the classmates to ask questions and express their fears is important at this time, and they should be reassured that your child’s cancer does not pose a risk or threat to them at all.

Helping Your Child

Many children with cancer are afraid to return to school. They are uncertain of how others will react to changes in their physical appearance, limitations, and loss of social status. They may be frightened that they will be rejected by their peers, and worry about what they have missed out on in their absence.

Keeping them connected with their friends and classmates while they are out of school can help with this to an extent.

Also giving your child an opportunity to visit the school and teachers before their return date can be very helpful to ease the transition.

If your child is struggling with their return to school, try to determine if there are any specific issues you can deal with. For example, if they are particularly worried about hair loss, maybe you could make arrangements with school administration to allow your child to wear a hat or scarf throughout the day to make them more comfortable.

You may also want to do a little role playing with your child before they return to school. This could help to prepare them for questions that the other kids might ask them, and how they will respond. Depending on their age, the other children may want to know if cancer is catching, if cancer hurts, or if your child is going to die. Questions like this can be surprising and hard to handle if they are unexpected.

If your child doesn’t feel comfortable talking about their diagnosis in these terms, you might encourage them to say something like “I don’t like to talk about these kinds of things at school” or “I don’t know how to answer that question” and change the subject.

Mental preparation can go a long way to decreasing you child’s fears about talking about cancer.

Preventing Infections

One of the biggest concerns for parents of a child with leukemia or lymphoma is that their child is going to come into contact with an infectious agent or substance when they return to school.

In particular, it is critical that you are aware if one of your child’s classmates develops chicken pox, shingles or measles, as these infections can cause serious problems in a child with a decreased immune system.

Your healthcare team and school administration can help come up with a strategy to help handle these situations. You may choose to write a letter for distribution to the other parents of classmates, letting them know the dangers of these infections to your child. You can ask that they contact you personally if their child shows any symptoms of these diseases so you can keep your child at home, or so that your child can get a chicken pox immune injection (varicella zoster immune globlulin) if they have been exposed in the last 72 hours.

Summing it Up

School is an important part of your child’s development and quality of life. However the return to school after an absence for cancer treatment can present many unique challenges. The key to a successful return to school is communication throughout your child’s illness.

Early and ongoing communication with the school and your child’s classmates can help them to prepare for what to expect, and will make the transition easier for all.

Updated January 2016, TI.

Sources

Halstead ME, McAvoy K, Devore CD, et al; Returning to learning following a concussion. Pediatrics. 2013;132(5):948-57.

Walker, C., Wells, L., Heiney, S., Hymovich, D., Weekes “Nursing Management of Psychosocial Care Needs” in Foley, G., Fochtman, D., Mooney, K. eds (1993) Nursing Care of the Child with Cancer- 2nd ed. Philadelphia: W.B. Saunders. (pp. 397- 435)

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