Pediatric Oncology – Between Play Schools and Hospitals
The thought of cancer can bring a lot of fear and apprehension in both the patient as well as the family. This distress is further intensified in the case of paediatric cancer. There is an interplay of various surrounding factors like parents, teachers, schools and peers which could influence lifestyle changes, emotional turmoil, behavioural concerns, and academic performance.
When diagnosed with cancer, the family faces a dilemma of whether the condition and its implications need to be shared with the child or not. Experts believe that the child’s awareness of the illness plays an important role in the treatment process. Children are smart and perceptive of the changes in the environment around them. This often makes them feel secure in school, home, as well as the hospital setup creating a sense of stability in their lives.
The involved healthcare professionals should be honest to the patient and his family about the process of the treatment, the medical procedures, and frequency of the hospital visits. This marginally reduces the child’s anxiety and normalizes their experience in the long run.
Families and school authorities need to encourage self-sufficiency and independence in the child undergoing treatment. Not making drastic changes in the daily routine, giving them responsibilities such as home chores, helping teachers in the classroom setting etc. helps in maintaining consistency and comfort for the child.
Focusing on the Here and Now
As a parent, healthcare professional, or a teacher, you also need to reassure the child that the consequences of cancer are temporary and that improvement will take place over time. Often adults underestimate the coping capacity of the child, especially in the case of long-term illnesses like cancer, thereby attempting to protect the child from the negativity of the stigma attached to terms like ‘cancer’, ‘chemotherapy’, ‘surgery’ and ‘radiation’.
Their emotional and behavioural changes could include dullness due to weakness, lack of interest in activities they enjoyed earlier, not wanting to interact or play with friends, or being quieter than usual during the day, at home as well as school. However, communicating about the illness, its symptoms, and impact on to the child is beneficial for them to get a realistic understanding of the situation.
Keeping in mind the child’s experience of the illness, it is common for them to undergo a sense of alienation, disconnect, feeling ‘left out’ and ‘different’. They develop a tendency to draw comparisons with their siblings, classmates and other friends in the same age group.
Further, the physical limitation attributed to the illness can make them feel fatigued, inefficient and incapable, thereby reducing their self-esteem and their overall confidence. Many times, academic performance suffers due to lowered concentration and attention span, due to adverse effects of the cancer treatment and medication. In the end, this makes them feel conscious as they realize that others do not understand them, further creating adjustment concerns, disruption of one’s self and identity.
How Can Parents Help?
Caregiving is not an easy task, especially in the case of children diagnosed with cancer. Children do not always understand how to work through difficult emotions which may arise during the course of the illness, and they might end up blaming themselves instead. “God is punishing me for scoring low marks in exams”, “I did not eat my vegetables, that’s why I am here”, “I lied to mummy, that’s why I fell ill” are some of the thoughts which might run through their minds.
Children dealing with cancer tend to get irritable, scared or angry and these emotional reactions need to be recognized by the parents. As a parent, it’s important for you to be able to provide reassurance to them, explaining the medical causes underlying their condition rather than holding themselves responsible. At the same time, it’s also important for you to able to take care of yourself, with the exhaustion or fatigue which could be experienced while you see your child go through varied emotional or physical changes during the course of cancer.
Cancer also makes children temperamental, leading to unreasonable demands, tantrums, noncompliance, mood and behavioural changes which the parents and teachers find difficult to address and handle. Often, parents give in to such unreasonable demands of the child, which needs to be discouraged, as these are likely to create an over-indulgent, over-protective and a pampered child, further making it difficult for the child to return to normalcy post the treatment process.
Role of Teachers
The role of teachers like parents is a very important one. With a considerable number of hours spent in schools, teachers are expected to look after a number of children of varied backgrounds and abilities. Having a sensitive and understaffing approach especially towards a child undergoing treatment for cancer becomes essential in a school set up.
In addition, a platform for inclusive learning gets established making the more confident and comfortable. For instance, delegation of responsibilities such as class monitoring, helping teachers mind the class, encouraging them to connect with their peers, can help in making the child feel included and efficient.
At the same time, it’s important to maintain a lateral approach for regular engagement and feedback mechanism between the parents and the teachers so that they are aware of the child’s progress at both the school and the home front.