Childcare During Cancer Treatment

This page is for parents going through cancer treatment, and for the partners and relatives helping them. It covers how to plan childcare around treatment, how to pay for it, and how to protect the parent in treatment from infection.

Most childcare plans made after a cancer diagnosis are built for the wrong shape of problem. People solve for chemo day. Chemo day is the easy part.

The harder parts are predictable if you ask for the schedule in advance:

• The day of infusion and the day after, when NCI suggests planning rest because fatigue is common.
• The window when your white blood cell count (your infection-fighting cells) bottoms out and a preschool cold becomes a hospital visit.
• Daily radiation, on the schedule your team gives you.
• Surgery recovery. Ask your team what you may lift and for how long.

Ask your oncology nurse for a written calendar with those windows marked. Then build coverage against it. A neighbor who can take the 3 p.m. pickup for eight weeks is worth more than five people offering to help "anytime."

State child care subsidy. States and territories get federal Child Care and Development Fund money to help low-income families pay for care. The federal eligibility floor is set in 45 CFR 98.20. The child must be under 13. A state may also cover a child under 19 who is physically or mentally unable to care for themselves or is under court supervision. Family income cannot exceed 85 percent of the state median income. Family assets cannot exceed $1,000,000.

There is a catch worth knowing about. The rule also requires the child to live with a parent who is working or attending a job training or educational program. The rule does not mention medical leave. If you have stopped working, ask your state agency directly how it handles your situation. Also ask about the protective services category. The rule lets a state agency waive the income and asset limits case by case for families in that category.

Head Start and Early Head Start. Childcare.gov says these programs help prepare children from birth to age 5.

State prekindergarten. Childcare.gov lists state-funded pre-K for ages 3 to 5.

Tax and workplace tools. Childcare.gov points to the Child and Dependent Care Tax Credit for children under 13 and the Earned Income Tax Credit. If you or your partner still have a job with benefits, a Dependent Care FSA can reduce your taxable income. IRS Volunteer Income Tax Assistance offers free tax help.

Start with your local Child Care Resource and Referral agency, which is the front door to most of these in every state.

Paying for care is one side of the problem. Time off work is the other. Here is the piece families miss: FMLA leave is not only for the person with cancer. An eligible employee can take it to care for a spouse, child, or parent with a serious health condition.

The eligibility rules are strict, and all three must be true:

• Employed by the employer for at least 12 months.
• At least 1,250 hours of service in the previous 12 months.
• The employer has at least 50 employees within 75 miles of the worksite.

Covered employers include private companies with 50 or more workers, all public agencies, and all local educational agencies regardless of size.

What you get is up to 12 workweeks in a 12-month period. The leave is unpaid, but your employer must maintain your group health coverage on the same terms as if you had not taken leave.

The most useful feature for a treatment calendar is intermittent leave. When medically necessary, leave can be taken in blocks rather than all at once, which fits infusion weeks and recovery days better than a single long absence.

If your child is in group care, count on exposure. CDC's guidance for people with weakened immune systems is reassuring on the main point: CDC says household contacts of people with weakened immune systems should get the live MMR, varicella and rotavirus vaccines when they are due. CDC says the nasal-spray flu vaccine can be given to healthy household contacts unless the person in treatment is in a protective environment, such as a room with special air filtration. If you are unsure about your child's shots, ask your care team or your child's doctor before changing them.

Two handling rules apply. Everyone should wash hands after changing the diaper of an infant who received rotavirus vaccine, since shedding can continue up to one month after the last dose. And if a child develops a rash after varicella vaccine, the person in treatment should avoid direct contact with it until the rash resolves.

The threshold that matters most: 100.4 degrees Fahrenheit (38°C) or higher means calling your care team right away, day or night. The CDC says to call your doctor immediately at that temperature. NCI's infection page lists 100.5°F (38°C). Use the lower number.

Also call your care team right away, day or night, for chills, a sore throat, mouth sores, burning when you urinate, redness or swelling at a catheter site, or any other sign of infection. Do this even if your temperature is normal. A normal temperature is not a reason to wait.

Call 911 or go to the nearest emergency department for trouble breathing, black or tarry stool, blood in vomit, heavy bleeding, sudden confusion, or being hard to wake.

Post these numbers where your babysitter can see them, along with the after-hours line.

NCI's advice to caregivers starts with an honest inventory of what you can and cannot do. The tasks it names as ones to share include chores such as cooking, cleaning, shopping and yard work, and driving your loved one to appointments or picking up medicines.

NCI points to SignUpGenius and Lotsa Helping Hands to organize requests. A shared calendar can keep you out of the middle of every arrangement.

Watch your own limits too. NCI lists fatigue and anxiety, depression or other mood changes among the signs of caregiver strain. It advises contacting your health care provider if changes last more than two weeks.

• Does this center have a child life specialist, and can my children meet one?
• Can infusion appointments be scheduled around school hours?
• Is there a family resource fund, and does it cover childcare or only travel?
• Which days should I plan not to be alone with a young child?
• Who signs FMLA certification paperwork here, and how long does it take?

• https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-98/subpart-C/section-98.20
• https://childcare.gov/consumer-education/get-help-paying-for-child-care/child-care-financial-assistance-options
• https://www.dol.gov/agencies/whd/fmla
• https://www.cancer.gov/about-cancer/coping/caregiver-support
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html