Childcare During Cancer Treatment

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 days after infusion, when fatigue and nausea peak.
• The window when your white cell count bottoms out and a preschool cold becomes a hospital visit.
• Daily radiation, usually given once a day, five days a week, over a course of weeks that depends on your plan.
• Surgery recovery, when lifting a toddler may be off limits for weeks.

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, or under 19 if physically or mentally incapable of self-care or 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. Cancer treatment is not job training. If you have stopped working, ask your state agency directly how it treats a medical exemption, and ask about the protective services category, which lets a lead agency waive income and asset limits case by case for specific vulnerable children.

Head Start and Early Head Start. These serve children from birth through age 5 at no cost to eligible low-income families, covering early learning, mental well-being, and physical health. More than 150 Head Start and Early Head Start programs serve American Indian and Alaska Native children.

State prekindergarten. Aimed at ages 3 to 5, offered at low or no cost in some states, in part-day or full-day form.

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 lets you set aside money that is not subject to payroll taxes. 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.

This 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: household contacts can still receive live vaccines, including MMR, varicella, rotavirus, and the nasal-spray flu vaccine. Do not pull your child's shots.

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: NCI says a fever of 100.5 degrees Fahrenheit — 38 °C is 100.4 °F; act at 100.4 °F —, or 38 degrees Celsius, means calling your team immediately. Post that number where your babysitter can see it, 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 delegable are the same ones that pile up on parents: cooking, cleaning, shopping, driving children, driving to appointments, and being the person who relays medical updates.

NCI points to SignUpGenius and Lotsa Helping Hands to organize requests. The reason to use one is not efficiency. It is that a shared calendar removes you from the middle of every arrangement.

Watch your own limits too. NCI lists fatigue, sleep problems, appetite or weight changes, headaches, higher blood pressure, and mood changes as signs of caregiver strain, and advises seeing a doctor when 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