These occur frequently in children and are usually sarcomas rather than carcinomas. They arise in fat, muscle, nerve, connective tissue, etc. They cannot be labelled benign or malignant until examined under the microscope. For this reason the physician removes most painless swelling in the soft tissues.

There is good opportunity for cure when these tumors are found early.

Nursing Care

The nurse who takes care of a child with cancer has a responsibility to both the child and his parents. One must consider the age of the child and know something of the parent-child relationships in the early years, as well as those in the later years. Also, the child's experience with illness in the past will have some bearing on his present reaction to what is happening.

The site involved will also make a difference to the child. For instance, a child with leukemia may react somewhat differently than a child who is told he may have an amputation of a limb. The emotional support given both the patient and his parents is as important as his physical care. The nurse must try to help the parents in the difficult task of facing the fact that some of their plans for the child may have to be revised. To elicit cooperation of the parents in the total plan of care the physician usually gives them the diagnosis, an explanation of what is involved in the treatment, and some idea of the length of time and the cost of the illness. People react in many ways to such information; some accept the diagnosis while others deny it in a variety of ways. There is often indecision and ambivalence as to whether certain treatments should be permitted, particularly when the child does not seem to respond well. It may be difficult to understand the parents' feelings about what happens when they face this kind of problem with their child. Their feelings may be based on many things, such as their own relationship with the child, their expectations for him, and the need to consider what might happen when the child no longer lives. It is during these difficult periods that the nurse may be helpful in listening and reflecting the attitude of the physician. There are also times when parents will need additional help from the clergy, social worker, or psychiatric personnel.

Specific nursing care depends on the area involved and the method of treatment. This may involve knowledge of postsurgical care, or care during radiation and/or drug therapy.

Nursing care includes measures to improve the child's general health and thus reinforce his powers of resistance. He should be helped in every way possible to regain maximum utilization of himself as he was prior to his illness.

The nurse has a special challenge in helping parents in maintaining the nutritional status of children with cancer. These parents are faced with the problem of providing adequate nutrition to meet the normal growth needs of the child and in addition are faced with the problem of feeding a sick child with a capricious appetite. This situation may be further complicated since the child may be suffering from toxic reactions to chemotherapy and may be on a sodium-restricted diet as well. See appendix II.

The parents are torn between force-feeding of the child and catering to his every whim. An oversolicitous parent only undermines the child's confidence in himself. In so far as possible the parents should treat him as they always have. He should not be made to feel more or less important than other children in the family.

The most effective aid in building good food habits is a hearty appetite. Unfortunately, sick children are not always hungry at conventional mealtimes. There is no easy answer but there are certain measures which may help to build up an interest in and desire for food.

Regularly spaced meals establish a schedule which will tend to make a child hungry at those times. A child's interest may be aroused by letting him help plan and select the family meals and even prepare some foods if he wishes. Usually the child does not need foods different from those eaten by the rest of the family. On the other hand, however, since it is important to get nutritious food into the child, a certain amount of catering cannot be avoided. The support the nurse gives parents in understanding this conflict is of real importance. Nutritious drinks, fruit pureed and frozen, puddings with a surprise in the bottom of the dish (piece of fruit, marshmallow), fruit whips reinforced with nonfat dried milk or gelatin may sometimes be helpful when the child refuses food at mealtime.

The importance of adequate rest, skin care, and freedom from infection are mentioned elsewhere in discussing care for the child with leukemia. The same principles apply for children with all malignancies. Attention to the details of physical care help to make the child secure since attention to his physical comfort promotes the feeling that he is loved and wanted.

The child's room should be sunny and cheerful, and if he is not too ill, shared with someone else. He must be encouraged to play with others, whether he is ambulatory or bedridden. Play routines can be encouraged even for those whose physical activity must be curtailed. Normal relationships with other children are important since these children sometimes become the central focus for everyone's attention. Attendance at school for as long a time as possible also helps to maintain a routine which is like that of other children. If the child cannot attend school a home teacher may be available in some communities.

There is sometimes a tendency for the parents to become so concerned with the child who is sick that they give too little attention to the rest of the children in the family. Sometimes, when a malignancy occurs in one child, the parents become overly solicitous and concerned about the siblings, especially when there is only one.

The parents should be given an opportunity to express their feelings. Experiences of those who have worked with parents have shown that the parents need to raise many questions which center around some of their feelings of anxiety about their responsibility as parents. Sometimes it is a question of, "Should I have taken the child to a doctor earlier?" or "Do you think because I spanked the child, this is a result?" The value of permitting the parents to ventilate is that it provides an opportunity for those who work with the parents to offer reassurance. This reassurance, however, must not be false, but must be based on the reality of the situation as far as the diagnosis is concerned. The parents' ability both to understand and to emotionally accept the reassurance must also be considered.

Occasional outbursts of resentment or hostility from the parents are not unusual. It may be difficult to listen without attempting to stop the discussion or without betraying how one feels about what is said. Nurses should recognize that the prolonged strain of uncertainty about the final outcome of the child's illness is extremely difficult.

Children sometimes fear their periods of hospitalization or their treatments. It is important that they be given the opportunity to verbalize their feelings. It should be recognized that illness fosters great dependence upon the parents and separation may be extremely difficult for everyone concerned.

The public health nurse can offer a tremendous amount of support to families as she relates with them in their homes, or in her role of coordinator between families and hospitals. This presupposes an understanding, on the part of the public health nurse, of the dynamics which have been heretofore discussed. It means too, that she must understand not only the nature of the disease but also the parents' involvement and her own relationship to this particular problem. The public health nurse can be most helpful with other siblings in the family and can help the parents to help the other children understand what is happening. Later if death occurs, she may be able to help them accept the loss of one of the members of their family.