Childhood Cancer: The Signs Worth Knowing, And Support In Singapore

A child who has cancer must deal with not just physical issues, but a whirlwind of emotions such as fear, pain, and sometimes even anger. If you know a child who has cancer, you can help the child by:

Childhood cancer is rare, and the symptoms that suggest it are almost always caused by something else. But a handful of signs are ones to know, because they’re easy to put down to ordinary childhood and the cost of a delay is real.

Watch for symptoms that persist, have no explanation, and aren’t getting better. Any one of these on its own is far more likely to be something benign, but persisting for weeks without explanation means seeing a doctor, not waiting longer:

Unexplained persistent fever, without an obvious infection
Unusual pallor and tiredness, particularly with bruising
Bruising or bleeding easily, or bruises in odd places, or frequent nosebleeds
Persistent bone or joint pain, especially waking a child at night, or a limp with no injury
A lump or swelling anywhere that doesn’t resolve
Persistent lymph nodes that keep enlarging over weeks
Headaches with vomiting, particularly in the morning, or new clumsiness, squint or vision changes
Unexplained weight loss
A white reflection in the pupil instead of the usual red-eye in a photograph. Learn this one specifically: it’s often the first sign of an eye tumour and is frequently spotted by a parent in a photograph

None of this means worrying about every bruise. “We thought it was growing pains” and “we assumed it was another virus” are the two most common reasons a diagnosis is delayed. And a child who isn’t getting better over weeks deserves a second look, not a fourth assumption.

The outlook for children with cancer

Most children diagnosed with cancer today survive it. Survival rates for childhood cancers, and particularly for the commonest, leukaemia, have improved enormously over recent decades. That’s the context for everything below, and it’s the first thing to say to a family that has just been told.

If your child is in treatment

Fever during chemotherapy is an emergency. Don’t wait and see.

Treatment suppresses the immune system, and an infection in that state can become life-threatening within hours. Any fever, or a child who’s simply unwell, even without a temperature, means going straight to the hospital, following whatever protocol your team has given you.

Don’t give paracetamol first and see. Don’t go to a GP or a polyclinic. Go to the unit treating them, and say the child is on chemotherapy at reception.

Your treating team will give you a specific number and protocol. Put it in your phone and in the hospital bag, and make sure everyone who cares for your child, grandparents, helper, the other parent, knows it too.

Telling the child

Use the word cancer. “Very sick” leaves a child terrified of every cold, and they’ll hear the word somewhere anyway. Much better from you.
Explain it simply. Some cells in the body are growing wrongly, the medicine is very strong so it’ll make them feel unwell for a while, and the doctors have treated many children with this.
Say this explicitly: it isn’t your fault, nobody can catch it, and you’ll be looked after.
Prepare them for what they’ll see: hair loss, the port or line, being sick, the ward. Described in advance it’s manageable; unprepared, it’s frightening.
Be honest about pain and procedures. Saying something won’t hurt when it does costs the trust you need for the next twelve months.
Give them control where it exists: which arm, which flavour, who comes in. Control is the thing treatment removes most completely.

The siblings

The most consistently overlooked people in the household.

Tell them what’s happening, truthfully and at their level. Children left to guess assume worse, and often assume they caused it.
Say it isn’t contagious and not their fault, explicitly.
Protect some time that’s theirs, however brief, and let them have ordinary childhood things without guilt.
Expect behaviour changes: regression, anger, or becoming conspicuously good and undemanding. The last one looks like coping and often isn’t.
Tell their school.

Practical support in Singapore

The medical social worker at the treating hospital. The first call to make: financial assistance, school liaison, counselling, and navigating everything else. No cost.
Children’s Cancer Foundation, which supports children with cancer and their families in Singapore with practical, financial and emotional help.
Hospital play specialists, who prepare children for procedures and make a real difference to how treatment is experienced.
MediShield Life, MediSave and MediFund: the social worker will help you work through what applies.
The school: ask about arrangements for continuing education during treatment.

For the parents

Two things to say plainly. The strain is enormous and it isn’t evenly shared. One parent often takes on the hospital and the other the household and the income, and both end up isolated from each other. Say so out loud early.

And parents of children in cancer treatment have high rates of anxiety, depression and trauma symptoms, during treatment and afterwards. That’s a normal response to an abnormal situation, and it’s treatable. Ask the social worker about support for yourselves, not only for the child.

Frequently asked questions

What are the warning signs of cancer in children?

Persistent unexplained fever, unusual pallor and tiredness, easy bruising or frequent nosebleeds, persistent bone or joint pain especially waking them at night, a lump that doesn’t resolve, lymph nodes that keep enlarging, morning headaches with vomiting or new vision changes, unexplained weight loss, and a white reflection in the pupil in photographs. Watch for what’s persistent, unexplained and not improving.

Should I worry about every bruise?

No. Almost all of these symptoms are caused by something benign. But “we thought it was growing pains” and “we assumed it was another virus” are the commonest reasons a diagnosis is delayed. A child not getting better over weeks deserves another look.

What’s the outlook?

Most children diagnosed with cancer today survive it, and survival rates, particularly for leukaemia, the commonest childhood cancer, have improved enormously in recent decades.

What should I do if my child on chemotherapy develops a fever?

Go straight to the treating hospital, following your team’s protocol, and tell reception the child is on chemotherapy. Treatment suppresses the immune system and infection can become life-threatening within hours. Don’t give paracetamol and wait, and don’t go to a GP or polyclinic.

How do I explain cancer to my child?

Use the word. “Very sick” leaves them frightened of every cold, and they’ll hear it elsewhere anyway. Explain that some cells are growing wrongly and the medicine is strong, and say explicitly: it isn’t your fault, nobody can catch it, and you’ll be looked after.

Where can families get support in Singapore?

Start with the medical social worker at the treating hospital: financial help, school liaison and counselling, at no cost. The Children’s Cancer Foundation supports children with cancer and their families, and hospital play specialists make a real difference to how children experience treatment.

What to remember

The signs to watch are persistent, unexplained and not improving over weeks, not any single symptom.

Learn one specific thing: a white reflection in the pupil in a photograph, instead of red-eye, needs checking.

Most children with cancer today survive it.

And if your child is in treatment, fever means the hospital immediately, not paracetamol, not the polyclinic.