In addition to the physical and psychological consequences for the child, chemotherapy for children with cancer also exposes the family to a series of emotional, cognitive, social, and economic pressures that can affect the balance of the family system. A diagnosis of cancer in childhood is usually accompanied by a sudden experience of threat, uncertainty about the future, worry about the effectiveness of treatment, and fear of losing the child, and it puts parents in a situation where they have to deal with their psychological turmoil and respond to the child's complex needs at the same time. In such a situation, parental anxiety is considered one of the most important psychological factors related to the quality of family care and the child's adjustment, as parents are the main source of security, peace, emotional support, and interpretation of threatening events for the child. From a theoretical perspective, the approach of family systems emphasizes the principle that the serious illness of a family member, especially a child, is not just an individual issue, but affects the relationships, roles, communication patterns, and decision-making style of all members. In this framework, parental anxiety can affect the child's psychological experience through changes in caring behaviors, the quality of emotional interaction, and the way in which he responds to the child's needs. Also, the attachment perspective shows that the child's sense of security is largely dependent on the emotional availability of caregivers and their ability to respond sensitively and predictably to their needs. When parents become distressed due to intense anxiety, burnout, or fear of treatment complications, they may have difficulty maintaining this pattern of response, although this outcome is not inevitable, and many parents, despite significant anxiety, are still able to provide effective care. Parental anxiety during chemotherapy can manifest as persistent concern about the outcome of treatment, hypersensitivity to the child's physical symptoms, fear of medication complications, sleep disturbances, difficulty concentrating, irritability, and feelings of inability to control the situation. Some parents may experience severe anxiety before each treatment session and may not even be able to distance themselves from thoughts related to the illness even in the intervals between sessions. Observing a child's nausea, weakness, hair loss, loss of appetite, or behavioral changes can exacerbate these concerns and lead parents' minds to anticipate negative outcomes. In many cases, these reactions reflect the child's emotional importance and the parents' efforts to protect them, but when the intensity of anxiety increases or persists for a long time, the family's ability to make informed decisions, regulate emotions, and maintain routine life activities may decrease. From a cognitive perspective, uncertainty about the course of the disease and the outcome of treatment can lead to the formation of catastrophic thoughts, an exaggeration of risk, and difficulty in tolerating ambiguity. Parents who constantly imagine the worst possible outcomes may view any physical changes as a sign of deterioration of the disease and repeatedly ask for the same information for reassurance. These behaviors sometimes lead to a temporary reduction in anxiety, but may reinforce the cycle of worry and the need for reassurance if repeated excessively. However, it is important to distinguish realistic anxiety from excessive anxiety, as some physical changes during chemotherapy require immediate attention from the medical team and should not be attributed solely to the psychological concern of the parents. Therefore, educating parents about possible treatment complications, warning signs, how to contact the treatment team, and the limits of home care can help both increase awareness and reduce ambiguity. Parental anxiety is related to a child's psychological adjustment in a variety of ways. One of these pathways is the transmission of emotion in everyday interactions; children, especially at an early age, use facial expressions, tone of voice, nonverbal behaviors, and caregiver reactions to assess the safety of the environment. When a parent shows severe agitation during a visit to the hospital, preparing for an injection, or facing complications of treatment, the child may perceive the situation as more threatening than he or she perceived. In contrast, parents who express their emotions in a manageable way and provide age-appropriate information to the child despite concern can help develop a sense of security and predictability. This does not mean that anxiety should be completely hidden from the child, but rather emphasizes the importance of managing and expressing emotions appropriately. Saying that parents are also worried at times, but seek help from doctors to care for their child can create a realistic and reassuring picture of the situation. The second path is the impact of anxiety on parenting and care practices. In response to the fear of harm, some parents resort to excessive care, restricting age-appropriate activities, or not allowing the child to comment on certain day-to-day decisions. These behaviors are usually done with the intention of protectiveness, but if persistent, they may reduce a child's sense of independence and worthiness, sending the message that he or she is not capable of facing the situation. On the other hand, intense anxiety may cause parents to show less tolerance for the child's restlessness, resistance, or crying, and inadvertently use threats, blame, or pressure to cooperate. Such reactions can increase conflict and make it more difficult for the child to experience medical procedures. In contrast, sensitive and flexible care, along with respecting the child's feelings and providing them with limited, age-appropriate choices, can foster their sense of shared and perceived control. The third path is related to the quality of family communication. When the bulk of family conversations are devoted to illness, tests, medications, and future concerns, the opportunity for normal interactions, games, jokes, and enjoyable activities may be reduced. In this situation, the child may feel that his or her identity is limited to the illness or think that expressing his or her discomfort puts more pressure on the parents. Some children hide their fears and worries to protect their parents, while others demonstrate their need for support by protesting or repeatedly asking for reassurance. Therefore, it is important to maintain a safe conversational space where the child can talk about their pain, fear, anger, nostalgia, and questions, without feeling like they have to be careful about the parents' emotional reaction. Research evidence in the field of cancer psychology and psycho-oncology suggests that the psychological distress of parents and children may be related to each other, and factors such as social support, quality of family communication, economic status, severity of physical symptoms, and family coping resources play a role in this relationship. Studies related to families of children with chronic diseases also emphasize the importance of emotional coordination, caregiver accountability, and social support in managing stress. However, this association does not necessarily mean a direct causal relationship, as a child's anxiety can also increase parental anxiety, and the severity of illness or complications of treatment may affect the mental health of both at the same time. Therefore, the relationship between parental anxiety and child adjustment should be considered a two-way process and influenced by multiple factors. For example, a child who had a severe fear of needles or an unpleasant medical experience prior to chemotherapy may show more restlessness as treatment approaches, and this behavior increases parental anxiety. Increased parental anxiety may also cause the child to receive more signs of danger and exacerbate their anxiety. This cycle can gradually reinforce resistance to medical measures, difficulty in separating from the caregiver, and anticipatory worry. Appropriate intervention should address both sides of this interaction and, rather than blaming the parent or child, identify the conditions that perpetuate the anxiety cycle. Child psychological adjustment in this context is a broader concept of the absence of anxiety and includes the ability to manage emotions, maintain meaningful relationships, continue activities appropriate to the situation, accept support, and participate in the treatment process. A child may seem calm and adaptable on some days, but experience severe anxiety on the eve of medical procedures; a child may also have difficulty expressing his or her emotions while showing appropriate cooperation behaviorally. For this reason, adjustment assessment should not rely solely on observing the parent's behavior or reporting, but also on the child's internal experience, daily functioning, educational status, social relationships, and reactions to therapeutic situations. The child's age, stage of cognitive development, history of anxiety, previous hospitalization experiences, the quality of the relationship with caregivers, and the extent to which he or she perceives the illness can play a role in how distress occurs. Young children are usually more dependent on the presence and calming of adults to regulate emotion, while older children may have more complex concerns about disease outcomes, changes in appearance, distance from peers, or the future of education. Therefore, psychological support should be tailored to each child's developmental level and specific needs, avoiding providing overly complex explanations or hiding essential information. In clinical application, early identification of parental anxiety and its impact on child interaction is an important part of comprehensive pediatric oncology care. The psycho-oncologist can determine the psychological needs of parents through clinical interviews, distress assessments, sleep quality and daily functioning, and discussion about support resources. When screening tools are used, it is necessary to use validated scales appropriate to language, culture, and family circumstances, and screening results should be taken as an indication for further evaluation, rather than a definitive diagnosis of the disorder. In cases where parental anxiety is severe, persistent, or impairing functioning, it is necessary to provide specific psychological interventions or a referral to a mental health professional. Psychoeducation about natural reactions to a cancer diagnosis, problem-solving skills, worrying thought management, relaxation exercises, and emotion regulation can help parents strengthen their coping resources. Cognitive-behavioral approaches, when appropriate to the individual's circumstances, are used to identify anxious thought patterns and modify persistent worry-bearing behaviors. Training in slow breathing, attention focus, and moment-presence skills may also help reduce physical arousal and increase the ability of parents to respond thoughtfully to the child's needs. These interventions should not be accompanied by the promise of complete elimination of anxiety, as anxiety is understandable in the face of serious reactive illness, and the main goal is to reduce disruptive distress and increase the ability to manage the situation. Along with individual interventions, family and social support are of great importance. Dividing caring responsibilities among family members, seeking help from trusted relatives, accessing social work, and using support groups can reduce the pressure placed on a parent. In families where one parent is primarily responsible for care, burnout and lack of time for rest may exacerbate anxiety and reduce the child's ability to respond emotionally to the child. Therefore, the care plan should also take into account the needs of parents as primary caregivers and consider rest, feeding, sleep, and maintaining minimal daily activities as part of therapeutic support. Also, in cases where parents disagree about how to explain the illness or answer the child's questions, family counseling can help create clear, coordinated, and age-appropriate messages. When communicating with a child, parents should be encouraged to validate their feelings, answer their questions honestly, and avoid promises that cannot be guaranteed. For example, instead of making definitive assurances that there is no pain, it can be explained that there may be a brief discomfort and that the treatment team will work to reduce it. Such an approach can maintain a child's trust and show them that adults take their concerns seriously. Preparing before medical procedures, using games and stories, practicing distractions, and creating predictable plans can also help reduce the child's and parents' anxiety. If possible, keeping the child connected to school and peers and providing the opportunity for enjoyable activities appropriate to their physical condition will prevent the child's family life and identity from being fully organized around the illness. However, implementing these strategies comes with challenges. The severity of chemotherapy complications, real concerns about prognosis, economic pressure, limited access to psychological services, and cultural differences may reduce the possibility of continued use of interventions. Some parents may avoid seeking help because of the social stigma associated with going to the psychologist or the perception that they have to manage family problems on their own. Another group may be so involved in treatment programs that they do not have the opportunity to attend support sessions. On the other hand, focusing solely on parental anxiety can run the risk of ignoring the child's actual physical problems or structural stressors. Therefore, the assessment should be comprehensive and should be considered alongside psychological interventions, the medical, social, and economic needs of the family. Another limitation is the differences in the tools to measure parental anxiety and child adjustment in research studies, which makes it difficult to compare the results. In addition, the severity of anxiety may change at different stages of treatment, and the assessment alone may not fully reflect the family's adjustment process at one point in time. Future researches should investigate the interaction between parental and child anxiety from the time of diagnosis to different stages of treatment and post-treatment follow-up. Paying attention to the differences between mothers and fathers, examining the role of siblings, assessing the impact of social support, and analyzing economic and cultural factors can also help to more accurately identify family vulnerability. Also, measuring outcomes such as quality of life, caregiver burnout, quality of family relationship, anxiety before medical procedures, and child participation in treatment can shed more light on the effectiveness of interventions. Finally, parental anxiety during pediatric chemotherapy is a multidimensional phenomenon that goes beyond the normal concern about the child's health and, if intensified, can affect the quality of care, family relationships, and psychological adjustment of the child. However, the presence of anxiety in parents alone does not mean that the child will be harmed, and should not lead to feelings of guilt or excessive responsibility. What is important is to identify distress in time, strengthen coping skills, and provide the conditions in which parents can provide more stable emotional support to the child while accepting their feelings. Effective care for a child with cancer is more complete when the family's mental health is also an integral part of the treatment plan. Collaboration between the oncology team, psycho-oncology, child psychologist, social worker, and family can help reduce manageable stress, improve communication, and increase access to essential supports. In such a framework, the goal is not to eliminate all concerns, but to strengthen the family's ability to cope with uncertainty, maintain emotional connection, and support the child's developmental and psychological needs along the path to chemotherapy.