Background Mothers of children with life-limiting illnesses describe facing challenges such as sometimes finding it difficult to communicate with their children, for example when their children become irritable due to their illnesses. This study explored the experience of communicating regarding the care of children with cancer, from the perspective of physicians, nurses, mothers, grandmothers and children in Palestine. This paper reports on the perceptions of the mothers and the grandmothers.

Methods This study employed an ethnographic, collective, qualitative case study approach. It was conducted in one oncology unit in a Palestinian hospital. Two data collection methods were employed: participant observation and semi-structured interviews.

Results The study generated 70 hours of observation and 35 interviews; physicians (n=5), nurses (n=11), children aged 6–18 (n=6), mothers (n=7) and grandmothers (n=6). Findings: The mothers and grandmothers stated that they pretended to be strong in front of their children to prevent them from feeling distressed by witnessing their mother’s suffering and grieving. Protecting children from seeing their mothers’ distress was thought to be essential to help children face their illness and their own suffering. Mothers talked to their children about their children’s strengths rather than the deprivations caused by their illnesses. Although they did not feel strong, the mothers tried to transfer their own strength to their children to strengthen them and protect them from being broken.

Conclusions Being the mother of a child with cancer is clearly distressing and they suffer along with their child. Their maternal role drives them to conceal their own grief and their conversations with their children are strengths-based. There is clearly a role for nurses caring for families of children with cancer to support mothers and give them the opportunity to express and share their grief and distress.