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Background. For clinicians to effectively help children with their illness and symptoms, it is important to communicate with them in a language they can understand. Methods. This study investigates how well children with cancer and healthy children understood 44 symptom terms; their thoughts about these symptoms in terms of causes, consequences, and cures; and what other terms the children use to express these symptoms. It also explores if there are differences in understanding and thoughts about symptoms between children who have the experience of cancer and those who do not. In all, 6 children with cancer and 8 healthy children participated in semistructured interviews. Results. Children demonstrated a good understanding of symptom terms, yet were not always able to explain the symptoms. They had a rich vocabulary to talk about symptoms but did not use childish terms. Children with cancer had a more varied vocabulary for symptoms, but they did not use more medical terms. This study contributes to knowledge about children's understanding of symptoms that can be helpful to clinicians when communicating with children about their illness.