Taking Care of Your Child at Home
Activity and Rest
Diet and Nutrition
Taking Your Child's
Temperature
Immunizations
Medications
Exposure To Sunlight
Discipline and Family
Relationships
The child who has been hospitalized or who is receiving treatment for
cancer may be more tired than usual and need additional rest. If your
treatment team has said it is safe for your child to return to school, you
may want to start by sending the child for half a day until you determine
his or her tolerance. It is important that a normal bedtime and daily
routine be resumed after the chaos of hospitalization.
Many parents report that children on treatment have surprising amounts
of energy and cannot be held back. If your child tolerates a normal daily
routine without becoming fatigued, there is no need to offer him or her
additional rest. A rapid return to the normal routine reassures your child
that he or she will recover and cope with his/her illness.
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Unless you have been told that your child requires a special diet,
there are no dietary restrictions related to cancer treatment. The best
diet is one which is well-balanced and includes items from the four basic
food groups (Grains, Fruits and Vegetables, Dairy Products, and Meats).
There are several booklets and pamphlets available from your treatment
team or from the dietician, which offer suggestions and recipes for
nourishing, tasty meals.
There are several aspects of cancer therapy which may interfere with
your child's ability to take in an adequate and nourishing diet. Some
drugs and radiation therapy can cause mouth sores, altered taste
sensations, decreased appetite, or nausea and vomiting, thus making eating
a normal diet difficult. Decreased activity levels and fatigue can
decrease a child's appetite. Mood swings can turn the dinner table into a
battlefield. Usually, these effects of treatment are temporary and do not
interfere with your child's growth or general health. Your child's weight
and nutritional status will be monitored by the treatment team and
measures will be taken to nourish a child who is unable to meet his or her
normal dietary requirements.
It is important not to let anxiety about your child's illness and
recovery turn the issue of eating into a conflict, as children who can
control very little of what is happening to them tend to control what they
put into their mouths. By offering nutritious and tasty foods and trust
that your child will do his or her best, you can avoid a contest of wills
and keep mealtimes pleasant.
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Fever is the most important sign of an infection which could cause
trouble for a child receiving cancer treatment. Symptoms of a fever which
should prompt you to take your child's temperature include fatigue or
listlessness ("just not himself/ herself"), chills or shakes, parched
lips, or skin warm to the touch.
An accurate temperature may be taken with a thermometer which can be
obtained at any pharmacy. Your child's temperature should be taken orally
(under the tongue, with the mouth firmly closed), or axillary (left
securely in place under the arm for 5 to 8 minutes). A child on cancer
therapy should not have his or her temperature taken rectally, unless a
Haematology doctor gives approval for this.
In a child who is receiving chemotherapy, especially when blood counts
are low or suspected to be low, a temperature of 101.3oF (or 38.5oC) or
higher is reason to contact the treatment team. It may be necessary for
the child to be seen by the treatment team, or even to be hospitalized for
intravenous fluids and antibiotics. Sometimes the fever can be safely
treated at home. It is important to let the treatment team know
immediately about fever so that the best decision can be made for your
child.
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Once your child begins chemotherapy, no vaccinations or immunizations
should be administered while the child is under treatment (i.e. until the
periodic chemotherapy treatments cease), because your child's immunity is
suppressed and he/she could become sick. The Haematology doctors will
advise when to go back to your paediatrician and when it is safe to resume
immunizations. Your child can receive any missed vaccines when
chemotherapy no longer affects the immune system --- which may be anywhere
from 6 to 18 months after the completion of the last course of treatment.
Family members should receive only "killed" or "inactivated" virus
immunizations while the child is on treatment. Ask your treatment team to
advise your local paediatrician when it is safe to resume immunizations.
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Most medications which are given orally for cancer therapy should be
given half an hour before meals or 2 hours after meals. However,
Prednisone should always be given with meals or with milk.
Aspirin should not be given because it may stimulate bleeding.
Aspirin-free medications such as Tylenol or Tempra may be used for pain,
fevers, or discomfort. Your child may be placed on Bactrim or Septra (an
antibiotic) twice a day, three times a week to help prevent a lung
infection called pneumocystis.
For small children unable to swallow pills or tablets, you may use
liquid preparations or crush pills to add them to food or juice. It is
best not to try to hide a pill or add it to a large amount of food or
juice in case the child is unable or refuses to finish the whole amount.
Frozen grape juice concentrate will mask the bitter taste of many
medications. You may also use a small spoonful of applesauce, baby food,
ice cream, yoghurt, or jelly. Try not to "burn out" all of your child's
favourite foods by associating them with the taste of medication.
If your child vomits within 15 to 30 minutes of taking a medication,
you cannot assume it has been absorbed. Do not repeat a chemotherapy
dose without first talking to your treatment team.
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It is generally good practice for everybody to wear sunscreen when
exposing themselves to sunlight. If your child has had radiation therapy
or certain chemotherapy drugs, he or she may be more susceptible to
sunburn and should be protected from exposure. This can be accomplished by
reducing the length of time in the sun, wearing protective clothes
(especially hats) and using an adequate sunscreen lotion (minimum of
Factor 25, preferably higher).
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Your child's diagnosis of cancer will cause many changes for your
family. Fears and concerns about your child's health, time spent in the
hospital and away from your home and community, or the pressure of meeting
your other responsibilities, will all put stress on your family
relationships. It is normal to experience these stresses and to need time
to adjust to the changes which occur in your family as a result of your
child's illness.
Parents often have a difficult time resuming normal patterns of
behaviour and discipline for their children, following the diagnosis of
cancer. It can be hard to say "no" to a child who has been sick, or to
watch him go off to school, or tell her to sleep in her own bed. Children
who have been sick may tend to regress, or act younger than they are, as a
response to the stress of illness. They may also test limits or rules to
see how much has really changed. If these types of behaviours are allowed
to continue, children can become insecure with others and difficult to
manage.
Children with cancer need to know that they are normal children and
that they are expected to behave as normal children. They should follow
the same rules and share the same responsibilities as they did before they
were diagnosed, and the same as their brothers and sisters are expected to
do. Resisting the temptation to indulge or overprotect your child with
cancer is the most important thing that you, as a parent, can do to
support your child's emotional health, despite the illness.
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