Generally, an ANC 500 to 1,000 provides children enough protective neutrophils to fight off exposure to infection due to bacteria and fungi. With an ANC this high, you can usually allow your child to attend all normal functions such as school, athletics, and parties. However, it is wise to keep close track of the pattern of the rise and fall of your child's ANC. If you know that the ANC is 1,000, but is on the way down, it will affect your decision about what activities are appropriate. Each hospital has different guidelines concerning activities for children with low ANCs.
The following are parent suggestions to prevent and detect infections.
• Insist on frequent, thorough hand washing for every member of the family. Use plenty of soap and warm water, lather well, and rub all portions of the hands. Children and parents need to wash before preparing meals, before eating, after playing outdoors, and after using the bathroom.
We always had anti-bacterial baby wipes in our car. We washed Justin's hands, and our own, after going to any public places such as parks, museums, or restaurants. They can also be used to wipe off tables or high chairs at restaurants.
• Make sure that all medical personnel at the hospital or doctors office wash their hands before touching your child.
Nurses and doctors frequently come into the room and don't wash their hands. I make them wash their hands, change their gloves, or squirt Purell on them. I always had a bottle of Purell with me. They would say that they washed their hands before they came into the room. Well, you just touched the doorknob and you have to wash them again. I had a situation like this with our oncologist. He washed his hands, and then right before starting Zoe's spinal, his cell phone rang and he answered it.
He started to proceed, and I stopped him and told him to wash his hands again because he touched the cell phone. He was taken aback for a second, and then agreed. Fortunately, he is a great guy and has fun ribbing me about my overprotective nature and attention to detail (I doubt these are the exact words he uses to describe me).
• Keep your child's diaper area and skin creases clean and dry.
• When your childs ANC is low, make arrangements with your pediatrician to use a back entrance to the office to avoid exposure to sick kids in the waiting room. It sometimes helps to make all appointments for early morning so your child can be seen in a room that hasn't had several sick children in it.
• Whenever your child needs a needle stick, make sure that the technician cleans your child's skin thoroughly with both betadine and alcohol.
• If your child gets a small cut, wash it with soap and water, rinse it with hydrogen peroxide, and cover it with a Band-Aid.
• When your child is ill, take his temperature every two to three hours.
• Do not permit anyone to take the temperature rectally (in the anus) or use rectal suppositories, as these may cause anal tears and increase the risk of infection and bleeding.
Believe it or not, we once stopped the nursing assistant from doing a rectal temp during an inpatient admission. When we had a room on the pediatric oncology side, this never happened. but for that admission those rooms were full, and we were on the other side of the floor.
• Do not use a humidifier, as the stagnant water can become a reservoir for contamination.
• Apply sunscreen whenever your child plays outdoors. Children taking certain chemotherapy drugs, such as methotrexate, or who have received recent cranial radiation therapy are sun sensitive, and a bad sunburn can easily become a site for infection.
• Your child should not receive routine immunizations while on chemotherapy. Your physician or nurse can prepare medical exemption cards for your child's school.
• Siblings should not be vaccinated with the live polio virus (OPV). They should get the killed polio virus (IPV). Verify that your pediatrician is using the appropriate vaccine for the siblings.
Katy was diagnosed just a week after her younger sister Alison had been given the live polio vaccine. Because there was a small risk that Alison could infect any immunosuppressed child with polio, we were not allowed to stay on the cancer floor of the hospital.
If your child's ANC is low, an infected site may not become red or painful.
My daughter kept getting ear infections while on chemotherapy. They would find them during routine exams. I felt guilty because she never told me her ears were hurting. I told her doctor that I was worried because she didn't complain of pain, and he reassured me by telling me that she probably felt no pain because she didn't have enough white cells to cause swelling inside her ear.
Shawn had continual ear infections while on treatment. He had two sets of tubes surgically implanted while on chemotherapy.
Never give aspirin for fever. Aspirin or aspirin-containing drugs interfere with blood clotting. Ibuprofen may be given if approved by your child's oncologist. If your child has a fever, call the doctor before giving any medication.
Call the doctor if any of the following symptoms appear: fever above 101° F (38.5° C), chills, cough, shortness of breath, sore throat, severe diarrhea, bloody urine or stool, and pain or burning while urinating.
Some people choose to keep their kids away from everything and everyone during treatment, while others restrict their activities when they're neutropenic or receiving a particularly heavy dose of chemo. You will learn how to trust your instincts and your doctor's advice, and also learn how to take your cues from your child. For us, we try to walk a fine line between keeping Hunter's life as normal and stimulating as possible, while not taking any foolish risks with his health. When he's neutropenic (ANC below 500) or when he's in a particularly heavy round of chemo, or when there's chicken pox going around we keep him at home. When he's doing well then we take him out a bit more, but sensibly: no shopping malls on Saturdays, no contact with anyone who's sick, and limited contact with other kids. During the week, I will take him with me to the grocery store, or to see his grandparents or cousins, provided everyone is healthy. When he's feeling well we also go to the park, ride our bikes, and do normal kid stuff. I carry around anti-bacterial hand wipes with me so I can keep him clean after playgrounds.
Two serious infections that plague children during treatment for leukemia are pneumonia and chicken pox.
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