Home Management:

A parent should call the doctor if the child has any symptoms that are out of the ordinary, including (but not limited) to:

• Any fever of 101°F or higher
• Any signs of a flu or cold
• Shortness of breath
• Severe diarrhea
• Blood in the urine or stools
• Trouble urinating

Home Management for Preventing Infection

Tracking Neutrophils. Parents should track their child's absolute neutrophil count. This measurement for the amount of white blood cells is an important gauge of a child's ability to fight infection.

• Counts over 1,000 usually provide sufficient protection so that children can engage in normal activities, including school and other functions where they are exposed to other children.
• If the count is between 500 - 1,000, the child should avoid large groups.
• If it falls between 200 - 500, the child should stay at home and should see only healthy visitors who have washed their hands vigorously.
• Neutrophil counts below 200 indicate that the child is at high risk for infection and should have no visitors.

Maintaining Strict Hygiene. Children with ALL and anyone exposed to them, not only friends and family members but also doctors and nurses, should maintain strict hygiene:

• Frequent hand washing with antibacterial soap is particularly essential.
• Everyone should wash their hands before and after meals, after being outside, before preparing food, and after going to the bathroom.
• When visiting the doctor, a parent should ask about a side entrance or areas where the patient will not be exposed to other sick children.

Vaccinations. Studies now suggest that young survivors of leukemia have an increased risk for measles, mumps, and rubella (MMR), even if they have been previously vaccinated. Children may need reimmunization. Siblings of patients with ALL who require polio vaccinations should be given the killed virus (IPV), not the live polio vaccination (OPV).

Other Precautions

• Use a soft toothbrush when counts are low to prevent gum bleeding.
• Avoid common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs). They increase the risk for bleeding and include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), and ketoprofen (Actron, Orudis KT).

Some of the drugs used for leukemia cause extreme sun sensitivity. Children should wear sunblock and be covered with sun-protective clothing when going outside to avoid sunburn, which can cause skin infection.