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

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.

Preventing Infection

It is very important to take precautions to prevent infection following chemotherapy or transplantation. Guidelines for infection prevention and control include:

• Discuss with the doctor what vaccinations are needed and when. Children with ALL may need reimmunization. In general, it is best to have immunizations prior to chemotherapy and to avoid live virus vaccines during treatment,
• Avoid crowds, especially during cold and flu season.
• Be diligent about hand washing and make sure that visitors wash their hands. Alcohol-based handrubs are best.
• Avoid eating raw fruits and vegetables -- food should be well cooked. Do not eat foods purchased at salad bars or buffets. In the first few months after the transplant, be sure to eat protein-rich foods to help restore muscle mass and repair cell damage caused by chemotherapy and radiation.
• Boil tap water before drinking it.
• Dental hygiene is very important, including daily brushing and flossing. Use a soft toothbrush to prevent gum bleeding. Schedule regular visits with your dentist.
• Do not sleep with pets. Avoid contact with pets' excrement.
• Avoid fresh flowers and plants as they may carry mold. Do not garden.
• Swimming may increase exposure to infection. If you swim, do not submerge your face in water. Do not use hot tubs.
• Report to the doctor any symptoms of fever, chills, cough, difficulty breathing, rash or changes in skin, and severe diarrhea or vomiting. Fever is one of the first signs of infection. Some of these symptoms can also indicate graft-versus-host disease.
• Report to the ophthalmologist any signs of eye discharge or changes in vision. Patients who undergo radiation or who are on long-term steroid therapy have an increased risk for cataracts.
• 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.