Your Child's Daily Cares
Once your child is admitted to the hospital, certain routines or cares will be followed every day. The health care team will explain each of these to you in more detail.
Isolation: The chemotherapy or radiation your child receives will destroy your child's bone marrow and immune system. Until new bone marrow begins to grow, your child's blood will not have enough white blood cells to fight infection. To protect your child from infection during this time, your child will be in isolation in his or her hospital room.
Isolation usually begins when your child's white blood cell count in less than 500, or the day your child receives the bone marrow. Isolation will continue until the count is greater than 500 for several days. It takes about 10 to 20 days after the new marrow is infused for white blood cell counts to begin to come back.
The health care team will let you know when the cell count is high enough to stop isolation. When this occurs, your child can put on a facemask and leave the room for short periods of time.
What isolation steps need to be followed?
- Please check with the health care team to see what visitors are allowed and when they are allowed to visit. Often, only 5 people are allowed to visit during your child's stay in the hospital. This is to protect your child from exposure to germs.
- The door to your child's room will be kept closed at all times. When out of the room, your child must wear a mask.
- The health care team and all visitors must follow special rules. They will wash their hands and arms up to their elbows with a special soap. This is done before entering the room. If they leave the room for any reason, they must again scrub with the soap before going back into the room.
- The bathtub in your child's room will be used only by your child. Family members may use the bathroom sink and toilet in your child's room. Remember to wash your hands and arms for a full minute with warm water and soap after using the bathroom.
- The health care team and all visitors will put on facemasks before they enter your child's room.
- Eating in the room will not be allowed. It is okay to drink in the room.
- No live plants or flowers will be allowed in your child's room. These can carry germs.
- Toys and other patient items will be washed with a special soap. This includes games, books and stuffed animals. Any items dropped on the floor must be washed before being used again.
Weight: Your child's weight will be checked every morning. Sometimes this will be done in the evening, too.
Skin Care: Clean, dry skin helps prevent infection. Dirty hands spread germs. Your child might need help with keeping skin clean, especially his or her hands. Another way to help skin stay healthy is to keep your child's hands away from sources of germs, such as the nose, eyes or open sores. Picking or scratching sores or areas of skin that have germs could lead to an infection.
Bathing: Each patient room has a bathtub. Your child will take a bath or a shower every day. A mild soap will be used for the skin. After each bath, dry the skin well. Apply lotion to the skin. The nurse will show you how to do this.
Your child may have diarrhea (loose, watery stools). If your child's skin becomes irritated from a lot of stooling, he or she may want to soak in the tub water once or twice a day.
IV tubings must stay dry. It they get wet from bathing, tell the nurse so the wet tape can be changed and the tubing dried.
Pacifier Use: If your child uses a pacifier, it may be sterilized every day. A pacifier that falls on the floor should not be used again until it is sterilized.
Mouth Care: One of the most important cares will be keeping your child's mouth clean and moist. Mouth care will begin as soon as treatment begins for your child's transplant. It will be done 4 times a day, following these steps:
- Brush teeth. Brush teeth, gums and tongue with a soft toothbrush or toothette.
- Rinse with salt water. Use normal saline (salt) water to rinse the mouth. Swish the water around in the mouth for about 3 seconds before spitting it out.
- Rinse with mouthwash. A special mouthwash is used next. This kills bacteria in the mouth. The mouthwash is swished around in the mouth for about 30 seconds before it is spit out. If this is too strong for your child, the health care team can show you how to dilute it with water.
- Put on lip ointment. After mouth care, your child will spread ointment on his or her lips. This helps prevent drying and cracking. Cracked lips are another place for bacteria to grow. The nurse will help you find an ointment that works best for your child. Ointments should never be shared with other family members or patients.
Special Needs for Mouth Care: If your child is too young to swish and spit, toothettes can be soaked with the salt water and the mouthwash. The nurse will help you swab the mouth with the soaked toothettes.
Your child will take certain medicines to help the mouth stay healthy. These work to prevent fungal infections. Your child may be offered one of several types of these medicines to use. The health care team will help you choose the one that works best for your child.
Intake and Output: You will hear the words intake and output often. This means the health care team will write down everything your child drinks by mouth or takes by IV (intake). The amount of urine, stool and vomit will also be recorded (output).
Your child will be weighed everyday. This helps the health care team know how much to give your child to keep fluids balanced.
Diet: Your child will be on a special diet during and after the transplant. Nutrition is very important during a bone marrow transplant so cells can heal and grow. If your child is not able to eat, special IV fluids will provide nutrition until he or she can eat again. These IV fluids are called Total Parenteral Nutrition or TPN. Tube feedings are another source of nutrition. A tube is inserted through the nose and threaded to the stomach. Feedings through the tube allow your child to get the nutrition needed until he or she is ready to eat again.
The dietician will teach you about the meal plans your child will follow, and how to prepare and store food properly to prevent problems.
Central Line Care: Every child who has a BMT must have a central venous line (CVL). The dressing around the central venous line is usually changed twice a week. At first, the nurse will change the dressing. As you watch and learn how to do this, you can begin changing the dressing.
If your child has sensitive skin or is allergic to cleaning solutions, dressings, or tape, be sure to tell the health care team. They may need to adjust how they clean and change the CVL dressing.
Pain Relief: The health care team can help with pain relief when your child feels discomfort. Let the nurse or a member of the team know when your child feels any pain or mouth soreness so medicine can be given right away.
Medicine will most often be given by IV. Older children may use a PCA pump. PCA stands for patient controlled analgesia. This machine allows your child to control the amount of pain medicine they need.
Tests: All exams and tests will be done in your child's hospital room when possible. Sometimes your child will go to radiology for an x-ray or to other departments for other tests.
Exams: Each morning, the medical team will visit their patients. They will listen to your child's heart and lungs, feel the tummy area, and examine the skin, mouth and ears. If you have any concerns or you have observed changes in your child, this is a good time to tell the medical team.
Each day, the nurse, pharmacist, and dietician will discuss your child's cares and activities for the day.
Physical Therapy: Physical therapy helps the muscle and bones stay strong and healthy. Your child will be tested before the transplant to see how much strength and endurance is present. The physical therapist will use this information to plan daily therapy for your child. Therapy will often include stretching, strengthening exercises, and active games to help your child move around. An exercise bike is available for patients to use.
Each day, the therapist will check with the health care team to see how your child is doing. Your child's blood counts and other test results will decide how much exercise will be allowed. There may be some days when your child feels ill or does not feel like getting out of bed to exercise. On those days, the therapist may only help your child do stretching exercises to keep muscles from becoming tight or sore.
School Activities: Your child can continue to do school work while in the hospital. Hospital teachers are available to talk with your child's schoolteacher. A teacher can visit everyday to spend 30-60 minutes with your child to provide tutoring.
Be sure to bring books and homework assignments with you when your child is admitted to the hospital. Schoolwork allows your child to keep a normal routine.