Childhood Cancer : Immunizations, Bleeding, Transfusions, Dental Care

by National Cancer Institute

(Page 11 of 14)

Immunizations

Most vaccines, and especially live virus vaccines (regular measles, German measles or rubella, mumps, polio, and chickenpox), should not be given to a child receiving cancer treatment, although some doctors do recommend varicella (chickenpox) vaccines for children with cancer and for their siblings. Some immunizations may be dangerous because chemotherapy cancer treatment lowers the body's ability to protect itself when given these vaccines. In addition, brothers or sisters should not receive the live polio vaccines while their sibling is having cancer treatment. You should discuss these matters in detail with both your child's oncologist and your children's primary care provider (for example, pediatrician, clinic, or family physician).

Vaccines that are not live may be safe to give during cancer treatment, including diphtheria, whooping cough, and tetanus immunizations (DPT, DT, or IPV shots). Flu shots are okay, but you should ask your child's doctor before any immunizations are given.

Bleeding

Platelets are blood cells that help the blood to clot. A low platelet count may cause your child to bleed more easily than usual. If your child's platelet count is low, he or she will need to avoid contact activities such as football, soccer, or skateboarding. If bleeding occurs, you may try the following:

• Apply pressure until the bleeding stops - a clean towel, handkerchief, or cloth firmly pressed to the wound will slow or stop the bleeding.

• For nosebleeds, have your child sit up; do not let your child lie down. Pinch the bridge of the nose over the bone for 5 minutes. The pressure must be tight on both sides to stop the bleeding.

If bleeding continues, call the doctor immediately.

Transfusions

Children who have cancer may need to receive whole blood or blood components (such as red blood cells). This procedure is called a transfusion. Packed red cells are often given to control anemia - a condition in which the blood becomes low in red blood cells or in hemoglobin. A platelet transfusion is given if the platelet count is low. White cell transfusions are not routinely given when white blood cell count is low. The doctor may, however, consider white cell transfusions when a child with a very low white cell count has a very serious infection that is not responding to antibiotics.

Each person has a certain type of blood. Each person can only receive the blood of the same type or from the universal donor type "O."

Dental/Mouth Care

If possible, your child should have a complete oral exam and any needed dental work before cancer treatment begins. Dental care is important during treatment, but even checkups should be avoided when blood counts are low. Always check with the doctor before starting any dental work, and let the dentist know your child is receiving cancer treatment. Your child may need to take an antibiotic before any dental work is done to prevent possible infections. In general, a low dose of amoxicillin is given before even a routine cleaning to patients who have a central venous catheter.

Keeping the child's teeth, mouth, and gums clean to protect against decay is especially important. Make sure your child's teeth are brushed after each meal, using a soft toothbrush. After each use, rinse the brush well with cold water, shake it well, and allow it to dry. Give your child paper cups to rinse his or her mouth. Dental floss may be used if care is taken not to cut or irritate the gums.

Mouth Care During Radiation Therapy

During radiation to the head and neck, less saliva is produced, so the mouth becomes dry. This dryness can lead to tooth decay. The doctor or dentist may recommend using a fluoride mouth rinse or order a fluoride gel. Check with your doctor before buying a mouthwash - many can cause burning pain in a child with a sore mouth. All children receiving radiation should rinse their mouths often during the day. One suggested mouth rinse is a mixture of salt and baking soda (1/2 teaspoon of each in a cup of water). To care for infants and toddlers, wrap a soft cloth around your finger and gently wipe the teeth and gums with the mouth rinse. Soft "toothettes" can also be used to apply the rinse to the child's mouth.

Mouth Care When Blood Counts Are Low

When your child's blood counts are low, mouth care needs to be especially gentle; your child can get an infection or start bleeding more easily. Use very soft bristle toothbrushes, cotton or glycerin swabs, or toothettes, and avoid using water jet devices or dental floss. Call the doctor if you see any red or white patches, mouth sores, or irritated areas in the mouth.

Mouth Care When Your Child Has Mouth Sores

When mouth sores, bleeding areas, or irritated areas occur, use only the mouth rinse described above or one the doctor recommends. Your child should rinse the mouth out well after every meal and before bedtime. Cotton or glycerin swabs or toothettes (available in drug stores) can help remove pieces of food from the mouth. If mouth sores become painful, a local anesthetic may help. The doctor can order an anesthetic and will tell you how often to use it. To make eating easier, put the anesthetic on the sore gums before meals. For dry lips, try a lanolin lip ointment to prevent them from cracking and becoming sore.

When to Call the Doctor

If you have worried about knowing when to call the doctor, you are not alone. Parents want to watch closely for any sign that their child may need to see the doctor but may not be sure what those signs are. They also may worry about "bothering" the doctor or treatment team. The best approach is to ask the doctor when to call about any problems your child may be having. If you are unsure, this list can be used as a guide for when to call the doctor.

Call the Doctor If...

Your child shows signs of infection.

Fever (100.4°F or 38°C) or other sign of infection, especially if your child's white count is low. (The doctor will tell you when it is low.) It is important to take your child's temperature with an accurate thermometer.

Your child has trouble eating.

• Mouth sores that keep your child from eating
• Difficulty chewing

Your child has digestive tract problems.

• Vomiting, unless you have been told that your child may vomit after the cancer treatment
• Painful urination or bowel movements
• Constipation that lasts more than 2 days
• Diarrhea

Your child shows changes in mobility or mood.

• Trouble walking or bending
• Trouble talking
• Dizziness
• Blurred or double vision
• Depression or a sudden change in behavior

Your child has troublesome symptoms.

• Bleeding, including nosebleeds, red or black bowel movements, pink, red, or brown urine, or many bruises
• Severe or continuing headaches
• Pain anywhere in the body
• Red or swollen areas

Your child needs treatment for other health concerns.

• Before your child receives immunizations or dental care, even scheduled vaccinations or regular dental checkups
• Before you give your child any over-the-counter medication

You are in any doubt whatsoever?

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