Bone marrow transplant in children - discharge

Your child's body is still weak. It may take up to a year for your child to feel like they did before their transplant. Your child will likely get tired very easily and may also have a poor appetite.

If your child received bone marrow from someone else, look for signs of graft-versus-host disease (GVHD). Ask the provider to tell you what signs of GVHD you should watch for.

Take care to lessen the risk of your child getting infections as suggested by your health care team.

• Keeping your house clean is important to help prevent infection. But do not vacuum or clean while your child is in the room.
• Keep your child away from crowds.
• Ask visitors who have a cold or other respiratory infection to wear a mask, or not to visit.
• Do not let your child play in the yard or handle soil until your provider says your child's immune system is ready.

Make sure your child follows guidelines for safe eating and drinking during treatment.

• Do not let your child eat or drink anything that may be undercooked or spoiled at home or when eating out. Learn how to cook and store foods safely.
• Make sure water is safe to drink.

Make sure your child washes their hands thoroughly with soap and water often, including:

• After touching body fluids, such as mucous or blood
• Before handling food
• After going to the bathroom
• After using the telephone
• After being outdoors

Ask the provider what vaccines your child may need and when to get them. Certain vaccines (live vaccines) should be avoided until your child's immune system is ready to respond appropriately.

Your child's immune system is weak. So it is important to take good care of your child's oral health. This will help prevent infections that can become serious and spread. Tell your child's dentist that your child has had a bone marrow transplant. That way you can work together to ensure the best oral care for your child.

• Have your child brush their teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles. Floss gently once a day.
• Air dry the toothbrush between brushings.
• Use toothpaste with fluoride.
• Your child's provider may prescribe a mouth rinse. Make sure it is alcohol free.
• Take care of your child's lips with products made with lanolin. Tell the provider if your child develops new mouth sores or pain.
• Do not let your child eat foods and drinks that have a lot of sugar in them. Give them sugarless gums or sugar-free popsicles or sugar-free hard candies.

Take care of your child's braces, retainers, or other dental products:

• Children can continue to wear oral appliances like retainers as long as they fit well.
• Clean retainers and retainer cases daily with an antibacterial solution. Ask your provider or dentist to recommend one.
• If parts of braces irritate your child's gums, use mouth guards or dental wax to protect the delicate mouth tissue.

If your child has a central venous line or PICC line, be sure to learn how to keep it clean to avoid infections.

• If your child's provider tells you your child's platelet count is low, learn how to prevent bleeding during treatment.
• Ask your child's provider about liquid food supplements that can help them get enough calories and nutrients.
• Protect your child from the sun. Make sure they wear a hat with a wide brim and sunscreen with an SPF of 30 or higher on any exposed skin.

Take care when your child plays with toys:

• Make sure that your child only plays with toys that can easily be cleaned. Avoid toys that cannot be washed.
• Wash dishwasher-safe toys in the dishwasher. Clean other toys in hot, soapy water.
• Do not allow your child to play with toys that other children have put in their mouth.
• Avoid using bath toys that retain water, like squirt guns or squeezable toys that can draw water inside.

Be careful with pets and animals:

• If you have a cat, keep it inside. Do not bring in any new pets.
• Do not let your child play with unknown animals. Scratches and bites can easily get infected.
• Do not let your child come near your cat's litter box.
• Talk to your provider if you have a pet and learn what your provider thinks is safe for your child.

Resuming schoolwork and returning to school:

• Most children will need to do schoolwork at home during recovery. Talk with their teacher about how your child can keep up with schoolwork and stay connected with classmates.
• Your child may be able to receive special help through the Individuals with Disabilities Education Act (IDEA). Talk with the hospital social worker to find out more.
• Once your child is ready to return to school, meet with teachers, nurses and other school staff to help them understand your child's medical condition. Arrange any special help or care as needed.
• Check with your child’s provider about timing of immunizations including COVID-19.
  

Your child will need close follow-up care from the transplant doctor and nurse for at least 3 months. At first, your child may need to be seen weekly. Be sure to keep all appointments.

If your child tells you about any bad feelings or symptoms, call your child's health care team. A symptom can be a warning sign of an infection. Watch for these symptoms:

• Fever
• Diarrhea that does not go away or is bloody
• Severe nausea, vomiting, or loss of appetite
• Inability to eat or drink
• Weakness
• Redness, swelling, or draining from any place where an IV line had been inserted
• Pain in the abdomen
• Fever, chills, or sweats, which may be signs of an infection
• A new skin rash or blisters
• Jaundice (skin or the white part of the eyes looks yellow)
• A very bad headache or a headache that does not go away
• A cough
• Trouble breathing when at rest or when doing simple tasks
• Burning when urinating

Transplant - bone marrow - children - discharge; Stem cell transplant - children - discharge; Hematopoietic stem cell transplant - children - discharge; Reduced intensity, non-myeloablative transplant - children - discharge; Mini transplant - children - discharge; Allogenic bone marrow transplant - children - discharge; Autologous bone marrow transplant - children - discharge; Umbilical cord blood transplant - children - discharge

Huppler AR. Infectious complications of hematopoietic stem cell transplantation. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 164.

Im A, Pavletic SZ. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 28.

National Cancer Institute website. Childhood Hematopoietic Cell Transplantation (PDQ®) - Health Professional Version. www.cancer.gov/types/childhood-cancers/hp-stem-cell-transplant. Updated February 4, 2022. Accessed November 7, 2022.

Updated by: Stergios Zacharoulis, MD, Associate Professor of Pediatric Oncology at Columbia University Irving Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.