Paediatrics

This booklet is yours to help you to understand why your child needs a Bone Marrow Transplant (BMT) and to explain some of the things that may happen to your child.

The bone marrow is the factory where all your blood is made.

Platelets stop you from bleeding when you get a cut or fall over and hurt yourself.

White blood cells help your body to fight infections.

Red blood cells give you energy to help you run around and play.

Your child is likely to have many tests before your transplant to make sure that your body is ready.

• X‑ray
• Ultrasound Scan
• Blood Tests
• Breathing Tests
• Height
• Kidney Test
• Weight
• Any other test as per doctor discretio

Try to find out which of these tests your child will need or if you will need to have anything else done.

Here is the list of the type of people you may meet.

• Transplant Doctors
• Nurses
• Dietician
• Social Worker
• Physiotherapists
• Cleaners

Before your child's transplant, you and your family will be explained about transplant unit, if available video will be shown.

Coming in for a bone marrow transplant can feel very strange. Your child will stay in hospital for around 6 weeks, sometimes longer. This may seem a long time and you probably want to know what will happen and how your child will feel.

Everyone feels differently about coming into hospital.

When your child has his / her transplant, you will need to go into a room on your own which will be your child's special bedroom, with family of course. You will hear people call this 'isolation.’

Only one person (caretaker) will be allowed to stay with the child.

Your child will need his / her central line for a few months for blood tests and any other treatment that he / she may need. It will not stop your child playing or going to school but he / she will not be able to go swimming.

Your child will be given some treatment before he / she can have the transplant. It helps to get the child's body ready for the transplant. For some children, this treatment is only a couple of days but for others it can last up to 2 weeks. This treatment may include chemotherapy or radiotherapy or both.

Chemotherapy is a special treatment with medicine. These medicines may be given through your line or into your mouth. Their main job is to kill any cells that don't work properly in your body and to destroy your own bone marrow cells so that they cannot fight with the new bone marrow cells when they are given to you.

Radiotherapy is not given to all children who have a bone marrow transplant. Radiotherapy is a special kind of X‑ray whose job it is to kill any cells in your body that don't work properly and to destroy your bone marrow.

Having radiotherapy does not hurt. It is very important that your child keeps still for his / her radiotherapy which will last about 20 minutes. No one else can stay in the room with your child while he / she has his / her radiotherapy but they can usually see and hear you on a special television screen.

Do you need to have radiotherapy before your transplant?

The need for chemotherapy drug and radiation will be decided by your doctor and will be discussed with you in detail.

Chemotherapy and radiotherapy can make your child's hair fall out about 2 weeks later. You may also notice that your eyebrows and eyelashes also fall out. Some children choose to have their hair cut short before their transplant. Other children buy a special cap, hat or wig to wear until their new hair grows back. The hair will grow back after about 3‑6 months.

Chemotherapy and radiotherapy can make your child feel sick. After your child's treatment has finished, this feeling may carry on because of other medicines or problems. The nurses will give your child medicine in his / her mouth or line to try to stop this feeling. It is really important to tell the nurses if your child feels sick so they can try to help you.

Suck ice cubes or drink small sips of water regularly.

Chemotherapy and radiotherapy can make child's your mouth sore because they kill the good cells as well. The best way to help this problem is to keep the child's mouth clean. We would like your child to clean your teeth 3‑4 times a day with a soft toothbrush and toothpaste. If child's your mouth becomes too sore for this he / she can use special sponges.

Your doctor and nurses will probably ask to look in your child's mouth every day. It is very important to tell them how it feels, especially when it hurts so they can help to make your mouth feel a bit better by giving you pain killers.

The tube helps your child to have the special feeds so that he / she can stay strong during the transplant. The tube could also be used for medicines which can really help your child.

If the feeds makes your child too sick he / she can have a special feed (TPN) through his / her hickman line.

However every child requires feeding tube.

The treatment given to your child will have his / her old bone marrow destroyed. This means that your child will not have many white cells they are in recovery phase. White blood cells are important to help protect the body against infection.

To keep your child safe from infection in hospital, he / she will have a bedroom of your own rather than sharing with other children. Someone from your family will be able to stay near the child to look after.

We also advice to take seitz bath, sitting in tub for 15‑20 minutes everyday.

The child may not be allowed to eat some of your favorite foods from outside / restaurants for a while because they may cause the child to have a sore tummy or diarrhoea.

Try to make a list of the foods that your child likes to eat so that your nurse can talk to you about what the child can and cannot eat during his / her transplant. Your child will probably not be able to eat the skin on fruit, a half boiled egg, etc. Complete diet chart will be provided to you by our specialized dietitians.

When your child's new bone marrow starts to work you will be allowed more visitors and be able to start leaving his / her room. The nurses and doctors will know when your child is ready to go out of the cubicle by checking your count.

Some children need to stay in isolation longer than this because of an infection.

Your child will need to take some medicines when he / she are at home. Your child will often be able to choose between tablets or liquids ‑ please ask if you are not given the choice.

When you return to the hospital, we will check your child's skin to make sure there are no spots or itchy patches. Sometimes your child's new bone marrow can have a fight with his / her body and give a rash or a bad tummy so we need to keep checking the child. Your child may need a different medicine to make it better. This can make the child very hungry and you get a bit bigger. Sometimes you may have to come back into hospital for a few days in case of any problem.

When your child comes out of hospital, you will have to be careful that the child does nit catch any germs.

This means staying at home to begin with and maybe having 2‑3 friends to visit the child as long as they have no infections but the nurses will tell you about this. You should not take your child to the shops or inside busy places but you can go outside into the fresh air and take short walks to the park if your child feel's strong enough.

Your child will not be able to go back to school for a few months.

Your child will probably feel quite tired a lot of the time too, especially if he / she have had radiotherapy. This is quite normal and the child will get stronger every day and be able to do a bit more.

When your child's new bone marrow is strong enough, he / she will be able to go back to school. You may send your child for half a day or for a few hours at first.

Your child's hair will start growing back after a few months. Sometimes hair can be a bit darker or a bit lighter when it grows back.

When your child stops needing blood tests or medicine, he / she will not need the line anymore. This will be about 3‑6 months after the transplant and then it can be taken out. You can then take your child for swimming or he / she can have a proper deep bath!!

We hope this patient information literature has helped you learn about transplant and understand what is going to happen. If you can think of anything else that you'd like to know, ask the doctors and nurses at your hospital.

Dr. Shweta Bansal
Head, Paediatric Haemato Oncology & Paediatric BMT

Mr. Omkar Desai
BMT Co‑ordinator

How to reach us? BMT Department, Room No. T ‑ 304, 3rd Floor, Tower Building Contact No.: 8591108967