During and after therapy

Chemotherapy, radiotherapy, other cancer therapies or the disease itself result in a reduced number of white blood cells (leukocytes) and our patients are therefore considered to be particularly at risk of infection. As infections can be dangerous in immunocompromised patients, there are rules to reduce the risk of infection. Avoid exposing your child to sources of infection:

• Avoid direct contact between your sick child and infected persons. Inform your family, relatives and friends. If contact cannot be prevented (e.g. with close family members), we recommend wearing a face mask if you have a respiratory illness or using different toilets if you have diarrhea.
   
• There is a risk of infection, especially in hospital. We therefore recommend that you and your child do not spend time in the entrance hall of the hospital or in the waiting area of the emergency department. Leave the hospital quickly when you go for a walk and use hand sanitizer, especially if you have touched door handles or banisters. 
   
• Your child should avoid crowds of people - e.g. on public transport or when shopping.
   
• Your child must not attend kindergarten or school for the duration of chemotherapy. 
   
• Vaccinations: Infectious diseases can also be transmitted within the family. By vaccinating yourself, the siblings of your sick child and any other household members against flu (influenza) and COVID-19, you can indirectly protect your child from infection. We also recommend vaccinating your child against influenza and COVID-19 - even during chemotherapy.
   
• Chemotherapy can reduce the protection provided by previous vaccinations. This is important if your child has open wounds that can lead to tetanus. Please bring your child to our outpatient clinic within 24 hours at the latest if it has been injured. We can then restore the vaccination protection by means of a passive vaccination.   
   
• Avoid close contact with pets and their excrement. Pets have no place in the patient's bed. However, stroking your own pet can promote recovery. Please wash your hands well afterwards. 
   
• Avoid contact with garden/flower soil. There should be no potted plants in your child's bedroom, as they may contain fungal spores.
   
• Soiled utensils of any kind: Please clean them first before they are used by your child again. Please boil pacifiers if they have fallen on the floor.
   
• We prescribe the antibiotic cotrimoxazole to almost all patients receiving chemotherapy. It must be taken two days a week and reliably prevents a certain form of pneumonia. It is important to take it regularly because this form of pneumonia can be life-threatening and, once it has occurred, is difficult to treat. 
   

Spending time outdoors is not associated with any particular risk of infection. On the contrary: exercise in the fresh air can contribute to recovery.

To detect infections in good time, we recommend:

• Taking the temperature at least twice a day and in case of abnormalities (shivering, malaise, hot forehead) 
   
• Daily observation of the entire skin as part of personal hygiene for rashes, spots, (painful) hardening, discoloration, swelling
   
• Pay attention to abnormalities such as diarrhea, constipation or, for example, pain when urinating
   

If there is a reduced number of red blood cells (erythrocytes), this is referred to as anemia (“anaemia”). The red blood cells carry the blood pigment (haemoglobin “Hb”), which is responsible for transporting oxygen in the body. Signs of anemia in need of treatment in everyday life may include the following:

• Patients are excessively pale, especially their lips, for example.
   
• Patients are very exhausted and tired. Small children no longer want to play. Adolescents report headaches, dizziness, and heart palpitations; it is difficult to concentrate on activities.

Due to the anti-tumor therapy or the disease itself, the body is temporarily unable to produce red blood cells itself. However, in order to overcome severe anemia, patients can receive a transfusion of red blood cells (erythrocyte concentrate “EC”). This quickly overcomes the symptoms mentioned above and the feeling of severe fatigue quickly subsides.

The reduced number of blood platelets (thrombocytes) leads to an increased risk of bleeding because the body can no longer stop bleeding in the usual way in the event of injuries of any kind. Signs of a pronounced risk of bleeding can be: 

• Bleeding points (petechiae) in the skin
   
• Numerous bruises, even without a memorable cause
   
• Frequent or prolonged nosebleeds or gum bleeding
   
• Blood deposits on the stool
   
• Red-colored urine

If the platelet count is very low, our patients therefore receive a platelet transfusion (platelet concentrate "TK")

During the period of low platelet counts, avoid accident-prone behavior by your child! To prevent dry nasal mucosa, regular moistening with sea salt (NaCl 0.9%) nasal drops and the application of an ointment (e.g. with dexpanthenol) can help.