Health

Vomiting: Vomiting may even occur before receiving chemo, or several days after the chemo. Find out how you can help your child cope.

WHEN TO CALL THE DOCTOR
Joetta DeSwarte-Wallace, RN, MSN

We frequently are asked to create a list of situations when you should call the doctor. The following can be used as a guideline, but remember:

IT IS ALWAYS OK TO CALL!! YOU WILL NEVER BE TOLD THAT YOU SHOULD NOT HAVE CALLED. DECIDING NOT TO CALL WHEN YOU ARE CONCERNED ABOUT ANYTHING IS THE WRONG DECISION!!

You should give this same information to anyone who is taking care of your child. They should have an immediate way of reaching you, then you should call the doctor.

SYMPTOM	DETAILS	OTHER INFO NEEDED
Fever	A temperature taken in the mouth (or ear) of 101 or greater, or under the arm of 100 or greater.	Last blood count with ANC When was chemotherapy last given? What medicines? How long has temperature been up? Any other symptoms? Behavior normal? Eating normal?
Bleeding	Nosebleeds that don’t stop, or come back quickly. Blood in urine or stool. Easy bruising or tiny red spots on skin	Last blood count with platelet count When was chemotherapy given? Behavior before the bleeding. Does it stop with pressure?
Unable to take medications as ordered	Vomits medicine Couldn’t get from pharmacy Need a different type (example, liquid instead	How many doses missed? Name of medicine and dose Phone number of your pharmacy
Change in activity, tiredness or personality	Observe for changes in overall behavior of child	Fever? Taking fluids/food OK? Last urination? Stools?
Constipation	No stool in 3 days Hard stool which is difficult to pass Blood streaks on outside of stool	Recent vincristine? Stool softener given? Stool stimulating medicines available? What usually works?
Diarrhea	Loose or liquid or painful stool more than 3 times a day.	Fever? Last urination? Drinking fluids? Give no medicines to stop stools without talking to the doctor.
Vomiting	Also nauseated? Specific time of the day or after specific med?	What chemotherapy has been given recently? What medicines have been tried? What anti-vomiting meds do you have? Last urination?
Pain	Where? Associated with any activity? New?	What have you tried to make it stop? How long has there been pain? What pain relievers do you have at home?
Rash, hives, change in skin color	What does the rash look like? Where is it located? Any swelling around mouth, tongue or eyes? Any difficulty breathing or clearing of the throat?	What medicines has he/she taken in the last 4 hours? Did he/she get l’asparginase (leg shot) today? Always have Benadryl (diphenhydramine) available.
Coughing, breathing fast or congestion	Fever? Runny nose? Other sick at home? Pain with breathing?	What cold remedies do you have at home? May need to be seen by a doctor (our office, hospital or your pediatrician.)
Exposure to chicken pox, shingles, measles or other contagious diseases	Has your child had this illness before? Has he/she been immunized against chicken pox? How close were they to the sick person?	You will be told the usual time from exposure to getting the infection. If appropriate, you will be told to take your child to the hospital for an injection to prevent the infection.

AGAIN, IT IS ALWAYS OK TO CALL!! YOU WILL NEVER BE TOLD THAT YOU SHOULD NOT HAVE CALLED. DECIDING NOT TO CALL WHEN YOU ARE CONCERNED ABOUT ANYTHING IS THE WRONG DECISION!!

Picking Snacks for Picky Eaters

It’s all in the balance! Is your child a picky eater? As you may know, kids are notoriously finicky. One minute they may love certain foods, and the next they may refuse them. Because of the wide assortment of snack foods and different ways to enjoy them., snacks offer children many different kinds of foods. Snacks can also help them meet their daily nutritional needs and compensate for picky eating that may occur at mealtime.

Restricting snack choices just because of the calorie, fat, or sugar content of any one food is unnecessary. Toddlers and preschoolers have high energy needs and require a moderate amount of fat, a concentrated source

of calories, to support growth and activity. Foods containing sugar can be an acceptable part of the wide range of food choices you offer your child. In fact, all foods in moderation can fit into a child’s diet.

Encourage Snack Attacks!
A variety of nutritious foods combined with regular physical activity is key to healthy growth and development in all children. Since kids have smaller stomachs than adults, they need to eat more frequently. Toddlers may need as many as three to four snacks a day along with their regular meals to sustain their energy level. Encouraging children to eat small snacks, spaced between meals throughout the day, may help establish sound eating habits for a lifetime.

Snack Selections
Nutrition experts agree that no food is “good” or “bad”. Use the five food groups in the Food Guide Pyramid as a practical tool to help you plan meals and snacks for children.

For example, a bowl of fortified sweetened cereal and milk is a great-tasting snack that provides key nutrients like iron, vitamin A, and calcium. One ounce of cereal is a serving from the bread, cereal, rice, and pasta group, and one cup of milk is a serving from the milk group. Sliced fruit topped with yogurt is also a refreshing and nutritious treat.

For kids who enjoy munching, offer a cup of their favorite raw vegetables, such as baby carrots, cauliflowerettes, and sugar snap peas with a low-fat ranch dressing for dipping. You may wish to offer tasty exotic vegetables like jicama strips or sliced red bell peppers—both are crunchy and sweet, and a source of vitamin C.

Prevention of Nausea and Vomiting
Jane Hodding, Pharmacist

Nausea and vomiting, common side effects of cancer chemotherapy, can be very distressing to your child. Our goal is to minimize these unpleasant side-effects by using an organized approach to prevention. In order to do so, we need your assistance. You can help us by understanding the following facts about prevention AND communicating with your doctor or nurse regarding your child’s response.

Facts about the prevention of nausea & vomiting due to chemotherapy:

Not all chemotherapy causes nausea and vomiting. If it is unlikely to cause nausea or vomiting, we do not need to use preventative therapy.

The choice of medications to prevent nausea and vomiting is directly related to the specific chemotherapy to be used (we choose specific preventative medications based upon the chemotherapy to be used and your child’s previous response to this medication).

Addition of Decadron to other medications used to treat nausea and vomiting will improve prevention.

Vomiting may occur before receiving chemotherapy. This may be due to anxiousness, or even certain smells or seeing people associated with the hospital or doctor’s office. A medication such as Ativan may be taken before coming to the hospital/doctor’s office to prevent this reaction. Let us know if this happens with your child.

Nausea or vomiting may occur again 1-2 days AFTER receiving certain chemotherapy such as Cisplatinum. In this case, medication to prevent this reaction may be continued for 2-3 days after chemotherapy.

While it may not always be possible to completely prevent nausea or vomiting, let us know if your child has more than 2 vomiting or retching episodes per day as we may need to add other medications.

Your child’s response to the medications used to prevent nausea and vomiting is important. Changes in treatment WILL occur to improve response AND minimize any side effects.

Previous responses/successes with prevention are recorded and used to determine the next course of therapy.

SYMPTOM

DETAILS

OTHER INFO NEEDED