Symptom Management

Symptom Management

Summarize

What is symptom management

 

As the disease progresses, children may experience symptoms or issues related to cancer or cancer treatment. The type and location of the cancer typically determine the symptoms a child will experience. The goal of symptom management is to identify the cause of the symptoms and provide appropriate treatment to alleviate pain or discomfort. Your child's doctors and nurses will discuss the potential symptoms with you. If new symptoms appear, it is important to contact your primary care physician and the nursing team immediately to ensure timely assessment and management of the symptoms.

 

Pain management

 

Pain is a common and often frightening symptom of cancer. For children, unrelieved cancer pain can be unbearable, affecting their daily activities, interactions with family and friends, and overall quality of life. Pain can also suppress the immune system, prolong recovery time, and increase the risk of depression. It is very difficult for parents to watch their children suffer. However, in most cases, proper diagnosis and the use of medications and other treatments can effectively manage the pain.

 

Epidemiological

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Etiology & Risk Factors

The cause of the pain

 

The suffering of cancer patients is influenced by various factors. For children with leukemia, the increase in leukemia cells can put pressure on the bone marrow, leading to bone pain. This pain may be felt in the legs, ankles, shoulders, or arms. Children might also complain about pressure from specific tumors in their head, abdomen, or chest. Additionally, treatments such as surgery, examinations (like bone marrow aspiration and blood tests), and side effects of chemotherapy can all cause pain.

 

Classification & Staging

1. Assessment of the degree of pain in children

 

Children experience pain in the same way as adults, but their vocabulary and life experiences are often limited, making it difficult for them to describe the nature and severity of their pain, which can make it challenging to communicate their pain. Parents should trust their instincts and observations; if they suspect their child is in pain, they should inform the doctor. The signs of pain in children vary with age. Infants and young children often express discomfort through crying, such as increased crying frequency, changes in their usual crying patterns, or a loss of previously effective soothing methods. Changes in sleep and eating habits can also be indicators of pain. Older children might hide their pain to avoid worrying their parents. Low growls, facial contortions, red and swollen eyes, and reluctance to move can all be signs of pain. Encourage children to share their feelings with their parents or doctors. Observing a child's behavior during play or rest can also help gauge the severity of their pain.

 

For older children, healthcare providers use a numerical rating scale (NRS) to communicate the level of pain, as illustrated in the figure below. On the left, 0 indicates no discomfort at all, and on the right, 10 represents the maximum intensity of pain that the child might have experienced. After ensuring the child understands the scale, the doctor asks the child to select a number between 0 and 10 that reflects their pain level.

 

 

 

 

Figure 1. Numerical Rating Scale (NRS)

 

Numbers 1 to 3 indicate mild discomfort, 4 to 6 indicate moderate pain, and 7 to 10 indicate severe pain

 

 

 

        For younger children, the Wong-Baker Facial Expression Scale is used to assess discomfort (Figure 2).

 

 

 

 

​ Figure 2. Wong-Baker facial expression scale

 

Note: For younger children, the Wong-Baker Facial Expression Scale is usually used to assess their discomfort

 

 

 

These pictures of facial expressions drawn by children can help them associate their feelings with facial expressions and choose the one that best represents their body sensations. The happiest face on the left indicates no pain, while the most distressed face on the right indicates experiencing severe pain. Each expression corresponds to a number at the bottom of the scale to quantify the degree of pain.

Clinical Manifestations

Gastrointestinal symptom management ​

 

1. Oral problems

 

Due to weakened immunity, poor oral intake, and a general reluctance to perform oral hygiene, children may develop oral problems. Regular oral care, such as brushing teeth twice daily with a soft toothbrush and using an antibacterial mouthwash (alcohol-free), can prevent various oral issues. For infants and young children, applying antibacterial gel to the teeth with a cotton swab can help clean the mouth.

 

1.1 Oral dryness

 

 

A dry mouth and chapped lips are common issues, often caused by breathing, dehydration, anxiety, medication, or infections. You can encourage your child to suck on ice cream, ice cubes, frozen juices, and other cold drinks to soothe their throat and quench their thirst. Chewing or sucking on sugar-free pineapple pieces or hard candies can also help keep the mouth clean. Regularly applying lip balm can help keep the lips moist and prevent them from cracking.

 

1.2 Oral ulcers

 

 

If the child has a neutropenia or an infection, they are likely to develop oral ulcers (mucositis). The inner lining of the mouth may turn red or develop painful ulcers, and white patches (small bumps) may appear, which are signs of fungal infection. Oral ulcers can be extremely painful. For small, superficial ulcers, a simple pain-relieving anesthetic mouthwash can help alleviate the discomfort. Before meals, gently apply an anesthetic gel to the ulcer with a cotton swab, which is also very effective in reducing discomfort.

 

Herpes simplex usually causes large ulcers that can be very painful. They can also appear in the throat, making it difficult for children to swallow. You can use an antibiotic for herpes along with a pain-relieving mouthwash. For severe ulcer pain, morphine may be needed to relieve it.

 

When you have a mouth ulcer:

 

50. Let your child drink plenty of fluids
50. Let your child drink liquids through a straw
50. Avoid spicy or acidic foods
50. Let your child eat cold or room temperature food
50. Try to get the child to eat soft, mushy (crushed or stirred) foods
50. Don't let your child eat dry, rough food
50. Cut the food into small pieces
50. Do this several times a day with water or mouthwash recommended by your doctor
50. Don't gargle with alcohol-based mouthwashes

 

 

Contact a healthcare provider if you experience any of the following

 

50. Your child is not getting enough fluids
50. Your child cannot swallow properly
50. The medication prescribed for your child will not relieve the pain

 

       

1.3 Oral bleeding

 

 

Children with low platelet counts are also prone to bleeding gums and oral skin. You can use a soft toothbrush or cotton swabs for oral care. Applying a cold pack or ice to the bleeding area can usually stop the bleeding. There are also medications available to alleviate symptoms of oral bleeding. For children with severe conditions, platelet transfusions may be necessary. It is beneficial to communicate more with healthcare providers to ensure the best treatment plan is adopted.

 

 

2. Nausea and vomiting

 

If a child shows symptoms of nausea and vomiting, contact a doctor or nurse immediately to start treatment promptly. Nausea and vomiting can be caused by various factors, with the most common being the use of medications like morphine. Other causes include constipation, intestinal obstruction due to tumors, infections, inflammation of the stomach, and increased intracranial pressure.

 

Currently, several medications are available to treat vomiting caused by various reasons. Once the child's doctor identifies the possible cause, medication will be prescribed. If possible, oral painkillers should be used. For severe vomiting, oral painkillers can be changed to intravenous, subcutaneous injections, or suppositories until the vomiting is controlled.

 

If the cause of nausea and vomiting is constipation, treating constipation can alleviate the vomiting. Increased intracranial pressure in the brain can lead to vomiting, often accompanied by headaches. This is more common in children with brain tumors. Steroids like dexamethasone can help relieve these symptoms, as can drugs that target the brain's vomiting center. If vomiting is due to intestinal obstruction, a nasogastric tube can be used to relieve vomiting and drain the stomach contents.

 

In addition to using medication, the following measures may help reduce nausea and vomiting:

 

50. Eat small, frequent meals
50. Encourage light foods such as biscuits, noodles, apple chunks and so on
50. In addition to daily drinks, cool fruit juices are available
50. Try to avoid spicy or greasy foods and exposure to strong odors
50. Encouraging children to sit up and eat can help reduce acid reflux

 

3. Diarrhea and dehydration

 

If your child has diarrhea, please inform the healthcare provider about the color, amount, and frequency of their bowel movements promptly, as frequent diarrhea can easily lead to dehydration. The doctor will assess the cause of the diarrhea and provide appropriate treatment. Simple measures, such as stopping certain medications, discontinuing nasogastric feeding, or adjusting the diet, often help alleviate diarrhea. In some cases, medication may be necessary to treat the diarrhea. These medications are generally well-tolerated and highly effective.

 

Here are some ways to help relieve diarrhea:

 

50. Eat soft, bland foods (such as bananas, rice, apple sauce, toast)
50. Drink plenty of warm water and eat small, frequent meals
50. Avoid spicy, fried and high-fat foods
50. Discuss with health care providers whether restrictions should be placed on the consumption of milk or dairy products
50. Encourage your child to drink small amounts of fluids frequently. While reading, watching a movie, or resting with your child, try giving your child a teaspoon of warm water or other liquid every few minutes

 

 

Fever, vomiting, and diarrhea can all lead to dehydration, especially when the body loses fluids that cannot be replenished by water intake. If your child's skin or lips are very dry, they don't cry with tears, or if they urinate less frequently, in smaller amounts, or with darker urine, they may be dehydrated. If your child shows any of these signs of dehydration, contact a healthcare provider immediately.

 

 

 

4. Constipation

 

 

Constipation refers to difficulty, discomfort, or delay in defecation when compared to a child's normal condition. For example, if a child usually has one bowel movement per day and does not have one for three days, it is important to inform a doctor or nurse. Constipation is a very common issue that can cause abdominal pain, nausea, vomiting, and diarrhea.

 

Constipation can be relieved by the following methods:

 

50. Encourage your child to increase fluid intake
50. Give a glass of pear juice or plum juice each day
50. Encourage physical activity such as walking to stimulate bowel movement
50. If the child is unable to drink a lot of fluids, try giving him or her foods high in water content (such as fruit) to help relieve constipation
50. Give your child foods high in fiber (fruits, vegetables, whole grains). If you're going to increase your child's diet, do it gradually
50. Take laxatives

 

Remember, if your child is taking opioid medications like morphine, they should also take stool softeners, as opioids are a common cause of constipation. If constipation cannot be managed with stool softeners and diet, you may need to use enemas or small enemas. These can typically clear the lower intestine and help restore normal bowel function. Once constipation is relieved, it's important to continue using stool softeners to prevent recurrence. Do not perform enemas or use enemas without a doctor's approval.

 

5. Weight loss and eating problems

 

In the later stages of palliative care, significant weight loss is very common. Watching one's child lose weight can be very distressing. There are many reasons for weight loss, such as pain, nausea, mouth ulcers, constipation, decreased appetite, anxiety, and depression. However, cancer itself is the primary cause of weight changes, though the exact mechanisms are not yet fully understood. As the disease progresses, the child's appetite will noticeably decrease.

 

Medical staff will closely monitor your child's weight. If your child is not eating enough, which could hinder their growth and health, the doctor may recommend that you supplement their nutrition through a feeding tube or intravenous infusion. A feeding tube (N.G. tube) can be inserted into the stomach from the nose, or a surgical incision can be made in the abdomen to insert a tube (stomach stoma or G-tube) into the stomach to provide a special nutritional solution. If your child vomits and cannot tolerate food, a special liquid called total parenteral nutrition (TPN) can be administered via intravenous injection.

 

Here are some tips to help your child maintain or gain weight:

 

50. Stock up on healthy foods your child likes
50. Give your child a snack or meal every two hours
50. Try to heat up more calories in foods that your child likes, such as adding more ice cream to a milkshake, peanut butter and jam on toast, or instant oatmeal in milk
50. Try not to let your child drink too much liquid during the meal, so that he or she will soon feel full
50. Cook foods with strong flavors to stimulate your child's appetite
50. Let your child help out with the cooking
50. Encourage children to be active before eating to improve their appetite
50. When your child is on a good appetite, encourage him or her to eat more
50. Keep food within easy reach of children

 

6. Weight gain

 

Some children need corticosteroid medications, such as prednisone or dexamethasone, to alleviate symptoms like headaches, vomiting, and the pressure caused by the brain tumor. Common side effects of steroids include fluid retention in body tissues, which can cause facial swelling and weight gain in children. They also stimulate appetite, leading to frequent eating. Children should eat healthy snacks multiple times a day and limit high-salt foods, as salt intake can increase fluid retention. These side effects usually disappear after stopping steroid medication.

 

Children are often very aware of changes in their appearance and may need the help of volunteers and occupational therapists to adapt to these changes. Parents and other family members also need to work hard to accept the changes in the child's appearance.

 

Respiratory symptom management

 

1. Difficulty breathing

 

Shortness of breath or difficulty breathing is more common in children with cancer. It's natural for kids to get anxious and distressed. Try to stay calm and use simple measures to help reduce anxiety and make breathing easier.

 

50. Changing the position from lying down to sitting can improve lung expansion
50. Using fans and opening Windows can increase air flow and improve indoor ventilation
50. For older children, encourage them to try deep and slow breathing
50. Playing relaxing music can also reduce anxiety and help maintain a slow breathing pattern

 

The causes of breathing difficulties include chest infections, airway obstructions, tumors in the lungs or chest wall, pain, anemia, and diaphragm pressure from abdominal tumors. Some conditions can be easily managed; for example, short-term antibiotics can treat chest infections, and pain medication can alleviate breathing difficulties caused by pain. If anemia is the cause of shortness of breath, a blood transfusion can help.

 

For children with lung tumors, oxygen therapy can help alleviate symptoms associated with low blood oxygen levels, such as headaches, dizziness, nausea, daytime sleepiness, and confusion. If long-term use is necessary, an oxygen generator can be installed at home, and a portable oxygen tank can be used when going out. Some patients only need oxygen therapy during physical activities, like walking or bathing. If oxygen therapy does not improve the child's quality of life and instead causes discomfort, it should not be used.

 

2. Coughing

 

Many conditions that cause breathing difficulties can also lead to coughing. Coughs can be triggered by irritation of the upper or lower respiratory tract, pleura, or diaphragm. Avoiding irritants, using antihistamine nasal drops, or taking antibiotics can help alleviate coughing. Simple cough syrup can soothe the throat and reduce irritative dry cough. Bronchial spasms or wheezing can also cause coughing, and using a spray may be helpful. For persistent dry cough in children, medications such as morphine might be necessary to suppress the cough. Occasionally, using morphine through a nebulizer can be beneficial.

 

 

Neurological symptom management

 

1. Muscle cramps

 

Children may also experience muscle spasms, which can be caused by prolonged inactivity, pain, or cramps. When children become less active and spend extended periods in bed, the occurrence of muscle spasms increases. Simple measures such as frequently changing positions on the bed, encouraging physical activity, and short-distance walking within their comfort zone can help. Medications can also be used to reduce or stop muscle spasms. Taking morphine can sometimes cause muscle cramps, but this issue is usually resolved by adjusting the dosage.

 

 

2. Epilepsy

 

As the disease progresses, epilepsy symptoms may also appear. Doctors and nurses will inform you if your child is at risk of having an epileptic seizure. The risk of seizures increases in the following situations: pre-existing epilepsy, brain tumors, leukemia cells in the cerebrospinal fluid, and changes in blood chemistry. Typically, doctors prescribe medication for these children in advance, and parents can administer the medication themselves if a seizure occurs at home.

 

Watching your child have an epileptic seizure can be very painful. However, knowing what to do during an epileptic seizure can greatly reduce the psychological stress.

 

50. Try to stay calm and remove any objects that could cause injury
50. If possible, turn the child to one side
50. Avoid putting fingers in the mouth of a child who is having an attack, which can cause bites
50. If you have a doctor's prescription for epilepsy, take it promptly, which will quickly relieve an attack
50. If you have a continuous seizure without prescription drugs, seek help from your local health care provider
50. Your child may need to be hospitalized for further monitoring and medication to prevent seizures

Clinical Department

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Examination & Diagnosis

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Clinical Management

Managing pain

 

The goal of pain management is to alleviate discomfort during rest and activity, and to ensure comfort during sleep. According to the World Health Organization (WHO) Cancer Pain Relief Program, medication is the primary method for pain relief. By providing the right medication, dosage, and timing, most pain can be effectively managed. Carefully monitoring the level of pain and the response to medication ensures timely adjustments. Parents, who can observe their children closely over long periods, play a crucial role in pain management. They are better equipped to recognize changes in their child's expressions and behavior, which may indicate pain or discomfort. If you are concerned about your child's pain, please contact the person managing your child's care.

Principles of pain management in WHO

 

 

The WHO has proposed the following principles for pain treatment in children: two-stage administration; administration according to appropriate routes; administration on time; administration according to individual specific needs.

 

 

The most convenient method of administration is through oral intake, in the form of tablets or liquids. Only when patients cannot take oral medication should other methods be considered, such as suppositories or intravenous injections. Intramuscular injections are generally not recommended for children due to the unreliable absorption of the drug and the pain associated with the injection. To achieve sustained pain relief, the medication should be taken regularly. For patients with mild pain, non-opioid drugs can be used as a starting point; however, most cancer pain patients require second-stage analgesics to achieve adequate pain management. In the second stage, opioids play a dominant role. For patients at any stage of pain, adjuvant treatments such as anti-anxiety medications or additional therapies like massage and electrotherapy can be used to enhance the effectiveness of pain management.

 

Non-opioid pain relievers

 

 

These drugs, also known as non-steroidal anti-inflammatory pain relievers (NSAIDs), are primarily used for mild pain management, including medications like ibuprofen and paracetamol. They are mainly used to treat somatic pain, such as bone metastasis pain or soft tissue pain. These drugs have a ceiling effect, meaning that after reaching a certain dose, further increases in dosage do not significantly enhance the pain relief. If the analgesic effect is unsatisfactory, stronger opioids may be necessary.

 

Opioid painkillers

       

 

Children with cancer often require stronger opioids, such as morphine and fentanyl, to achieve the desired effect. However, for various reasons, parents are sometimes reluctant to have their children start using morphine. They may fear that morphine can lead to addiction, cause fatigue and drowsiness in children, or even suggest that its use is a sign of impending death. Due to these misconceptions, the excellent pain-relieving effects of opioids are often not fully utilized, leaving many cancer patients to endure unnecessary suffering daily.

  

 tolerance

 

 

Drug resistance is a physiological change that occurs with prolonged use of opioid medications. However, in most clinical settings, the increase in dosage typically indicates a worsening of the cancer condition. Cases where an increase in opioid dosage is required due to drug resistance are not common. It is important to note that many patients experience adverse reactions, such as drowsiness and nausea, which can improve due to 'side-effect tolerance.'

 

 physiological dependence

 

 

Physiological dependence is also a physiological change under long-term opioid treatment. If the treatment is suddenly stopped or the dose is abruptly reduced, patients will develop withdrawal syndrome. But in fact, as long as it is used correctly, physiological dependence does not affect the use of opioids.

 

 addiction

 

 

Addiction is an abnormal psychological state that patients develop in response to opioid drugs, leading to drug abuse. Addiction is not a necessary outcome of opioid use; it depends on the user's psychological state and motivations. When patients exhibit issues with their medication use (such as overusing painkillers for sudden pain), this does not necessarily indicate an addiction tendency but is more likely due to inadequate pain management.

 

How to use morphine

 

 

Morphine is the preferred drug for treating moderate to severe pain in children, known for its relatively low cost and availability in various formulations. It can be administered orally, by injection, or as a suppository. Oral administration is the preferred method because it is easily absorbed and tolerated by most children and is convenient to administer at home. Typically, patients start with short-acting morphine liquid mixtures that provide rapid pain relief, given every 4-6 hours. Once the pain is well controlled, longer-acting sustained-release morphine formulations, such as tablets, capsules, syrups, or granules, can be used, once or twice daily. Sudden pain, characterized by sudden onset, short duration, and severe intensity, is more common in cancer patients. The first-line treatment for this type of pain is rapid-release short-acting morphine formulations or morphine intravenous injection.

 

Recording the use of painkillers daily can be very helpful for both children and their parents. This also helps doctors adjust the medication dosage based on the child's needs. When a child's pain worsens, it is crucial to contact healthcare providers promptly. Do not wait until morning to inform the doctor, as the child's discomfort may take longer to subside. To ensure the child's comfort, the dose of morphine can typically be adjusted. Generally, opioid drugs do not have a ceiling effect, meaning there is no upper limit to the dosage. By adjusting the dose, a better balance between pain relief and side effects can be achieved.

 

Side effects of morphine

 

 

All formulations of morphine may have side effects. However, when used correctly (such as with appropriate dose adjustments) and side effects are managed properly, opioids can be effectively used for pain management. Constipation is a major concern in opioid use. When children take morphine, it is important to prevent constipation by using laxatives, increasing physical activity, and consuming high-fiber foods. Other side effects, such as nausea and drowsiness, tend to lessen as the body adapts to the medication, but constipation does not improve over time. If nausea and vomiting occur at the start of morphine use, short-term antiemetics can be taken. Taking a breakthrough dose of morphine often results in drowsiness, which tends to diminish once the dose stabilizes. If itching occurs, antihistamines can be taken to relieve it.

 

How to use fentanyl

 

 

Fentanyl is another type of potent painkiller, available for direct injection or as a transdermal patch. For children, the more common method is using a transdermal patch every three days, which avoids the inconvenience of taking oral morphine regularly. The drug takes time to be absorbed through the skin, making it unsuitable for acute pain relief or for patients with fluctuating pain levels. Transdermal patches rarely cause constipation. Before switching to fentanyl, the child should have already adapted to a stable dose of morphine.

 

Non-drug management of cancer pain

 

 

For certain types of cancer pain, pediatric oncologists may recommend chemotherapy or localized radiation therapy. These treatments can be used alongside painkillers to effectively alleviate pain caused by tumor compression. After effective radiation therapy, the dose of morphine can typically be reduced. Some types of cancer pain are not responsive to opioids, especially when the pain is due to nerve compression. Other methods of pain relief may be more effective for this type of pain.

 

 physicotherapeutics

 

 

By utilizing various biophysical effects such as cold, heat, light, electricity, sound, and magnetism, physical therapy can effectively alleviate pain. You can purchase cold and heat packs from hospitals or pharmacies and apply them to the areas where the child feels uncomfortable. Massage and touch are simple yet effective methods for soothing. There are specific massage techniques for different body parts, including the head, shoulders, back, hands, and feet. Using gentle oils or lotions can make the massage more comfortable and relaxing. Inviting siblings or other relatives to join in the massage care of the child can create a special family bonding moment. Additionally, there are other physical therapy methods like electrotherapy, ultrasound, and interferential waves, which should only be performed after professional evaluation.

 

 movement

 

 

Walking and other gentle exercises can improve blood circulation and stimulate the production of endorphins, a natural painkiller produced by the body that combats chronic pain and makes people feel good.

 

 distract attention

 

 

Encourage children to engage in light-hearted and enjoyable activities, such as playing with friends, watching movies, or reading stories. Older children often benefit from relaxation techniques like deep breathing exercises, meditation, guided imagery, music therapy, and art therapy. These techniques help divert their attention from the pain of illness and provide them with a helpful tool to cope with stressful situations.

 

 

Anemia and bleeding management

 

1. Anemia (low red blood cell count)

 

Anemia occurs when bone marrow reduces the production of red blood cells, and hemoglobin (Hb), which carries oxygen in the blood, is low enough to fail to transport enough oxygen throughout the body. If anemia interferes with a child's daily activities and causes fatigue, headache or irritability, a blood transfusion may be needed.

 

Low hemoglobin may present with the following symptoms:

 

50.  tired out ​
50. Shortness of breath, rapid breathing
50.  headache
50. Heart rate is fast
50. The skin or gums are white
50.  dizzy

 

2. Blood transfusion

 

If your child needs a blood transfusion, the blood type will be the same as your child's. The blood will be given intravenously within a few hours by central venous catheter or intravenous injection. During the transfusion, medical staff will monitor your child to prevent adverse reactions.

 

Sometimes people worry about the risk of contracting HIV or hepatitis from blood transfusions. However, the risk of infection is very low. Each donor's blood is tested for infectious disease markers, including HIV, hepatitis, and other diseases. Any blood with positive markers will be discarded. Additionally, direct blood donation, where family members or friends donate blood, can also be considered. Research shows that direct blood donation does not necessarily make the blood safer. However, being willing to donate blood is always a good thing; it also makes friends and family feel they are doing something helpful. For more information on direct blood donation, consult healthcare professionals.

 

 

3. Bleeding (low platelet count)

 

Platelets stop bleeding by clotting, and children with bone marrow disease are likely to have persistent bleeding due to low platelet counts.

 

 

If your child has a low platelet count, he or she may show the following symptoms:

 

50. Bruising or petechiae (small red spots on the skin)
50. Nosebleeds, gum bleeding, or central venous catheterization bleeding
50. Black stools or black vomit (which may indicate gastrointestinal bleeding)

 

Doctors determine the treatment plan based on the location of the bleeding and the child's overall health. Blood platelet transfusions may be suitable for certain conditions, and other treatments can be considered for minor bleeding. For children living in rural areas, it can be challenging to obtain blood platelets quickly. For these children, regular blood platelet transfusions once or twice a week can help maintain platelet levels and prevent bleeding.

 

4. How to stop the bleeding

 

If your child has a nosebleed, ask him to sit up straight and press his nostrils with his finger for 10 minutes. If the bleeding does not stop, inform the medical staff immediately.

 

 

If your child has a low platelet count, they should avoid sports that involve physical contact, such as football or rugby. Use a soft-bristled toothbrush to prevent gum bleeding. Unless advised by a doctor, do not give your child aspirin (salicylate) or ibuprofen (Motrin®, Advil®, or PediaProfenTM). These medications can interfere with the normal function of platelets. Some over-the-counter medications, like cold and flu remedies, also contain aspirin or ibuprofen. Before giving any over-the-counter medication to your child, read the instructions and consult a healthcare provider. Do not give your child an enema or use suppositories (medications inserted into the rectum), nor measure the rectal temperature. Inserting anything into the rectum can cause bleeding.

 

 

Other symptoms of cancer treatment

 

1. Hair loss (alopecia)

 

Some chemotherapy and head radiation therapy can cause hair loss or thinning. Hair loss symptoms may start 7 to 10 days after treatment begins. Sometimes, all hair, including eyelashes, eyebrows, armpit hair, and pubic hair, can be completely lost. Some children and parents choose to cut their hair as short as possible once hair loss starts. Others opt to shave their heads to prevent further hair loss. Many children wear hats or scarves, or buy wigs until their hair regrows. If needed, you can help your child purchase a wig or head accessory.

 

Hair usually begins to regrow when cancer treatment is reduced or stopped. The color and texture of a child's hair may be slightly different from before cancer treatment (it may become more curly, denser, or thinner). In some cases, especially after high-dose radiation therapy, hair in the treated area may not grow back.

 

 

2. Fatigue

 

Many children with cancer feel tired during and after treatment. Children may say they are tired or weak. Many factors can cause fatigue:

 

50. Cancer treatment (surgery, chemotherapy, radiotherapy)
50. The blood cell count was too low
50.  innutrition
50.  have  a fever
50.  pain
50.  sleep debt
50. Poor sleep quality
50. Anxiety or depression
50. Trying to do too much
50. The body lacks activity

 

3. Fatigued care

 

If your child is feeling tired, please tell the doctor. There are many things you can do to help your child overcome fatigue:

 

50. Encourage your child to be physically active as much as possible. If necessary, ask a therapist to help set up an exercise program to help your child build strength and endurance
50. If your child has a poor appetite, give him or her healthy food every 2-3 hours while he or she is awake
50. Make every snack as nutritious as possible
50. Let your child consume caffeine
50. Get your child to bed on time
50. Get your child enough sleep every night
50. If your child's pain is affecting sleep, contact a healthcare provider

 

4. Side effects of cancer treatment in the later stage

 

Years after cancer treatment, side effects may still occur, such as damage to the kidneys, liver, lungs, heart, brain, and reproductive organs, or a recurrence of cancer. The risk of late-side effects depends on the type and dosage of the treatment your child received. As your child grows, it is important to regularly consult with cancer specialists for follow-up examinations, which should continue even into adulthood. These follow-ups include regular monitoring for late-side effects. After your child completes their treatment, ask your doctor for a record of their cancer treatment. This record will help other doctors understand the specific long-term side effects to watch out for in the future.

Prognosis

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Follow-up & Review

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Daily Care

Home care devices

 

For older children and those with mobility issues, using medical devices at home can be very helpful. Using wheelchairs or strollers can make it easier for children to leave the house and participate in activities. When children spend a lot of time in bed, soft mattresses or wave-patterned mattresses can help prevent excessive pressure on certain body parts. For older children, using medical beds is more convenient because the height and backrest angle can be adjusted. Bathing chairs, toilet chairs, and commodes can make bathing and using the toilet easier. It is often beneficial to discuss with nurses or occupational therapists how to use medical devices at home.

Cutting-edge therapeutic and clinical Trials

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References

 reference material ：

 

1. Sunflower Family Handbook

2. https://www.caresearch.com.au/QuoCCA/Portals/6/Documents/Palliative-Care-for-Children-with-Cancer.pdf

3. http://www.nhri.org.tw/NHRI_ADM/userfiles/file/tcog/pain.pdf

 

4.http://apps.who.int/iris/bitstream/handle/10665/44540/9789241548120_Guidelines.pdf;jsessionid=40ECD10059DAC1A65E48FB47235C0649?sequence=1

Audit specialists

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