The Child Life Specialist
Your Child Life Specialist at Children's Hospital has spent time working with children who have cancer, as well as those who are getting a BMT. You probably already know her from previous stays in the hospital. Part of her job is to help your child and your family understand what will happen during the transplant admission. Your Child Life Specialist will spend time with you before your child is admitted to help you to prepare for staying in the hospital for a few weeks.
She will give you some suggestions on items to bring from home to make your child's hospital stay a little less stressful. We want your child to feel as comfortable as possible during this time so some favorite items from home will be important to bring. When you arrive for the transplant admission, your child will receive a bag of goodies. This will include all kinds of craft supplies (crayons, markers, scissors, glue, paper, etc). You will not need to bring these items from home.
Your Child Life Specialist will also work with you to help your child comply with some of the medical tasks (mouth care, dressing changes, taking medications, etc.), which must be completed daily. It will be normal for your child to experience some behavioral changes while admitted for the BMT. She will be there to assist you with managing these changes.
Once admitted, your child will be isolated in the room to reduce the risk of infection. Your Child Life Specialist will arrange for private playroom sessions daily while your child's ANC remains above 500. Once the ANC drops below 500, she will provide your child with activity time in the room. This will allow you to take frequent breaks.
Everyone on the BMT team is committed to helping your family get through this difficult process. Your Child Life Specialist will visit your child every day during your admission. If you are having any questions or concerns about how your family is coping emotionally, please be sure to talk to her.
Write to UPMC Children's Hospital of Pittsburgh's BMT team via e-mail at BMTkids@chp.edu or call 412-692-6740.
During and After Infusion
A blood and marrow transplant is much more like a blood transfusion than like a solid organ transplant. Unlike other types of transplants, the patient does not go through a surgical procedure, and general anesthesia is unnecessary. Instead, the patient is awake as stem cells are given through a tube inserted into the vein. An allogeneic transplant uses freshly harvested stem cells. An autologous BMT–or cord blood transplant–uses frozen-thawed stem cell product that contains DMSO, a preservative used to protect the cells during freezing. This technique is well established, safe and widely practiced. In general, stem cell infusion is relatively uneventful or associated with mild symptoms. Patients receiving autologous infusions may experience greater side effects during the infusion due to the DMSO. During the infusion, your child may experience any or all of the following symptoms:
- Nausea and vomiting
- Chills
- Fever
- Hives
- Chest pain
- High or low blood pressure
- Change in heart rate or rhythm
Most of these side effects are transient and treatable. Patients are frequently given pre-medications to reduce the risk of reactions. Your child will be closely monitored during and immediately following the stem cell infusion.
When will my child be discharged?
Your child will likely spend several weeks in the hospital. The decision when to discharge your child following transplant is based on several factors. The child should:
- Have recovered from infections and other complications
- Not require intensive medical care or monitoring
- Be relatively transfusion independent
The decision to discharge a child is made by the BMT team and by the family, who must be comfortable with caring for their child in the outpatient setting.
After being discharged from the hospital, recovery continues at home. Sometimes, a transplant patient is required to stay within a certain distance or travel time from our facility to ensure safety should any complications arise. Staying at the Ronald McDonald House or a similar care facility may be an option. Some children will continue to receive intravenous nutrition or other medications at home. Prior to discharge, care coordinator and home health care agencies become involved and help families prepare for continuing care at home.
Although your child will be well enough to leave the hospital, recovery will be far from over. For the first several weeks your child may be too weak to do much more than sleep, sit up and walk a bit around the house. Frequent visits to the clinic will be required to monitor progress and to administer any medications and/or blood products needed. The frequency and duration of the visits will be determined by your child's transplant team.
See Minimizing the Risk of Infection for information about preparing your home for your child's arrival.
