Considerations at School
Going to school is an important part of a child’s life. School reentry after a diagnosis of childhood cancer is an important step in returning to their normal routine. Although there are some inherent risks of infections and “catching something”, the benefits of attending school far outweigh the risks. Maintaining friendships and routine interactions with peers are essential to normal psychological development and are as, or more important than academic issues.
A child with cancer will have many physical changes that will be noticeable. These include hair loss, nausea/vomiting, decrease energy levels/fatigue and an increase potential for bruising and nosebleeds. Some temporary changes include weight gain or loss, mood swings, facial fullness, problems with coordination, difficulties with fine and gross motor control, muscle weakness and body marks resembling tattoos, which identify sites of radiation.
Most children will have a central venous access device (CVAD). These devices permit the delivery of chemotherapy, medications, blood and blood products. They are also used for blood sampling as needed. These devices are placed on the chest and are available in two main types: external tunneled catheters and implanted subcutaneous ports. The external tunneled catheters will have tubing that exits from the chest. There will be a sterile occlusive dressing covering the exit site from the chest. An implanted subcutaneous port will appear as a bump under the skin but will not have any visible parts. More information about CVAD
Many children undergoing treatment for cancer may have fatigue, which they describe as feeling tired, weak or sad. The fatigue may be severe enough that the child needs a nap during school time or is only able to attend for half days.
Often the child can not fully participate in physical activities due to their fatigue, but they should be encourage to do as much as they feel they can.
Guidelines for school personnel
School personnel should establish contact with the oncology team and the parents to identify specific needs for any child who is receiving treatment for cancer. However the following guidelines may provide some guidance:
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When a child runs a fever of >101F, they must seek medical attention immediately.
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Exposure to chicken pox which is defined as being in the same room with an individual for at least 1 hour who is in the contagious time. The contagious time starts 2 days before the pox appear on the skin through the first 5 days of breakout.
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Active bleeding that includes nosebleeds, bruising, pink, red or brown urine, red or black “tarry” stools, or “coffee ground” vomit.
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Central line problems which include any pus, swelling or redness around the site. If you notice leaking or a break in the external tubing, clamp the tubing between the leak and the child.
Karen Stormer, RN, Children's Medical Center, Dayton, OH
