1. What is an infection?

Infections are a common and dangerous complication children receiving cancer treatment can fall prey to. An infection means the invasion and growth of germs in the body, such as bacteria, viruses and fungi. It can appear anywhere in the body and spread to different parts.

2. Why are infections more common during cancer treatment?

Usually, the body has an immune system that prevents infections and fights against diseases. However, this immune system can get damaged by the cancer itself or by the cancer treatment. If the body’s immune system is not behaving properly, children can get severe infections. 

Stress, poor nutrition, and insufficient sleep can also weaken the immune system, making infections more likely.

If we do not catch the infection early and treat it, it can be dire, and the child can die of the illness. Sometimes, even with the available treatment options, a child with cancer can die because of an infection, as germs are very resistant to currently available treatment. 

3. What is Neutropenia?

Neutropenia means a low neutrophil (a type of white blood cell) count. It is also referred to as having a low ANC (Absolute Neutrophil Count). Neutrophils are the body’s primary defence against infection. Neutropenia is a frequent side effect of cancer treatment and increases your risk of diseases.

4. How do I know if my child has neutropenia?

Your child’s cancer doctor will let you know when you should do a blood test after chemotherapy. It will tell you if your child is neutropenic. Approximately 7-12 days after each chemotherapy dose (cycle), the number of white blood cells in your child’s body will be at its lowest. This is called the Nadir period. It usually lasts for 5-7 days. During this time, your child will show the highest chances of infection. 

After the Nadir period, your child’s blood cell count will rise, decreasing the risk of infection. The doctor will only give the next dose of chemotherapy after their blood counts have recovered to a safe level. 

 This period varies depending upon the chemotherapy drug or combination of chemotherapy drugs given. Therefore, you should carefully observe for signs and symptoms of infection during this time. 

5. Does my child need to take any medicine during cancer treatment to prevent infection? 

To support your child immune system during chemotherapy, sometimes your doctor may prescribe an injection that will help your child’s body make more white blood cells. In addition, your doctor may give you medication to prevent infection in some situations. 

6. How do I recognize infection in my child?

An infection can cause any of these signs and symptoms:

• Fever > or =100.5 °F (38 °C) 
• Cough or sore throat
• Chills
• Diarrhea
• Ear pain, Headache or Sinus pain 
• Stiffness or Soreness in the neck
• Skin rashes
• Sores or white coating in your mouth or on your tongue
• Swelling or redness, especially where the catheter enters your body
• Urine that is bloody or cloudy, or pain on urination

7. What should parents do when they suspect an infection in children?

Infections during cancer treatment can be life-threatening and require urgent medical attention. You should immediately phone the doctor if your child develops a fever or is not feeling well. 

8. Should I take paracetamol to control pain while my child is on chemotherapy?

Paracetamol can be used to control fever and pain. Fever is a symptom of infection and warrants assessment by a doctor urgently. Antibiotic is given in most of the cases during chemotherapy treatment. If paracetamol is used to control pain, it may suppress the fever, so you may miss signs of the infection. Therefore, it is better to avoid paracetamol as pain medicine in children undergoing cancer treatment. 

9. How can I prevent infection?

• Wash your hands often and well. 
• Routine handwash requires hands to be thoroughly lathered for 10-15 seconds and then washed in running water. You should then thoroughly dry them with a “dry” towel.
• Make sure people around you wash their hands well too.
• Stay extra clean. If your child has a central line (Port A Cath), keep the area around it clean and dry. 
• Clean your child’s teeth well and check your child’s mouth for sores or other signs of infection each day. 
• When diagnosing cancer, make sure that a Dental doctor checks your child’s teeth to ensure that teeth with potential risks of infection are treated.
• Inform your doctor or nurse if your child’s bottom is sore or bleeding, as this could increase your risk of infection.
• Stay away from sick people or those with colds.
• Avoid crowds
• Avoid children who have just had a live vaccine, such as one for measles or polio.
• Follow food safety guidelines; make sure the meat, fish, and eggs your child eats are well cooked. 
• It is much better if your child eats fruits and vegetables that can be peeled or can be cooked well. 
• Use a suitable antimicrobial skin cleanser. 
• Vacuum cleaning is recommended over brooming to prevent the dispersal of dust.
• Patients with a low white cell count should be in a private room as much as possible. Any person entering the room should wear a mask, and people with respiratory infections should not be allowed inside. Plant and flowers should not be allowed in the room. The patient should wear a mask when travelling to other areas of the hospital.

10. What are the precautions one can take during intravenous injections? Should children with cancer on therapy be given vaccines?

These children are immunocompromised, so live vaccines should not be given during chemotherapy. Instead, all children should have routine childhood vaccinations six months after completing chemotherapy.