Caring for Your Child with Cancer at Home

What do I need to remember about low white blood cell (WBC) counts?

  • Your child is neutropenic when the Absolute Neutrophil Count (ANC) is low.
  • Children are at an increased risk for infection when they are neutropenic.
  • The ANC needs to be higher than 500 for your child to best fight infections.
  • Call the oncology team if your child has any general signs of infection:
    • Fever and/or chills
    • New or worsening cough
    • New or worsening pain, including pain with urination or while having a bowel movement
  • Your child may have a central line. Call the oncology team if your child has signs of infection at the central line site:
    • Redness, swelling, pain, and/or pus
    • Shaking/chills when the central line is flushed
  • Remember to clean your hands often!

What do I need to remember about hemoglobin and platelet counts?

  • Although a low hemoglobin and low platelet count are expected side effects of cancer treatment, this may be dangerous for your child.
  • When the platelet count is low, your child is at an increased risk for bleeding.
  • Do not take your child’s temperature rectally.
  • Do not give your child rectal suppositories or enemas.
  • Do not give your child ibuprofen (Motrin) or aspirin, unless directed by your healthcare team.

Be aware of any signs or symptoms of low hemoglobin and low platelets. Call the oncology team if your child has any of these signs or symptoms or if you have any concerns about your

Signs of low hemoglobin:

  • Headache
  • Tiredness
  • Shortness of breath
  • Increased heart rate
  • Pale skin or gums
  • Dizziness

Signs of low platelets:

  • Bruising
  • Petechiae (very small red-purple dots on the skin)
  • Nosebleeds or bleeding gums
  • Black or bloody stools
  • Bloody or red-brown vomit
  • Bleeding around the central line site

What should I keep in mind if my child has a fever?

  • Fever is often the first sign of an infection.
  • Children who are neutropenic can become very sick, very fast.
  • Always call when your child has a fever:
    • Fever of 101.3 F (38.5 C) once, or
    • Fever of 100.4 F (38 C ) three times in a 24 hour period, taken at least 2 hours apart
  • Please do not give acetaminophen (Tylenol) until you talk to the healthcare team.

Important points about infection prevention

  • Hand washing is the most important way to prevent infections.
  • Stay away from people who are sick and avoid large crowds (like malls or movie theaters); especially when your child’s blood counts are low.
  • Ask all visitors and playmates if they have a fever, runny nose, cough, vomiting, diarrhea, or rash.
  • Do not allow sick visitors to come to your home.
  • Keep your child’s skin clean and moisturized; use sunscreen (SPF 30 or higher).

What are the important points about gastrointestinal (GI) side effects?

  • Dehydration due to vomiting, diarrhea or drinking less may cause your child to be admitted to the hospital for IV fluids.
  • Call the oncology team if your child is unable to drink enough liquids to urinate 5-6 times a day. Your child’s urine should be a clear yellow color.
  • Constipation can cause your child to be admitted to the hospital. Call the oncology team if your child has not had a bowel movement in 2 days, or is complaining of pain with bowel movements.

Call your oncology team if you are concerned about any symptoms your child may have or if your child seems ill

  • Call 911 for all emergencies
  • Call the Oncology Triage Nurse at 215-590-2299, 8:30am-5:00pm, 7 days a week (including holidays)
  • After hours: Call the hospital operator at 215-590-1000 and ask for the Oncology Fellow On-Call
  • For Voorhees, call 856-435-7502
  • For King of Prussia, call 267-425-8800

Written 9/11, Revised 5/17

©The Children’s Hospital of Philadelphia 2017. Not to be copied or distributed without permission. All rights reserved.

Patient family education materials provide educational information to help individuals and families. You should not rely on this information as professional medical advice or to replace any relationship with your physician or healthcare provider. 

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