Bone Marrow

To prepare for the transplant, your child will need a central line inserted, which will stay in place for several months. This line is used for administering blood tests, treatments, and medications. While it won't interfere with your child’s daily activities like attending school, swimming will be restricted.

Your child will receive preparatory treatment before the transplant. This treatment can range from a few days to two weeks and may include chemotherapy, radiotherapy, or both.

• Chemotherapy involves special medications that are either administered through the central line or taken orally to target and destroy any malfunctioning cells in the body, including the bone marrow cells, to make way for the new, healthy bone marrow cells.
• Radiotherapy is not given to all children who have a bone marrow transplant. Radiotherapy is a special kind of X‑ray whose job it is to kill any cells in your body that don't work properly and to destroy your bone marrow. Having radiotherapy does not hurt. It is very important that your child keeps still for his / her radiotherapy which will last about 20 minutes. No one else can stay in the room with your child while he / she has his / her radiotherapy but they can usually see and hear you on a special television screen.

The need for chemotherapy and radiotherapy will be decided by your doctor and will be discussed with you in detail.

Chemotherapy and radiotherapy can cause temporary hair loss about 2 weeks later, including eyebrows and eyelashes. Many children choose to have their hair cut short before treatment or wear a wig, cap, or hat until their hair grows back, which typically takes 3-6 months. Sometimes hair can be a bit darker or a bit lighter when it grows back.

Chemotherapy and radiotherapy can make your child's mouth sore and may cause nausea. To help manage this:

• Encourage your child to drink small sips of water or suck on ice cubes.
• Maintain good oral hygiene. We would like your child to clean your teeth 3‑4 times a day with a soft toothbrush and toothpaste. If mouth sores make brushing difficult, special sponges can be used instead.
• Inform the nurses if your child feels sick or has mouth pain so they can provide the necessary treatments to ease discomfort.

If your child has trouble eating, they may require a feeding tube to get the nutrition they need. The tube could also be used for medicines which can really help your child. If the feeds make your child too sick, special feeds (TPN) may be administered through a Hickman line. A feeding tube is essential during recovery to keep your child strong.

During the recovery phase, your child’s bone marrow will be destroyed, leading to a lower white blood cell count and a weakened immune system. To protect against infections:

• Your child will stay in a private room, rather than sharing with other children, to minimize exposure to germs. 
• A family member will be able to stay with your child to help with care.
• Daily Seitz baths (sitting in a tub for 15-20 minutes) are recommended for hygiene and comfort.
• Your child's hair will start growing back after a few months. 

Certain foods may not be allowed during the transplant period, as they could cause digestive upset. Your child will probably not be able to eat the skin on fruit, a half boiled egg, etc. A list of recommended foods will be provided by the hospital’s dietitians, and the nurse will guide you on which foods are safe for your child.

As your child’s new bone marrow begins to function, they will gradually be able to interact more and leave their room. The doctors and nurses will monitor blood counts to determine when it is safe for your child to have visitors or leave their room. If an infection is present, your child may need to stay in isolation for longer.

At home, your child will need to continue taking medications. You may be able to choose between liquid or tablet forms. Please ask if the options aren’t provided.

After leaving the hospital, your child will have regular check-ups to monitor recovery and prevent complications. Your child may need to stay on special medications if they experience side effects such as rashes or digestive issues. Sometimes you may have to come back into hospital for a few days in case of any problem.

Once your child leaves the hospital, it’s important to limit exposure to germs:

• Keep visits to a few close friends who are healthy and free of infections.
• Avoid crowded places like shopping malls for the time being.
• Short walks outside in fresh air are encouraged if your child feels strong enough.
• School attendance may be delayed for a few months. Initially, your child may return for half-days or a few hours at a time.
• Your child will likely feel tired, especially if they have undergone radiotherapy. This is normal, and with time, their energy levels will improve.

Once your child no longer needs the central line for blood tests or treatments (usually around 3-6 months after the transplant), it will be removed. At that point, your child can resume swimming and enjoy regular baths.