How do I keep my child healthy after transplant?
When to Call the Doctor/Clinical Nurse Specialist
- If your child repeatedly vomits medicine after it is given
- If several medication doses have been missed
- If too much medicine is accidentally given
- If your child has any of the side effects mentioned
- If your child is vomiting or had diarrhea (more than five runny stools)
- If your child has any symptoms of rejection.
- If your child has a temperature of 101 degrees (F) or greater.
Nutrition
Your child now has a healthy liver and should be able to digest foods high in fat. Decreasing the salt (sodium chloride) in your child’s diet may help to decrease some water gained after the transplant. Limit salty foods and do not add salt to foods already prepared. If your child’s physician orders a specific salt-restricted diet, your dietician can provide written guidelines.
If your child was eating poorly before the transplant, it may take some time before he will reach an optimum state of well-being As long as your child is eating a reasonably balanced diet containing foods from the food guide pyramid (meat, bread, dairy, fruits and vegetables), then you know he has a healthy diet. A well-balanced diet with enough calories and a standard multi-vitamin (e.g. Flintstone’s, Bugs Bunny) may be all your child needs.
Steroids (Prednisone) may cause your child to have an increased appetite and weight gain. Do not allow your child to get into the habit of overeating. As the steroid dose decreases, his increased appetite should become less of a problem.
A few points to remember about meals and snacks:
- Children often eat better when they are not urged or tired.
- Usually, small children prefer small portions with second helpings, rather than one large serving.
- Suggestions to increase your child’s intake of high calorie foods include offering nutritious snacks such as raisins, cheese and granola, adding non-fat milk to other foods (whole milk, casseroles, puddings) and generously using foods such as mayonnaise, creamed sauces, dressings, margarine/butter, cream cheese and peanut butter.
Activity
Your child can return to his normal activity level almost immediately. However, he should avoid contact sports and vigorous exercise for at least three months after the transplant surgery. Many children have weak muscles due to chronic liver disease. In fact, many children with liver disease have motor delays. After transplantation you should notice a gradual improvement.
Dental Care for Your Child
All children should receive regular preventive dental care after the primary teeth are in place. Children with liver disease may have some staining of the primary teeth or permanent teeth. Regular preventive care of the teeth will not remove the discoloration. More frequent dental visits may be required to prevent gingival hyperplasia (overgrowth of the gums), especially in children who are taking Cyclosporine or Nifedipine. Inform the dentist of your child’s transplant history and obtain antibiotics prior to routine (teeth cleaning) or invasive procedures (filling a cavity). Your dentist can consult with the transplant office regarding the protocol.
Sun Exposure
Because your child is on immunosuppressants they are at higher risk for developing skin cancer Apply an effective sun screen year round on all exposed areas. The sun screen should have a minimum sun protection factor (SPF) of 30. Reapply the lotion frequently if they are swimming. Avoid exposure to the sun between 10 a.m. and 2. p.m.
Medical Alert
A medical alert application will be provided prior to discharge. It is very important for your child to wear a medical alert bracelet or necklace at all times.
Immunizations
Young children will need to continue to receive regular immunizations. They should not receive live virus vaccines such as oral polio, chicken pox, flu mist or the MMR. Siblings should also not receive live vaccines
Childhood Illnesses
Many children have not had chicken pox prior to transplantation. Chicken pox can be a serious illness for your child because he is immunosuppressed. Chicken pox is spread through the air or by close contact with someone who has the virus. A person with chicken pox is contagious 1-2 days before the rash develops. The contagious period lasts until all of the pox have developed a scab. If your child is exposed, they may develop chicken pox from 14-21 days after the exposure. Chicken pox often begins with a fever and a splotchy rash on the trunk that spreads downward. The rash consists of small watery blisters with red rings around them. If your child is exposed to chicken pox notify the transplant office immediately.
Behavioral Changes
It is not unusual for children to become very demanding after you return home. Your child probably received a lot of attention during the illness and hospitalization. It may take some time before your child realizes he does not need to be the center of attention.
After transplantation, your child will have a higher energy level. They may behave aggressively to act out feelings of fear, frustration or loss of control experienced in the hospital. Some children have fears about the incision and worry about their body not being intact. To help deal with fears, medical play in the hospital and at home may be helpful.
Proper limit setting and appropriate disciplinary measures should help your child adjust.
Return to School and Daily Routine
During clinic visits, parents will be advised when to send children back to school. In the meantime, contact the school and obtain home tutoring. Discuss with your physician the appropriate activity and return to physical education and sports after transplantation. At the time of discharge, avoid large crowds at the mall, church and grocery store.
Because of changes in physical appearance some children experience teasing on their return to school. Try to be as supportive as possible and help the child or teen to feel confident enough to handle the teasing.
