Leukemia — Part 3
Physical/dietary/other restrictions
Physical restrictions will vary from person-to-person. The doctor and
health care team will let the person know what, if any, physical restrictions
they should observe. If the patient has a central line, or intravenous
catheter, precautions should be taken to ensure that it does not become
dislodged or kinked. When platelets are low, the health care team may
recommend restricted physical education and recess activities. Other limitations
may be suggested to help prevent catching an infection, such as staying
away from large crowds, using good hand washing techniques, and others.
However, it is important for young people with leukemia to do as much
as possible throughout their treatment.
It is important for a person on treatment for leukemia to try to eat
well during the cancer therapy. They will need enough calories to maintain
a good weight and enough protein to keep up strength. Good nutrition can
help the person feel stronger and more energetic. However, it is sometimes
difficult to eat well during treatment due to the side effects of medications.
The doctor or dietitian may be able to offer suggestions to help maintain
a healthy diet. If a person receives a stem cell transplant, some foods
may be restricted to control exposure to bacteria. Again, the doctor is
your best source for more information.
Implications for school
The presence of a leukemia may result in significant implications for
a child in school, and the management of leukemia at school has several
facets. Educators must consider the physical, psychosocial and cognitive/educational
issues of this diagnosis in order to ensure that the young person with
a leukemia is successful at school.
The physical aspects of leukemia must be addressed at school. The following
accommodations and adaptations may be warranted for a child with leukemia.
- Due to the possibility of fatigue, a child with a brain tumor
may need to rest during the school day. It is usually best to do this
in the nurse’s office, or in a location away from the other students
in order to not increase peers’ feelings that the child is different.
- Restroom privileges should be flexible and on an “as needed”
basis.
- Exercise may benefit the child with leukemia by helping to increasing
muscle strength. The child with leukemia should be encouraged to participate
in all physical activities at school. From day to day, the child may be
limited in how much he/she can do or the duration of time that he/she
can participate in physical endeavors. There may be times, due to steroids,
that the child has difficulty with movement as a result of weight gain
and fluid retention. The child should be encouraged to do as much as possible,
and allowed to set his/her own limits for physical activity.
- Physical stamina should be evaluated by the school nurse, and
any modifications or accommodations that are indicated should be incorporated
into the student’s IEP.
Psychosocial concerns for the student with leukemia may be significant.
Due to frequent absences, frequent infections and limitations on physical
activity, young people with leukemia struggle with issues of “fitting
in”. They may feel left out by their peers, or struggle with keeping
up socially as they flow in and out of school. In order to help facilitate
healthy psychological, emotional and social adjustment, the school should
consider:
- Educating peers, with the consent of the child and parents, about
leukemia. The hospital school teacher is a good resource for offering
a presentation, suggesting materials, or assisting with the education
of educators, peers or other interested community members.
- Encourage peers to stay in contact with their friend when he/she
is absent. Cards, letters and phone calls can serve to bridge the gap
when youngsters with chronic illnesses must be away from school and activities.
- This is a wonderful opportunity to teach peers about supporting
a friend, how to show compassion and other essential life lessons.
- Identify strong peers to mentor the student with leukemia when
he/she returns after an absence. Having someone to “fill you in”
on what you missed while hospitalized or home ill may make all the difference
in facilitating a good reentry.
- Help the student find areas of expertise and ways to excel in
the school environment. Mentoring support could be included in the IEP
to help the young person maintain or develop a strong self-concept.
- Including social work or counseling services as part of the IEP.
Having someone at school to talk to or act as an advocate for the youngster
with leukemia can be a significant asset. The student may need the opportunity
to discuss his/her fears about dying or about the future in general, keeping
up in school, socialization issues, concerns about other family members,
etc.
Part 3 — Restrictions and implications for school
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305