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Thirteen percent do not reveal the relationship until it is clear that cohabitation and or remarriage is likely pulse pressure deficit indapamide 2.5mg without prescription. Anderson and colleagues suggest that practical matters influence which gatekeeping method parents may use arteria testicularis indapamide 1.5 mg amex. Parents may be able to blood pressure 88 over 60 generic 2.5mg indapamide free shipping successfully shield their children from a parade of suitors if there is reliable childcare available blood pressure chart cholesterol cheap 1.5mg indapamide amex. The age and temperament of the child, along with concerns about the reaction of the ex-spouse, may also influence when parents reveal their romantic relationships to their children. Rates of remarriage: the rate for remarriage, like the rate for marriage, has been declining overall. This represents a 44% decline since 1990 and a 16% decline since 2008 (Payne, 2015). Brown and Lin (2013) found that the rate of remarriage dropped more for younger adults than middle aged and older adults, and Livingston (2014) found that as we age we are more likely to have remarried (see Figure 8. This is not surprising as it takes some time to marry, divorce, and then find someone else to marry. However, Livingston found that unlike those younger than 55, those 55 and up are remarrying at a higher rate than in the past. In 2013, 67% of adults 55-64 and 50% of adults 65 and older had remarried, up from 55% and 34% in 1960, respectively. Livingston (2014) reported that in 2013, 64% of divorced or widowed men compared with 52% of divorced or widowed women had remarried. This gender gap has closed mostly among young and middle aged adults, but still persists among those 65 and older. In 2012, Whites who were previously married were more likely to remarry than were other racial and ethnic groups (Livingston, 2014). Moreover, the rate of remarriage has increased among Whites, while the rate of remarriage has declined for other racial and ethnic groups. This increase is driven by White women, whose rate of remarriage has increased, while the rate for White males has declined. Success of Remarriage: Reviews are mixed as to the happiness and success of remarriages. While some remarriages are more successful, especially if the divorce motivated the adult to engage in self-improvement and personal growth (Hetherington & Kelly, 2002), a number of divorced adults end up in very similar marriages the second or third time around (Hetherington & Kelly, 2002). Remarriages have challenges that are not found in first marriages that may create additional stress in the marital relationship. There can often be a general lack of clarity in family roles and expectations when trying to incorporate new kin into the family structure, even determining the appropriate terms for these kin, along with their roles can be a challenge. All of this may lead to greater dissatisfaction and even resentment among family members. Even though remarried couples tend to have more realistic expectations for marriage, they tend to be less willing to stay in unhappy situations. The rate of divorce among remarriages is higher than among first marriages (Payne, 2015), which can add additional burdens, especially when children are involved. Goldscheider and Sassler (2006) found children residing with their mothers reduces the mothers likelihood of marriage, only with respect to marrying a man without children. There is also some evidence that individuals who participated in a stepfamily while growing up may feel better prepared for stepfamily living as adults. Goldscheider and Kaufman (2006) found that having experienced family divorce as a child is associated with a greater willingness to marry a partner with children. Greene, Anderson, Hetherington, Forgatch, and DeGarmo (2003) identified two types of parents. In contrast, the adult-focused parent expects that their child can adapt and should accommodate to parental wishes. Anderson and Greene (2011) found that divorced custodial mothers identified as more Source adult focused tended to be older, more educated, employed, and more likely to have been married longer. Additionally, adult focused mothers reported having less rapport with their children, spent less time in joint activities with their children, and the child reported lower rapport with their mothers. Lastly, when the child and partner were resisting one another, adult focused mothers responded more to the concerns of the partner, while the child focused mothers responded more to the concerns of the child. Understanding the implications of these two differing perspectives can assist parents in their attempts to repartner. Grandparents In addition to maintaining relationships with their children and aging parents, many people in middle adulthood take on yet another role, becoming a grandparent. In multigenerational households, grandparents may play a greater role in the day-to-day activities of their grandchildren. While this family dynamic is more common in Latin America, Asia, and Africa, it has been on the increase in the U. In developed nations, the greater mobility of the society can mean that grandparents may live long distances from their grandchildren. Technology has brought grandparents and their more distant grandchildren together. Sorenson and Cooper (2010) found that many of the grandfathers they interviewed would text, email, or Skype with their grandchildren in order to stay in touch. Thirty percent of grandparents were remote as they rarely saw their grandchildren. Usually they lived far away from the grandchildren but may also have had a distant relationship. Fifty-five percent of grandparents were described as companionate as they did things with their grandchildren but had little authority or control over them. The involved grandparent had frequent contact with and authority over the grandchild, and their grandchildren might even have lived with them. In contrast, more grandfathers than grandmothers saw their role as family historian and family advisor (Neugarten and Weinstein, 1964). Bengtson (2001) suggests that grandparents adopt different styles with different grandchildren, and over time may change styles as circumstances in the family change. Today more grandparents are the sole care providers for grandchildren or may step in at times of crisis. With these changes grandparents are redefining how they see their role in the family with fewer adopting a more formal role (Hayslip, Henderson & Shore, 2003). Early research on grandparents has routinely focused on grandmothers, with grandfathers often becoming invisible members of the family (Sorensen & Cooper, 2010). Yet, grandfathers stress the importance of their relationships with their grandchildren as strongly as do grandmothers (Waldrop et al. Even among grandfathers that took on a more involved role, there was still a greater sense that they could be more light-hearted and flexible in their interactions with their grandchildren. Many grandfathers reported that they were more openly affectionate with their grandchildren than they had been with their own children. Having a close friend is a factor in significantly lower odds of psychiatric morbidity including depression and anxiety (Harrison, Barrow, Gask, & Creed, 1999; Newton et al. The availability of a close friend has also been shown to lessen the adverse effects of stress on health (Kouzis & Eaton, 1998; Hawkley et al. Additionally, poor social connectedness in adulthood is associated with a larger risk of premature mortality than cigarette smoking, obesity, and excessive alcohol use (Holt-Lunstad, Smith, & Layton, 2010). Degges-White and Myers (2006) found that women who have supportive people in their life experience greater life satisfaction than do those who live a more solitary life. Unfortunately, with numerous caretaking responsibilities at home, it may be difficult for women to find time and energy to enhance the friendships that provide an increased sense of life satisfaction (Borzumato-Gainey et al. Emslie, Hunt and Lyons (2013) found that for men in midlife, the shared consumption of alcohol was important to creating and maintaining male friends. Drinking with friends was justified as a way for men to talk to each other, provide social support, relax, and improve mood. Although the social support provided when men drink together can be helpful, the role of alcohol in male friendships can lead to health damaging behavior from excessive drinking. The importance of social relationships begins in early adulthood by laying down a foundation for strong social connectedness and facilitating comfort with intimacy (Erikson, 1959). To determine the impact of the quantity and quality of social relationships in young adulthood on middle adulthood, Carmichael, Reis, and Duberstein (2015) assessed individuals at age 50 on measures of social connection (types of relationships and friendship quality) and psychological outcomes (loneliness, depression, psychological well-being).

It has been suggested that episodic memories may be harder to blood pressure medication good for pregnancy cheap 1.5 mg indapamide free shipping encode and retrieve because they contain at least two different types of memory arrhythmia band cheap indapamide 2.5 mg mastercard, the event and when and where the event took place arteria e veia 2.5 mg indapamide with amex. They note that older adults poorer performance on episodic memory appeared to blood pressure chart by age order 2.5 mg indapamide overnight delivery be related to slower processing of the information and the difficulty of the task. They found that as the task became increasingly difficult, the gap between each age groups performance increased for episodic memory more so than for semantic memory. Studies which test general knowledge (semantic memory), such as politics and history (Dixon, Rust, Feltmate, & See, 2007), or vocabulary/lexical memory (Dahlgren, 1998) often find that older adults outperform younger adults. However, older adults do find that they experience more ?blocks at retrieving information that they know. Implicit memory requires little conscious effort and often involves skills or more habitual patterns of behavior. Priming refers to changes in behavior as a result of frequent or recent experiences. If you were shown pictures of food and asked to rate their appearance and then later were asked to complete words such as s p, you may be more likely to write soup than soap, or ship. The answer is typically ?no for most older adults (Schacter, Church, & Osowiecki, 1994). Episodic memories are the recall of events in our past, while the focus of prospective memories is of events in our future. In general, humans are fairly good at prospective memory if they have little else to do in the meantime. However, when there are competing tasks that are also demanding our attention, this type of memory rapidly declines. The explanation given for this is Source that this form of memory draws on the central executive of working memory, and when this component of working memory is absorbed in other tasks, our ability to remember to do something else in the future is more likely to slip out of memory (Schwartz, 2011). However, prospective memories are often divided into time-based prospective memories, such as having to remember to do something at a future time, or event-based prospective memories, such as having to remember to do something when a certain event occurs. When age-related declines are found, they are more likely to be time-based, than event-based, and in laboratory settings rather than in the real-world, where older adults can show comparable or slightly better prospective 400 memory performance (Henry, MacLeod, Phillips & Crawford, 2004; Luo & Craik, 2008). This should not be surprising given the tendency of older adults to be more selective in where they place their physical, mental, and social energy. Recall versus Recognition: Memory performance often depends on whether older adults are asked to simply recognize previously learned material or recall material on their own. Generally, for all humans, recognition tasks are easier because they require less cognitive energy. Older adults show roughly equivalent memory to young adults when assessed with a recognition task (Rhodes, Castel, & Jacoby, 2008). With recall measures, older adults show memory deficits in comparison to younger adults. While the effect is initially not that large, starting at age 40 adults begin to show declines in recall memory compared to younger adults (Schwartz, 2011). For example, older adults often perform as well if not better than young adults on tests of word knowledge or vocabulary. With age often comes expertise, and research has pointed to areas where aging experts perform quite well. For example, older typists were found to compensate for age related declines in speed by looking farther ahead at printed text (Salthouse, 1984). Compared to younger players, older chess experts focus on a smaller set of possible moves, leading to greater cognitive efficiency (Charness, 1981). Accrued knowledge of everyday tasks, such as grocery prices, can help older adults to make better decisions than young adults Source (Tentori, Osheron, Hasher, & May, 2001). Attention and Problem Solving Changes in Attention in Late Adulthood: Changes in sensory functioning and speed of processing information in late adulthood often translates into changes in attention (Jefferies et al. Research has shown that older adults are less able to selectively focus on information while ignoring distractors (Jefferies et al. Other studies have also found that older adults have greater difficulty shifting their attention between objects or locations (Tales, Muir, Bayer, & Snowden, 2002). How do changes or maintenance of cognitive ability affect older adults everyday lives? Researchers have studied cognition in the context of several different everyday activities. Although older adults often have more years of driving experience, cognitive declines related to reaction time or attentional processes may pose limitations under certain circumstances (Park & Gutchess, 2000). In contrast, research on interpersonal problem solving 401 suggested that older adults use more effective strategies than younger adults to navigate through social and emotional problems (Blanchard-Fields, 2007). In the context of work, researchers rarely find that older individuals perform poorer on the job (Park & Gutchess, 2000). Similar to everyday problem solving, older workers may develop more efficient strategies and rely on expertise to compensate for cognitive decline. Problem Solving: Problem solving tasks that require processing non-meaningful information quickly (a kind of task that might be part of a laboratory experiment on mental processes) declines with age. Older adults resolve everyday problems by relying on input from others, such as family and friends. They are also less likely than younger adults to delay making decisions on important matters, such as medical care (Strough, Hicks, Swenson, Cheng & Barnes, 2003; Meegan & Berg, 2002). The processing speed theory, proposed by Salthouse (1996, 2004), suggests that as the nervous system slows with advanced age our ability to process information declines. This slowing of processing speed may explain age differences on many different cognitive tasks. For instance, as we age, working memory becomes less efficient (Craik & Bialystok, 2006). Yet, when given sufficient time older adults perform as competently as do young adults (Salthouse, 1996). Thus, when speed is not imperative to the task healthy older adults do not show cognitive declines. In contrast, inhibition theory argues that older adults have difficulty with inhibitory functioning, or the ability to focus on certain information while suppressing attention to less pertinent information tasks (Hasher & Zacks, 1988). In directed forgetting people are asked to forget or ignore some information, but not other information. For example, you might be asked to memorize a list of words but are then told that the researcher made a mistake and gave you the wrong list and asks you to ?forget this list. While most people do well at forgetting the first list, older adults are more likely to recall more words from the ?forget-to-recall list than are younger adults (Andres, Van der Linden, & Parmentier, 2004). One explanation is that the type of tasks that people are tested on tend to be meaningless. For example, older individuals are not motivated to remember a random list of words in a study, but they are motivated for more meaningful material related to their life, and consequently perform better on those tests. When age comparisons occur Source longitudinally, however, the amount of loss diminishes (Schaie, 1994). A third reason is that the 402 loss may be due to a lack of opportunity in using various skills. When older adults practiced skills, they performed as well as they had previously. In fact, Salthouse and Babcock (1991) demonstrated that processing speed accounted for all but 1% of age-related differences in working memory when testing individuals from 18 to 82. Longitudinal research has proposed that deficits in sensory functioning explain age differences in a variety of cognitive abilities (Baltes & Lindenberger, 1997). Not surprisingly, more years of education, and subsequently higher income, are associated with higher cognitive level and slower cognitive decline (Zahodne, Stern, & Manly, 2015). Intelligence and Wisdom When looking at scores on traditional intelligence tests, tasks measuring verbal skills show minimal or no age-related declines, while scores on performance tests, which measure solving problems quickly, decline with age (Botwinick, 1984). As you recall from last chapter, crystallized intelligence encompasses abilities that draw upon experience and knowledge. Measures of crystallized intelligence include vocabulary tests, solving number problems, and understanding texts. Fluid intelligence refers to information processing abilities, such as logical reasoning, remembering lists, spatial ability, and reaction time.

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These results are sobering and actom [15] hypertension 5 year old best 1.5mg indapamide, driving most notably high risk neuroblastomas blood pressure formula purchase indapamide 1.5mg visa. Even in the presence of a Precision medicine and targeted therapies targetable alteration blood pressure medication and foot pain discount indapamide 1.5 mg visa, available drugs may substantially Over the past two decades blood pressure chart easy to read discount 1.5mg indapamide amex, basic research expanded our differ in their efficacy depending on the cellular context. The prime example, delivering a breakthrough in alterations were identified and appropriate drugs adminis therapy, was the analysis of the Philadelphia chromosome. This genetic alteration exists not only in chronic proliferation and metastasis [31] deserves consideration Burdach et al. Downregulation of pathognomonic fu need to be verified as well as delivery of targeting drug. It has also been assumed that, the terms ?precision medicine,?personalized medicine, apart from rare hereditary cancer syndromes, there is no and ?individualized medicine are now part of medical con genetic predisposition. The trials cited above have now cepts that seek to identify and target molecular structures opened a new view on malignant diseases in children, in many diseases, including cancer. It has been shown in Barack Obama launched the Precision Medicine Initiative six independent studies that 5?10% of patients have in 2015 (?Cancer Moon Shot Initiative), comparing it to germ-line mutations that predispose to cancer [18, 19, the first moon landing. This is all the more surprising be Health are using this initiative to form new strategies for cause these mutations affect primarily patients from diagnosis and therapy, particularly of cancer [7]. Thus, we have to assume that they while blocking differentiation and cell death [6]. Normally, are de novo mutations and yet to understand many con cells receive external signals that are transmitted into the sequences of these findings, particularly for targeted cell by receptors, for instance tyrosine kinase receptors therapies. Deregulated activation of tyrosine kinases significant difference in the number of mutations be is characteristic of most cancers [42](Fig. Whereas virtually all cancers in elderly patients case may not be easy, as deregulated activation can arise have multiple genomic alterations, where tumor cells are not only from activating mutations but also from inacti often polyploid with multiple aberrations of chromo vating mutations in suppressors (Table 1). The identifi somes; most pediatric tumors however, exhibit only few cation of tyrosine kinase inhibitors, initially in adult mutations and genetic alterations [4, 18]. This limits the cancers, has provided a spectrum of substances that can availability and use of drugs for targeted therapies. We are still missing identified in anaplastic large cell lymphoma and later systematic functional trials addressing this issue. Only a found in a significant share of neuroblastoma patients single institution transcriptomic trial from one of the au and in high frequency in lung cancer with activating mu thors institution revealed druggable targets in all pa tation [43, 44]. Although the specific kinase inhibitor cri tients and a survival advantage of patients with targeted zotinib was not very effective in the treatment of therapies [22]. Cancer cells are defined by overactive signaling cascades, often mediated by tyrosine (tyr) kinases. Common therapeutic strategies are either blocking of the tyr kinase receptor by inhibiting antibody/pharmacological inhibitor (which does not work for ligand-independent signals and has reduced potency if the target is overexpressed), or utilizing pharmacological inhibitors that block kinase activity (dependent/independent of mutational status) [42] may be more effective in this malignancy and are now exemplary here. The driver translocation t(9;22) of Phila being evaluated in clinical trials [29, 45, 46]. It im There is a broad spectrum of diseases in pediatric on plies that different cells have different genetic alterations. Therefore, their use is only inant clone resistant to therapy; these cells may not be de feasible and appropriate in the context of trials after se tectable initially [59?61]. This suggests a combination of peutic personalization has lead to novel designs of therapies addressing different structures and signaling path clinical studies such as basket (same target in different ways. These results also suggest that the ability of the im entities) and umbrella (different targets in same entities) mune system to control and eliminate tumor cells has to be studies. Apart from tyrosine kinase inhibitors, there is interest In summary, the molecular analysis of tumors and in other therapeutic strategies that aim to influence cell leukemia in childhood and adolescence has made ground survival in general or target the ?motor independent of breaking progress in our understanding of cancer. Immunotherapy Chronic lymphatic leukemia, defined by differentiation Evolution and function of the immune system of B-lymphocytes and virtually untreatable through How long does it take from a scientific breakthrough in chemotherapy, shows an excellent and long-lasting re basic research to clinical application? History reveals that translational different tumor entities, which were previously thought research may reduce the latency period. In medulloblastoma, there are four clearly 2013, when Science magazine picked cancer immunother distinguishable, molecularly defined subgroups with dif apy as the breakthrough of the year, there were still serious ferent genetic alterations that result in deregulated signal doubts amongst the jurors about whether this break transduction, i. Their molecular the adaptive (or specific) immune system has two evolu profiles can provide possible targets for approaches in tionary related effector mechanisms: humoral and cellular precision medicine. Antibodies are produced by B-lymphocytes and bind to molecules on the surface of tar Perspectives of targeted therapies get cells; thus, the repertoire of antibodies is limited to the analysis of tumor genomes led to substantial insights those target molecules that occur on the outer cell mem into cancer development. Genomic analyses can provide brane of blood cells or cellular organisms circulating in the biomarkers and identify novel targets for targeted therapies. Effectors of humoral cytotoxicity are Nevertheless, there are limitations: while there are bona fide myeloid cells of the innate immune system. Antibodies developed earlier than jawed vertebrates have been fulfilled due to primary or secondary resistance in evolution and the inborn immune system (innate, [57]. Furthermore, there is an intrinsic problem within the non-specific or natural immunity) is evolutionarily older Burdach et al. Molecular and Cellular Pediatrics (2018) 5:6 Page 7 of 15 than the adaptive immune system. It can already be found To execute the cytotoxic function, T-cells perforate in plants. Effectors of More than 100 years ago (clearly before the advent of cellular adaptive immunity system are T-lymphocytes. In unspecific immunotherapy is based on a stimulation of contrast to bacteria, viruses require host cells for replica the inborn immunity resulting in an inflammatory reac tion and thus are primarily controlled by T-cells in con tion that can elicit an anti-tumor effect. Molecular and Cellular Pediatrics (2018) 5:6 Page 8 of 15 stimulatory effect of mifamurtide is mediated via the peptide bridge. Allison showed in 1996 for the first time, that cination trials against pediatric solid tumors have been pub blocking inhibitory receptors on tumor-infiltrating lished, amongst them high and low grade glioma [75, 76], T-cells can be therapeutically effective. The antibodies atypical teratoid-rhabdoid tumor [77], hepatoblastoma [78], he developed against those inhibitory receptors have be and neuroblastoma [79], showing antigen-specific immune come a new class of substances in cancer therapy known response and even improved survival in high-risk sarcoma as checkpoint inhibitors. Due to the gener a conjugate of an antibody and a cytotoxic agent; these ally low mutational load of childhood cancers, its relevance conjugates contain. In a phase 2, single-cohort, 25-center, global molecules on target cells with high affinity. The separ overall remission rate within 3 months was 81% ongoing ation between antibody binding and cytotoxicity is an evo remission in 60% between 8 and 18 months. T-cells were safer but less efficacious, since they did not contain the costimulatory domains of later generations. Perspectives of immunotherapy T-cells that do not undergo negative but only positive Table 2 gives an overview of progress in precision medicine thymic selection include T-cells of the alloreactive reper in immuno and cell-based therapy in pediatric oncology. Therefore, they are attractive candidates for cancer the centennial success of pediatric oncology was based immunotherapy. Alloreactive T-cells are thought to have on the multidisciplinary approach involving less mutilat a higher risk of cross reactivity compared to conven ing surgery in a neo-adjuvant setting as well the cytotoxic tional T-cells. But these conventional T-cells usually do not eliminate tumors presenting self-peptides with few Table 2 Immuno and cell-based therapy in pediatric oncology mutations. Molecular and Cellular Pediatrics (2018) 5:6 Page 11 of 15 modalities of mutagenic cell toxins. Disruptive high-throughput leads to an increased risk of infections similar to that ob technologies may provide an urgently needed paradigm served in primary treatment or salvage of patients with shift here. Autoimmune adverse events are not fully appreciate the heterogeneity of increasingly sub common in the treatment with checkpoint inhibitors. This individualization implies the risk that antibody ipilimumab [102] and even with a delay of sev the efficacy (and even more superiority) of these novel eral months after treatment [103]. These wired by oncogene addiction pathways and the Heisen challenges have to be addressed by novel study concepts, berg principle applies to cancer heterogeneity and plasti including adaptive design, basket and umbrella trials, es city, targeted therapies may well prime for resistance: tablishing surrogate endpoints. This individualization of therapy will put Apart from these side effects and drawbacks, the fi the individual patient into the focus of research. A substantial events, but by a selection advantage of any genetic event part of this toxicity is a consequence of the regulatory favoring dedifferentiation and the reversion to the em fundamentalism in dealing with of advance therapy me bryonic default mode. Reprograming Conclusions T-cells with chimeric receptors to manipulate selectively Current successful therapies in childhood cancer come at that tumor microenvironment may open here new hori a high cost. Thus, devel opment of precision medicine in pediatric oncology is an Side effects and draw backs of targeted therapies urgent medical need in public interest. It is part Translocation of c-ab1 oncogene correlates with the presence of a Philadelphia of the Prospective Validation of Biomarkers in Ewing Sarcoma for Persona chromosome in chronic myelocytic leukaemia. Boudalil M, Previti C, Wolf S, Schmidt S, Chotewutmontri S, Bewerunge-Hudler Pediatr Blood Cancer 64. Molecular and Cellular Pediatrics (2018) 5:6 Page 13 of 15 refractory or relapsed cancer in youth.

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Sharing your feelings with your child tells them that it is okay to blood pressure medication glaucoma cheap indapamide 1.5 mg feel upset or angry hypertension 20 year old male order indapamide 2.5mg otc. Children of different ages understand and react differently to arrhythmia signs and symptoms indapamide 2.5mg low price cancer and its treatment heart attack now love buy generic indapamide 1.5 mg online. They often become more dependent on adults, or they may act younger than their age (baby talk, wetting pants after being potty trained, tantrums, etc. The section also contains specifc suggestions for how to help children in each age group cope. Toddlers show you how they feel by their actions because they do not have the words to describe their feelings. Loss of normal Try to keep eating, sleeping, and bathing routines as normal routine as possible. They may view the hospital and treatment as punishment for something they did wrong. Fear of harm to Let your preschooler play with toy medical kits and safe their body and the medical supplies, such as a blood pressure cuff. School-age children are able to understand cause and effect and have a better sense of time. Being away from Encourage your school-aged child to stay in touch with friends and school their friends via email, phone calls, cards, and letters. Illness and treatment cause teens to be different from their peers when they are trying very hard to be the same. Teens are able to understand cause and effect, and can also see things from many points of view. If your child develops a fever, chills, or does not look well, it is important to call your health care provider right away. If your child has a serious infection and does not receive medical care right away, they could get very sick and this could be life-threatening. Your child may need to be admitted to the hospital or come to clinic for antibiotics to treat the infection. The most common types of infections in children with cancer are bacterial, opportunistic, and viral infections. Bacterial Infections Bacteria can cause serious infections in children with low white blood cell counts. However, when the white blood cell count is low, the chance of getting an infection goes up. Children who have central lines also have a higher risk of getting a bacterial infection in the blood. These infections include those caused by mold or fungi, and a type of pneumonia called pneumocystis. Your health care provider may give your child medicines to help prevent opportunistic infections. Some viral infections, such as chickenpox and shingles, may cause more serious illness in children with cancer that may require treatment or hospitalization. The varicella virus stays in the body long after a person has recovered from chickenpox. If the immune system is not working well, such as during cancer treatment, the virus may become active again. It is possible your child will need to get a medicine to protect against chickenpox. For the medicine to work, your child must get it as soon as possible after exposure. If your child is exposed but has already had chickenpox or the chickenpox vaccine, they may have antibodies to fght the virus, and may not need to get the extra medicine to protect against chickenpox. Some suggestions for preventing infections in your child with cancer are described below. Encourage your child not to share cups, eating utensils, or toothbrushes with other people. Screen Visitors and Playmates for Infections Your child should play and visit with other children, but be sure to ask ahead if the playmate or visitor has been exposed to or has an infection. Anyone who has a fever, runny nose, cough, diarrhea, or rash should not visit or play with your child. Brush the teeth after each meal and before bed with a soft toothbrush and toothpaste. Your health care provider may want to prescribe antibiotics before dental work, or the dental work may need to be postponed. Your child should not clean animal cages (such as a bird cage or turtle aquarium) or empty cat litter boxes. If you live on a farm, talk with your health care provider about any additional precautions that may need to be taken when working with animals. Live vaccines can cause illness in children who are at increased risk of infection. Some medicines (such as methotrexate, doxorubicin, busulfan, thiotepa, Bactrim and Septra) and radiation make the skin more sensitive to sunlight. Remember to protect children from sunburn when the skin is exposed to the sun, even on cloudy or hazy days. If your child is outdoors for a long period of time, reapply the sunscreen after a few hours. Always check to make sure your child is taking the right medicine in the right amount. Use only a very small amount of food or fuid so that your child can swallow all of it. For example, your child may complain that some foods have a metallic taste, and their usual food preferences may change. The appetite usually returns to normal after a specifc phase of treatment is over. One is a yellow liquid that contains protein, carbohydrate, minerals, vitamins, and electrolytes. These may include instructions for changing the dressing, fushing the line, and giving medicines. Call your health care provider right away if your child develops: Redness, swelling or pus around the insertion site Shaking chills after fushing the central line Pain at the central line site Fever If your child has an external line, never use scissors near the line or the dressing. If you see a break or leak in the line, clamp the line above the break right away. If you are fushing the line and you feel resistance (fuid is hard to push in), do not force it. For more information about caring for central lines at your hospital, refer to the ?Information from My Hospital section of this handbook, or ask your health care team. School also helps children to feel good about themselves and hopeful for the future. Your health care provider will talk with you when your child is ready to go back to school. Tell your health care provider if your child is worried about going back to school. The diagnosis of cancer brings changes to your life and the lives of the whole family. Talking with family and friends, a member of the health care team, or another parent of a child who has cancer may be helpful. The fear of the unknown and what a cancer diagnosis means for your child may be overwhelming. Dealing with the stress of your child adapting to a new and sometimes frightening environment may be diffcult. However, taking your anger out by yelling, fghting or other violent actions is not a healthy way of coping. Brothers and sisters may also feel guilty that they are healthy, and they may worry that they caused the illness by something that they did or thought. For example, a brother or sister may be thinking ?We had a fght and I wished he would die?and now he has cancer! You may notice symptoms of grief, such as crying spells, decreased appetite or compulsive eating, lack of interest, decreased energy, lack of concentration, poor problem solving, and physical symptoms such as tightness in the chest or headaches. With the support of family, friends, and the health care team, most parents are able to work through these emotions and use coping skills that are needed to meet care demands. Sometimes parents fnd that their emotions are so overwhelming that they feel they cannot cope with the demands being placed on them.

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