Visitors should be screened. If they have any cold or flu symptoms, cold sores, open sores, or recent exposures, they should not visit. Feel free to check with your nurse if there is any question. If your visitor is a child, they must be screened by a nurse. This is especially important because children may have been exposed to contagious illnesses such as chicken pox or may have recently received immunizations. In either case, they should not visit or be on the PBMT unit.

The PBMT unit receives air that has passed through "hepa filters". The large hepafilter units in the hallway and the portable room sized filters in each room gives your child plenty of protection. The small filters in your child's room should be on at all times and should always be set on speed "4". Your child will remain in a filtered room during the transplant and immediate time after transplant. When your child's counts have recovered, he/she may be moved to another private room.

Even though the air is filtered, we still ask that your child wear a blue mask when out of their room. Please change the mask if it gets moist or soiled and always throw it away if it drops to the floor. We also ask that your child routinely changes their mask two to three times a day. When off of the unit, a white, heavier mask is required.

If your child prefers to shower, make sure you clean their bottom area thoroughly. If the bottom becomes sore, baths are preferred because the soaking helps to clean and heal the bottom. Each child is prone to diarrhea and good bottom care is important to prevent skin breakdown. Rectal sores may be treated by doing a sitz bath two or three times a day. There are options available for creams to apply to your child's bottom area and your nurse will be happy to help you pick the best treatment for your child.

Skin Care
Skin care should be an important part of your child's daily routine. Total body irradiation, chemotherapy, and the general dryness on the PBMT Unit will all add to your child's dry skin. Even if dry skin has not been a problem in the past, it is very likely to be now.

The key to skin care is beginning with a skin care routine right from the start. You should use a mild soap and if you want, you can add bath oil to your child's bath or rub it in during their shower. The bath water should not be too hot as hot water is more drying. After the bath or shower, dry off by patting the skin with a towel. While still slightly damp, apply lotion over all of your child's body. Before radiation, applying lotion once a day is adequate. It is best to apply the lotion after radiation is completed for the day. After radiation is complete, start a routine of applying lotion twice a day. If you have any questions on the lotion or soap that you are using, please ask your nurse.

Oral Care
Your child should do oral care four times a day. A soft toothbrush can be used even if the platelet count is low. The only time that we ask that you not use a toothbrush is if your child experiences any bleeding from their gums. If there is any gum bleeding or irritation, we prefer that you use a toothette or a very soft toothbrush for all mouth cares. Mouth care is very important to prevent oral sores and infections. It is best for your child not to get behind with mouth cares. This means that even if they do their first one at noon and their second one at six, they still have two more that day. If the night nurse comes on and finds that your child is behind, your child may be asked to get up at midnight to do one. Remember, it is only being done to help. An antifungal and antibacterial rinse will be ordered to accompany normal brushing (see procedure below).

If using a toothette:

• swab all surfaces of mouth with toothettes soaked in normal saline
• if old enough, swish with normal saline
• swish with antifungal agent and swallow (for babies, swab medication into mouth) making contact with all surfaces - do not just squirt it in with a syringe. This is especially important if there is thrush along those hard-to-reach areas of the gum line).
• A & D or vaseline to lips

Nystatin and clotrimazole are the two most common antifungal agents. Clotrimazole slowly dissolves in your mouth or it can be crushed, mixed in water, and swished and swallowed. If you choose to suck on the troche, move it around in the mouth as it dissolves. It is best to suck on the troche until it is completely dissolved. If this is not possible, it must be sucked on for 30 minutes before throwing it away. Nystatin is a yellow liquid. You swish for 30-60 seconds and then swallow.

Peridex is an antibacterial mouth wash which is to be used twice a day. It needs to be swished for

30-60 seconds and then spit out. Peridex can cause a temporary discoloration or staining of the tongue and teeth on some people. If you notice any of this, do not be concerned as it can be easily removed with a routine dental cleaning. (For parents who swab peridex into their child's mouth with a toothette, peridex is not harmful if swallowed).

Pediatric dentistry will see your child initially and is available for follow-up visits as needed. They are often helpful when it comes to problems and finding effective remedies.

Exercise
Exercise should be a part of your child's daily routine on the PBMT unit and needs to be done at least three times a day. Younger children generally do not have a problem in this area as they are usually up and in the playroom or out riding bikes in the hallways. If your child is older, it is often harder to make them get out of bed to exercise, especially if they are not feeling well. We know it is hard, but cannot stress enough how important good exercise is to your child as they go through the transplant process.

If your child is having trouble in this area, we will initiate an exercise schedule for them, such as walking around the unit three times a day or riding the exercise bike ten minutes twice a day. If your child chooses walking or riding the stationary bike as their form of exercise, you may want to keep a record of the progress your child makes (time, miles, tension, etc.). We like to avoid the use of wheelchairs as much as possible. Physical therapy is always available, and can help you set up some goals for your child's exercise. Let your nurse know if at any time you would like your child to see a physical therapist.

Another form of exercise specific to your lungs is the incentive spirometer. This needs to be done (ten repetitions) at least four times a day (in addition to your other exercise) and helps by fully expanding the lungs. Your nurse will show you and your child how to properly use your incentive spirometer.

Physician Rounds
Two times a day, usually around 8:30 a.m. and 4:00 p.m., the physician and/or physician assistants will be in to visit with you and your child. In the morning, a complete assessment will be done on your child. Evening rounds are usually to check in with you and see if your child has any needs. We like for parents to be here for rounds. This is an excellent time for you and your child to talk with the medical and nursing staff about your questions, comments, concerns and needs. Please feel free to ask questions or express concerns at any time with the PBMT staff.

Schedules
For the child undergoing a bone marrow transplant, there is a lot of stress. Along with doing fun activities and talking with your child about their feelings, it is important to develop a daily schedule to help your child cope. Children usually handle stress better when they have a familiar routine to follow.

You and your child then know what is expected every day. A schedule also provides clear direction for your child's daily activities. Working with your child to develop a daily schedule also allows your child to feel control. Feeling like they have a say in their day increases cooperation.

Daily tasks that must be completed, along with fun and rest times can be scheduled. Allowing the child to decorate their schedule and the use of stickers as rewards will help to make the schedule a fun activity.

Your primary nurse can assist you and your child to develop a daily schedule that will help make the stress of being hospitalized a little easier if you are interested.

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