Doctor & Hospital Visits

When your child has a serious or chronic illness, it’s hard to think beyond the next treatment. While health is the first priority, education also is important. School is part of every child’s normal day, and even the most reluctant learner would prefer to be healthy and in school rather than in the hospital. You’ll want to help your child stay on top of schoolwork as much as possible and plan for when he or she can return to school.

Not only does staying connected to school bring academic, cognitive, psychological, and social benefits — it’s also your child’s legal right. Under federal law, kids with chronic or life-threatening illness and/or disabilities are entitled to educational support, and your child might qualify for free services under the Individuals with Disabilities Education Act (IDEA). If your child attends private or parochial school, you might consider enrolling him or her in your local district, as services are more readily available than in the private sector.

With a little planning and a lot of communication, you can help your child balance treatment and academics.

Plan Ahead

First, talk to your doctor about how long your child is likely to be away from school and whether the treatment might interfere with concentrating, doing homework, and meeting deadlines. Are there side effects that might have an academic impact? What does your doctor recommend when it comes to attendance, tutoring, or studying?

Then talk to the teachers and school staff, and encourage your child, if well enough, to do the same. It may be necessary to set a reduced schedule or shift due dates for papers and tests. With your help, your son or daughter can work with teachers to help plan the workload. The more notice teachers have, the easier it will be to come up with a flexible solution.

Some kids who spend a lot of time away from school or in the hospital have Individual Education Programs (IEPs). These are customized goals and learning strategies created by the teachers, school psychologists (or other specialists), and counselors.

IEPs take a child’s individual academic needs into account. Under the IDEA, kids who qualify for an IEP will receive one at no cost, in addition to receiving free support services (such as a tutor) to help them reach educational milestones.

Your child may also be entitled to a 504 Plan, which will specify physical accommodations necessary to help him or her navigate school grounds, access classrooms and bathrooms, acquire an aide, or qualify for special transportation.

IEPs and 504 Plans can be requested by you or anyone on your child’s education team. Creating an IEP involves meeting with a variety of support personnel from your school and the school district. Be sure to contact the Special Services Office in your school district as soon as your doctor decides it is time to plan for your child’s discharge and eventual return to school.

Find Hospital-Based Support

If your child will be spending long stretches in the hospital, ask a doctor, nurse, social worker, or child-life specialist about onsite schooling. Many hospitals provide hospital/homebound instruction free of charge to their patients.

The two most common types of educational support include bedside schooling and classroom schooling. Typically, bedside schooling is for children who are too ill to leave their hospital rooms or have weakened immune systems due to chemotherapy. Other kids who are well enough might be educated individually or in small groups in an onsite hospital classroom.

Licensed teachers who are K-12-certified in a variety of subjects and special education work intensively with students to make sure that they don’t fall behind in their studies. To stay on track, hospital-based teachers work closely with teachers from a child’s school to maintain curriculum continuity, create IEPs and 504 Plans, arrange for homebound instruction upon discharge, and ease reentry into the classroom when the child is well again. School is scheduled around medical tests and therapies, and always takes a child’s medical condition and strength into consideration.

Whether your child is being educated at school, in the hospital, or at home, remember that getting better is the main priority. So be realistic about what he or she can handle. Kids may feel an unspoken pressure from parents, teachers, and themselves to continue with schoolwork, and this anxiety could hurt their recovery.

Stay Connected

Maintaining ties with classmates and teachers can help your child retain a sense of normalcy during this difficult time. Your child might even be able to Skype or FaceTime into a lesson at school over the computer. Programs nationwide offer free or low-cost laptops for use in the hospital. Check with your social worker, hospital school program, or the hospital IT department to see if this service is available to you.

In addition to academic isolation, your child may feel cut off socially from friends and classmates. When an illness means an extended absence from school, kids can feel that their classmates and teachers have forgotten about them. This can lead to depression as well as anxiety about returning to the classroom, particularly if the child looks different after treatment. Online social networking sites, email, instant messaging (IM), text messaging, and talking on the phone can help kids stay connected. Also, ask teachers to encourage a letter-writing, email, or care package campaign from classmates — you might even set up a collection box at school where teachers and classmates can deposit notes and pictures.

Arrange for visits from your child’s friends and, if the doctor says it’s OK and your son or daughter is up to it, encourage him or her to attend school plays, sports events, classroom parties, and other social gatherings.

Hospital school programs, along with Child Life departments in the hospital, offer reentry assistance to students transitioning back to school. Depending on a child’s needs, they may visit the school ahead of the return date, speak with faculty, attend IEP meetings, or present informational programs for classmates to help them understand why the child has been absent, what they can expect when the child returns, and — most important — how they can help the child feel welcome.

Staying connected will make for a smoother transition socially, emotionally, and academically when your child returns to school after treatment.

You’ll make plenty of decisions during pregnancy, and choosing where to give birth — whether in a hospital or in a birth center setting — is one of the most important.

Hospitals

Many women fear that a hospital setting will be cold and clinical, but that’s not necessarily true. A hospital setting can accommodate a variety of birth experiences.

Traditional hospital births (in which the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room) are still the most common option. Doctors “manage” the delivery with their patients. In many cases, women in labor are not allowed to eat or drink for medical reasons, and they may be required to deliver in a certain position.

Pain medications are available during labor and delivery (if the woman chooses); labor may be induced, if necessary; and the fetus is usually electronically monitored throughout the labor. A birth plan can help a woman communicate her preferences about these issues, and doctors will abide by these as much possible.

In response to a push for more “natural” birth events, many hospitals now offer more modern options for low-risk births, often known as family-centered care. These may include private rooms with baths (birthing suites) where women can labor, deliver, and recover in one place without having to be moved.

Although a doctor and medical staff are still present, the rooms are usually set up to create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also may be available.

In addition, many hospitals offer childbirth and prenatal education classes to prepare parents for the birth experience and parenting classes for after the birth.

The number of people allowed to attend the birth varies from hospital to hospital. In more traditional settings, as many as three support people are permitted to be with the mother during a vaginal birth. In a family-centered approach, more family members, friends, and sometimes even kids might be allowed. During a routine or nonemergency C-section, usually just one support person allowed.

Hospital Births

If you decide to give birth in a hospital, you will see a variety of health professionals:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 additional years of training after medical school in women’s health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and also perform C-sections.

Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.

If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they’re trained to handle low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

In addition to obstetricians and CNMs, registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might be present during the birth. Some family doctors also offer prenatal care and deliver babies.

While you’re in the hospital, if you choose or if it’s necessary for you to receive anesthesia, it will be administered by a trained anesthesiologist. A variety of pain-control measures, including pain medication and local, epidural, and general anesthesia, are available in the hospital setting.

Birth Centers

Women who deliver in a birth center are usually those who have already given birth without any problems and whose current pregnancies are considered low risk (meaning they are in good health and are the least likely to develop complications).

Women giving birth to multiples, who have certain medical conditions (such as gestational diabetes or high blood pressure), or whose baby is in the breech position are considered higher risk and should not deliver in a birth center.

Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.

Natural childbirth is the focus in a birth center. Since epidural anesthesia usually isn’t offered, women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. Comfort measures (such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques) are often used. The woman is free to eat and drink as she chooses.

A variety of health care professionals operate in the birth center setting. A birth center may employ registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care).

Although a doctor is seldom present and medical interventions are rarely done, birth centers may work with a variety of obstetric and pediatric consultants. The professionals affiliated with a birth center work closely together as a team, with the nurse-midwives present and the OB/GYN consultants available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.

The baby’s heart rate is monitored often during labor, typically with a handheld Doppler device. Birth centers do have medical equipment available, such as IV lines and fluids, oxygen for the mother and the infant, and other equipment necessary to treat sick babies and moms.

A birth center can provide natural pain control and pain control with mild narcotic medications, but if a woman decides she wants an epidural, or if complications develop, she must be taken to a hospital.

Birth centers often provide a homey birth experience for the mother, baby, and extended family. In most cases, birth centers are freestanding buildings, although they may be attached to a hospital. Birth centers may be located in residential areas and generally include amenities such as private rooms with soft lighting, showers, and whirlpool tubs. A kitchen may be available for the family to use.

Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so find out if the birth center you choose has all the proper credentials.

Which One Is Right for You?

How do you decide whether a hospital or a birth center is the right choice for you? If you’ve chosen a particular health care provider, he or she may only practice at a particular hospital or birth center, so you should discuss your decision. And check with your health insurance carrier to make sure your choice is covered. In many cases, accredited birth centers as well as hospitals are covered by major insurance companies.

If you have any conditions that classify your pregnancy as higher risk (such as being older than 35, carrying multiple fetuses, or having gestational diabetes or high blood pressure, to name a few), your health care provider may advise you to deliver in a hospital where you and your baby can receive medical treatment as necessary. In fact, you might not be eligible to deliver in a birth center because of your risk factors. And if you want interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.

For a woman without significant problems in her medical history and whose pregnancy has been classified as low risk, a birth center can be an option. Women who want a natural birth with minimal medical intervention or pain control may feel more comfortable in a birth center, as may those who want friends or family members there for the birthing experience.

Once you’ve decided on either a hospital or a birth center, you may still have to choose which hospital or which birth center. Before you make a choice, be sure that your health care provider — whether he or she is a doctor or a CNM — can deliver at the facilities you’re considering.

Also, try to get a tour of the hospital or birth center so you can see for yourself if the staff is friendly and the atmosphere is one in which you’ll feel relaxed.

Questions to Ask

Before your labor pains start, get answers to these questions:

If Choosing a Hospital

• Is the hospital easy to get to?
• How is it equipped to handle emergencies?
• What level nursery is available? (Nurseries are rated I, II, or III — a level III neonatal intensive care unit [NICU] is equipped to handle any neonatal emergency. A lower rating may require transportation to a level III NICU.)
• How many deliveries take place at the hospital each year? (A higher number means the hospital has more experience with various birth scenarios.)
• What is the nurse-to-patient ratio? (A ratio of 1:2 is considered good during low-risk labor; a 1:1 ratio is best in complicated cases or during the pushing stage.)
• What are the hospital’s statistics for cesarean sections, episiotomies, and mortality? (Keep in mind, though, that these numbers include high-risk and complicated deliveries.)
• How many labor and support people may be present for the birth?
• What procedures are followed after your baby’s birth? Can you breastfeed immediately if desired? Is rooming in available?
• How long is the typical postpartum stay for vaginal deliveries? For C-sections?
• Can the baby and the father stay with you in your room around the clock, if you desire?

If Choosing a Birth Center

• Is the birth center accredited by the Commission for the Accreditation of Birth Centers?
• Is the birth center easy to get to?
• What situations during labor would lead to a transfer to a hospital? How are transfers handled? What emergencies are the transfer facilities able to handle?
• What professionals (such as midwives, doctors, and nurses) are available on staff? On a consulting basis? Are they licensed?
• What childbirth and prenatal education classes are offered?
• What are the center’s statistics for hospital transfers, episiotomies, and mortality?
• What procedures are followed after your baby’s birth? How long is the typical postpartum stay and how will your baby be examined?

It’s wise to choose where to deliver your baby as early in your pregnancy as possible. That way, if complications do arise, you’ll be well informed and can concentrate on your health and the health of your baby.

Numerous medical advances have helped health care professionals manage, lessen, and prevent certain side effects of cancer treatments. But parents whose kids need chemotherapy — one of the most common treatments for childhood cancer — often have many questions and concerns about it.

About Chemotherapy

Chemotherapy (often just called “chemo”) refers to medications that kill actively dividing cells. Unlike healthy cells, cancer cells grow continuously because they don’t respond to normal signals that control cell growth. Chemotherapy works by disrupting cell division and killing actively dividing cancer cells. In contrast to radiation therapy, which destroys cancer cells in a specific area of the body, chemotherapy works to treat cancer throughout the body.

If your child has been diagnosed with cancer, doctors will develop a customized treatment plan that takes into account your child’s age, the type of cancer, and where it’s located. A pediatric oncologist (a doctor who specializes in the treatment of childhood cancer) will work with other health care professionals to determine the chemotherapy regimen that’s best for your child.

How Chemotherapy Is Given

Just as other medicines can be taken in various forms, there are several ways to get chemotherapy. In most cases, it’s given intravenously into a vein, also referred to as an IV. An IV is a tiny tube inserted into a vein through the skin, usually in the arm. The IV is attached to a bag that holds the medicine. The chemo medicine flows from the bag into the vein, which puts the medicine into the bloodstream. Once the medicine is in the blood, it can travel through the body and attack cancer cells.

Sometimes, a permanent IV called a catheter is placed under the skin into a larger blood vessel of the upper chest. That way, a child can get chemotherapy and other medicines through the catheter without having to always use a vein in the arm. The catheter remains under the skin until all the cancer treatment is completed. It also can be used to obtain blood samples and for other treatments, such as blood transfusions, without repeated needle sticks.

Chemo also can be:

• taken as a pill, capsule, or liquid that is swallowed
• given by injection into a muscle or the skin
• injected into spinal fluid through a needle inserted into a fluid-filled space in the lower spine (below the spinal cord)

Chemotherapy is sometimes used along with other cancer treatments, such as radiation therapy, surgery, or biological therapy (the use of substances to help the body’s immune system fight cancer).

Lots of kids and teens receive combination therapy, which is the use of two or more cancer-fighting drugs. In many cases, combination therapy lessens the chance that the cancer will become resistant to one type of drug — and improves the chances that the cancer will be cured.

When and Where Chemo Is Given

Depending on the method used to administer chemotherapy, it may be given at a hospital, cancer treatment center, doctor’s office, or at home. Many kids receive chemotherapy on an outpatient basis at a clinic or hospital. Others may need to be hospitalized to monitor or treat side effects.

Kids may receive chemotherapy every day, every week, or every month. Doctors sometimes use the term “cycles” to describe a chemotherapy schedule because treatment periods alternate with periods of rest so a child can recover and regain strength.

Common Side Effects of Chemotherapy

Although chemo often effectively damages or eliminates cancer cells, it also can damage normal, healthy cells. This can lead to side effects.

Chemotherapy side effects are different for each child. The type of anticancer drug used, the dose, and a child’s general health affect the risk of developing side effects. The good news is that most side effects are temporary — as the body’s normal cells recover, the side effects gradually go away. It’s also important to remember that doctors have ways of helping with many common side effects of chemotherapy.

Cancer treatment is multifaceted — that is, patients receive a lot of care (i.e., fluid and nutrition support, transfusion support, physical therapy, and medicines) to help them tolerate the treatments and treat or prevent side effects such as nausea and vomiting.

It’s difficult to predict which side effects a child might experience, how long they’ll last, and when they’ll end. If your child has side effects, be sure to talk with your doctor about how to cope with them.

Fatigue

Fatigue is the most common side effect of chemotherapy. Kids may need to reduce or eliminate activities during chemo, and may feel very tired even after sleeping and resting. Fatigue may last for days, weeks, or months, but it does go away once treatment is over.

Encourage your child to rest and sleep as often as possible — even if it doesn’t immediately result in more energy — because rest helps the body recover from chemo. Short naps or breaks from activity may be more beneficial than longer ones.

Discomfort and Pain

There may be some initial discomfort when a chemotherapy catheter or IV needle is placed in the vein. Certain anticancer drugs also cause mouth pain, headaches, muscle pains, and stomach pains. Chemo medicine may cause temporary nerve damage, which can result in burning, numbness, tingling, or shooting pain in the fingers and toes.

Kids taking pain medication should not skip doses — waiting until pain is bad can make it harder to control. If your child’s pain persists or worsens at any time, talk to your doctor. Also, be sure to discuss the use of alternative or over-the-counter medicines and vitamins. There may be drug interactions with chemo you want to avoid.

Skin Damage or Changes

Skin may be red, sensitive, or easily irritated in the days, weeks, and months during and after treatment. If your child had radiation therapy prior to chemotherapy, the treated skin may turn red, blister, and peel once chemo begins. This condition is known as “radiation recall.”

A child who has sensitive or irritated skin should wear loose, soft clothes and avoid using lotions or other commercial products on the affected area. Your doctor may recommend an ointment or cream to reduce irritation. Prolonged sun exposure should be avoided. If your child is going to be outside, speak with the doctor about using sunscreen.

Common Side Effects (continued)

Hair Loss and Scalp Sensitivity

Because chemotherapy often kills the healthy cells responsible for hair growth, it’s common for kids undergoing chemo to lose their hair or have a sensitive scalp.

Hair thinning and hair loss may occur all over the body during treatment, including the head, face, arms and legs, underarms, and pubic area. Your child’s hair may become thinner and then fall out completely or in clumps.

Losing hair can be scary for kids and make them feel nervous about standing out. Getting a shorter haircut may make it less traumatic once hair loss starts. Your child may also feel more comfortable wearing hats, bandannas, baseball caps, scarves, or wigs until the hair grows back. And it will grow back. Most kids’ hair regrows before treatment ends or within 3 months following its end, though it may be a slightly different color or texture than it was before.

To protect the head from sun exposure, have your child wear a hat and sunscreen while outside. Even if your child doesn’t have hair loss, using mild shampoo and other hair products can help prevent scalp irritation.

Mouth, Gum, and Throat Sores

Chemotherapy may cause sores in the mouth, gums, and throat or cause gum tissues to become irritated and bleed. The doctor may prescribe a mouth rinse or other products to reduce pain, dryness, and irritation.

Be sure to take your child for regular dental checkups and follow the dentist’s advice on how to brush the teeth during chemotherapy. Kids with mouth or throat pain may find soft, cool foods easier to chew and swallow; acidic foods and juices should be avoided.

Gastrointestinal Problems

Gastrointestinal problems (including loss of appetite, constipation, diarrhea, nausea, and vomiting) can occur, although medications can help prevent or reduce nausea and vomiting. Talk to your doctor about medicines or dietary changes that may help ease an upset stomach, prevent weight loss, or combat constipation.

If your child doesn’t feel like eating a large meal, try serving small meals throughout the day. And be sure to offer foods high in nutrients to prevent weight loss. Avoid serving fatty, sweet, spicy, or fried foods. And even though your child may not feel like drinking, water, clear broth, juices, and sports drinks can replace fluids lost through vomiting and diarrhea. Room-temperature beverages may be easier to drink than hot or cold liquids. The doctor or a registered dietitian may have suggestions for ensuring adequate nutrition and hydration.

Urinary System Problems

Some chemotherapy drugs can irritate or damage the bladder or kidneys and can cause the urine (pee) to change color or take on a strong odor for a day or two. The doctor may ask for a blood or urine sample before beginning chemotherapy to evaluate kidney function.

Giving your child plenty of fluids to drink will ensure good urine flow and help prevent problems in the urinary tract. Be sure to let the doctor know if your child develops symptoms that may indicate a problem with the urinary system, such as painful or frequent urination, reddish or bloody urine, or an inability to urinate.

Common Side Effects (continued)

Central Nervous System Problems

Chemotherapy may cause temporary confusion and depression, which should go away once treatment is completed.

Decreased Blood Counts

• Low hemoglobin (anemia)
  The doctor will monitor your child’s blood counts to check for anemia (low levels of red blood cells, which are made in the bone marrow and carry oxygen throughout the body). Kids with anemia may feel tired or have a headache. Red blood cell transfusions may be necessary.
• Low platelets (thrombocytopenia)
  Chemotherapy drugs may inhibit the body’s ability to produce platelets, which help blood to clot. Your child may bleed or bruise easily because of a reduction in platelets. Platelet transfusions may be necessary.

Increased Risk of Infection

Chemo can deplete white blood cells, which are part of the immune system and help the body fight infection. This can increase the risk for infections both during and after treatment. To help protect your child:

• Remind everyone in your family to wash their hands before eating, after using the bathroom, and after touching animals. They shouldn’t share cups or utensils with friends or family members.
• Friends and family members with contagious illnesses (such as a cold, the flu, or chickenpox) should not visit. Try to avoid crowds and children who have received certain vaccines, such as chickenpox, oral polio, and the flu nasal spray — these are live virus vaccines and can spread disease to kids with low blood cell counts. Your child also shouldn’t receive immunizations without your doctor’s OK.
• To prevent foodborne infection, your child shouldn’t eat raw fish, seafood, meat, or uncooked eggs.

Long-Term Side Effects
Chemotherapy can cause long-term side effects (sometimes called late effects), depending on the type and dose of chemotherapy and whether it was combined with radiation. These effects may involve any organ, including the heart, lungs, brain, kidneys, liver, thyroid gland, and reproductive organs. Some types of chemotherapy drugs may also increase the risk of cancer later in life.

Receiving chemo during childhood also may place some kids at risk for delayed growth and cognitive development, depending on the child’s age, the type of drug used, the dosage, and whether chemotherapy was used in addition to radiation therapy.

Report any side effects to your doctor so that they can be treated and your child made as comfortable as possible.

Caring for Your Child

Your child may have many questions about cancer and its treatment. Be honest when talking about it — discuss the disease in age-appropriate terms and encourage your child to share his or her feelings. And remember that you’re not alone: Doctors, nurses, psychologists, psychiatrists, social workers, child-life therapists, and other members of the cancer treatment team are there to answer questions and support you and and your child before, during, and after chemotherapy.

Kids who are scared about starting chemo might benefit from a tour of the hospital or clinic beforehand or joining a support group for families coping with childhood cancer. Besides making treatment seem less frightening, meeting other cancer patients and survivors might help your family develop a network of friends and supporters dealing with the same issues.

Also remember to care for yourself during your child’s treatment. Don’t be afraid to ask for help from family and friends, both early in your child’s treatment and later on. Caring for yourself will help you to care for your child as well as you possibly can.

Once chemo is done, it’s still important for the doctor to monitor your child’s health and progress in follow-up appointments. During these checkups, the doctor will ask if there are continuing side effects and check for any signs of the cancer recurring.

It can be difficult to cope with a cancer diagnosis, let alone take in facts about chemotherapy. Remember that while it can be a long road, children and teens treated for cancer often go on to lead long, healthy, and happy lives.

By meeting yearly with your teen, the doctor can keep track of changes in physical, mental, and social development and offer advice about avoiding unhealthy behaviors, such as smoking and drinking.

The doctor also can help your teen understand the importance of choosing a healthy lifestyle that includes good nutrition, proper exercise, and safety measures.

The more that teens understand about their physical growth and sexual development, the more they will recognize the importance of active involvement in their own health care.

What to Expect at the Doctor’s Office

Teens should visit their doctors annually. Those with a chronic medical condition or certain clinical signs or symptoms might need more frequent visits.

Medical care should include screenings for high blood pressure, obesity, eating disorders, depression, and if indicated, hyperlipidemia (an excess of cholesterol and/or other fats in the blood). Older teens may be screened for alcohol, drugs, and sexually transmitted diseases (STDs). A tuberculin (PPD) test may be done if a teen is at risk for tuberculosis.

Vision and hearing will be checked. Teens are also checked for scoliosis (curvature of the spine).

Immunizations

By age 13, teens should have already had these immunizations:

• chickenpox (varicella) vaccine (if they have not had chickenpox)
• measles, mumps, and rubella (MMR) vaccine
• hepatitis B vaccine (HBV) series
• hepatitis A vaccine (HAV) series
• meningococcal vaccine
• human papillomavirus vaccine (HPV)
• diphtheria, tetanus, and acellular pertussis booster (Tdap)

Doctors recommend a Tdap booster at 11–12 years of age, with a tetanus and diphtheria booster (Td) every 10 years after that. The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had it before, or when it was last given. The flu vaccine, given before flu season each year, also is recommended.

As teens go through puberty, issues of sexual health will be addressed. Young women may be referred to a gynecologist for a first visit. Young men will be checked for hernias and testicular cancer and taught how to do a testicular self-exam.

Teens should be asked about behaviors or emotional problems that may indicate depression or the risk of suicide. The doctor also should provide counseling about risky behaviors and other issues, including:

• sexual activities that may result in unintended pregnancy and STDs
• use of alcohol and other substances, including anabolic steroids
• use of tobacco products, including cigarettes and smokeless tobacco
• drinking and driving
• the importance of bicycle helmets, seatbelts, and protective sports gear
• how to resolve conflicts without violence, including how to avoid the use of weapons
• learning problems or difficulties at school
• importance of regular physical activity

Common Medical Problems

Sports injuries and other problems, such as knee pain and headaches, are common concerns. Your teen’s doctor should evaluate any pain that is severe or long-lasting.

Issues involving puberty and sexual development are typical concerns for teens. Doctors can be a valuable resource by answering questions and giving guidance during this period of physical and emotional changes. Teens should be reassured that anything they discuss with their doctor will be kept confidential, unless their health or the health of others could possibly be in danger.

If You Have Concerns

Parents or other caregivers should receive health guidance from their teen’s doctor during these routine checkups. The doctor will share information about normal development, including signs and symptoms of illness or emotional distress and ways to watch for and manage potentially harmful behaviors.

If you think that your teen has a physical disorder, a psychological problem, or a problem with drugs or alcohol, contact the doctor.

Well-Child Visits

Regular well-child exams are an important part of keeping kids healthy and up to date on immunizations against many serious childhood diseases.

Checkups also are a chance for you and the doctor to talk about developmental and safety issues, and for you to get answers to any questions about your child’s overall health.

What to Expect at the Doctor’s Office

At a typical well-child visit, your child will be weighed and measured and these results will be plotted on growth charts for weight, height, and body mass index (BMI). Using these charts, doctors can see how kids are growing compared with other kids the same age and gender. The doctor will take a family and medical history and do a physical exam.

Your child may be screened for anemia, lead poisoning, tuberculosis, high cholesterol, or other conditions. The doctor also will ask about your child’s eating habits.

The doctor will make sure all immunizations are up to date. At this age, most kids should have had these recommended vaccines:

• four doses of diphtheria, tetanus, and pertussis (DTaP) vaccine
• three doses of inactivated poliovirus vaccine (IPV)
• three or four doses of Haemophilus influenzae type B (Hib) vaccine
• one dose of measles, mumps, and rubella (MMR) vaccine
• three doses of hepatitis B vaccine (HBV)
• one dose of chickenpox (varicella) vaccine
• two or three doses of rotavirus vaccine (RV)
• four doses of pneumococcal conjugate vaccines (PCV, PPSV)
• one or two doses of hepatitis A vaccine (HAV)

Your child should also get the flu vaccine every year, ideally before flu season begins. Other vaccines might be needed if the doctor determines that your child is at risk for conditions like meningococcal or pneumococcal disease.

Developmental Progress

The doctor will check your child’s developmental progress, asking about behavior and specific developmental milestones. Doctors also give a screening test to help identify developmental delays and autism at the 24- or 30-month visit.

Child safety is another topic discussed at well-child visits. The doctor will talk about the importance of using car seats, closely watching kids around swimming pools, preventing poisoning, not smoking around kids, and using sunscreen. In homes with guns, weapons and ammunition should be stored separately and kept locked at all times.

When to Call the Doctor

Some symptoms can be signs of an infection, chronic medical condition, or other medical problem. Call your doctor if your child has any of these:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• a failure to grow in height as expected
• a fever and also looks sick
• long-lasting or frequent vomiting or diarrhea
• severe or long-lasting irritability or tiredness
• signs of a skin infection or a long-lasting rash
• long-lasting cough, wheezing, shortness of breath, or other breathing problems
• localized pain, such as pain caused by an ear infection

Common Medical Problems

Young children have an average of 6 to 8 colds a year, and also may have several bouts of diarrhea and vomiting, as well as ear infections.

Sleep problems and behavior or discipline concerns are very common at this age and can be frustrating for parents. Your doctor can offer guidance to help you manage these issues too.

The Well-Child Visit

Regular well-child exams are an important part of keeping kids healthy and up to date on immunizations against many serious childhood diseases.

Checkups also are a chance for you and the doctor to talk about developmental and safety issues, and for you to get answers to any questions about your child’s overall health.

What to Expect at the Doctor’s Office

At yearly exams, your child will be weighed and measured, and these results will be plotted on growth charts for weight, height, and body mass index (BMI). Using these charts, doctors can see how kids are growing compared with other kids the same age and gender. The doctor will take a medical and family history and do a physical exam.

During checkups, your child’s blood pressure, vision, and hearing will be checked. Your child may be screened for anemia, lead poisoning, tuberculosis, or high cholesterol.

Immunizations given might include:

• fifth diphtheria, tetanus, and pertussis (DTaP) vaccine
• second measles, mumps, and rubella (MMR) vaccine
• fourth inactivated poliovirus vaccine (IPV)
• second chickenpox (varicella) vaccine

The flu vaccine, given before flu season each year, also is recommended. Other vaccines might be needed if the doctor determines that your child is at risk for conditions like meningococcal or pneumococcal disease.

The doctor will check for crossed eyes and any vision and hearing problems, and also check the teeth for tooth decay, abnormal tooth development, malocclusion (abnormal bite), dental injuries, or other problems. In addition to the doctor’s dental evaluation, your child should be making regular visits to the dentist.

The doctor also will check on behavioral and social development, asking questions to see if your child’s everyday behavior is age appropriate, how well your child does in social situations, and how well he or she communicates.

Developmental Milestones

Developmental milestones for 4-year-olds include being able to:

• help with household tasks
• play cooperatively with other kids
• understand the concept of gender
• identify colors

Developmental milestones for 5-year-olds include being able to:

• dress independently and tie shoes
• know their address and phone number
• draw a person with head, body, arms, and legs
• print some letters

Child safety is another topic discussed at well-child visits. The doctor will talk about the importance of using car seats, closely watching kids around swimming pools, preventing poisoning, not smoking around kids, and using sunscreen. In homes with guns, weapons and ammunition should be stored separately and kept locked at all times.

When to Call the Doctor

Some symptoms can be signs of an infection, chronic medical condition (such as asthma), or other medical problem. Call your doctor if your child has any of these:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• a failure to grow in height as expected
• a fever and looks sick
• lasting vomiting or diarrhea
• trouble keeping liquids down
• signs of a skin infection or long-lasting rash
• a lasting cough, wheezing, or other breathing problems
• localized pain, such as from an ear infection

Common Medical Problems

Problems often found in this age group include bedwetting and sleep disturbances, such as nightmares. Kids also might have growing pains in their calves at night.

Your doctor can offer guidance to help you manage these issues.

At the Doctor’s Office

Regular well-child exams are an important part of keeping kids healthy and up to date on immunizations against many serious childhood diseases.

Checkups also are a chance for you and the doctor to talk about developmental and safety issues, and for you to get answers to any questions about your child’s overall health. As kids grow, they can also ask their own questions about their health and changing body.

At yearly exams, kids are weighed and measured, and their results are plotted on growth charts for weight, height, and body mass index (BMI). Using these charts, doctors can see how kids are growing compared with other kids the same age and gender. The doctor will take a medical and family history and do a physical exam.

During the visit, your child’s blood pressure, vision, and hearing will be checked. Your child may be screened for anemia, tuberculosis, or high cholesterol.

Immunizations given might include:

• tetanus, diphtheria, acellular pertussis booster (Tdap)
• first HPV vaccine
• first meningococcal vaccine

The flu vaccine, given before flu season each year, also is recommended.

The doctor might also ask about your child’s sleep, exercise, and eating habits. A yearly exam also lets older kids talk with their doctors about any questions they have about puberty.

The doctor also might talk with your child about the importance of personal care and hygiene; warn against using alcohol, tobacco, or drugs; and stress safety (wearing a bicycle helmet, using seatbelts, etc.).

The doctor also may ask about and provide counseling on behavioral issues, learning problems, difficulties at school, and other concerns.

As your child becomes a teen, the doctor may ask you to leave the room to allow a more private conversation. It’s an important part of kids moving toward independence and taking responsibility for their own health.

If You Suspect a Medical Problem

Parents usually can judge if their child is sick enough for a visit to the doctor. Some symptoms that may require a doctor’s attention include:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• failure to progress in height or pubertal development as expected
• menstrual problems
• a fever and looking sick
• frequent, long-lasting vomiting or diarrhea
• signs of a skin infection or an unusual or lasting rash
• stubborn cough, wheezing, or other breathing problems
• localized pain

Common Medical Problems

Common problems found in this age group include sleep disorders, bedwetting, strep throat, and colds. Some preteens also may be injured playing sports or other activities, and some kids develop stress-related stomachaches or headaches.

These are rarely serious, but if a problem persists, call your doctor.

When they know they’re “going to the doctor,” many kids worry a bit about the visit. Whether they’re going to see their primary care doctor or a specialist for a routine exam, illness, or special problem, kids are likely to have fears, and some may even feel guilty.

Some fears and guilty feelings surface easily, so that kids can talk about them. Others are kept secret and remain unspoken. Here’s how to help your child express these fears and overcome them.

Common Fears and Concerns About Medical Exams

Things that often top kids’ lists of concerns about going to the doctor include:

• Separation. Kids often fear that their parents may leave them in the exam room and wait in another room. The fear of separation from the parent during mysterious examinations is most common in kids under 7 years old, but can be frightening to older kids through ages 12 or 13.
• Pain. Kids may worry that a part of the exam or a medical procedure will hurt. They especially fear they may need an injection, particularly kids ages 6 through 12.
• The doctor. Some kids’ concerns may be about the doctor’s manner. A kid may misinterpret qualities such as speed, efficiency, or a detached attitude and view them as sternness, dislike, or rejection.
• The unknown. Kids sometimes worry that a medical problem is much worse than their parents are telling them. Some who have simple problems suspect they may need surgery or hospitalization; some who are ill worry that they may die.

Also, kids often have feelings of guilt: They may believe that their illness or condition is punishment for something they’ve done or neglected to do. Kids who feel guilty also might believe that examinations and medical procedures are part of their punishment.

How to Help

Encourage your kids to express their fears, and then address them in words that they understand and aren’t likely to misinterpret. Here are some practical ways to do this:

Explain the Purpose of the Visit

If the upcoming appointment is for a regular health checkup, explain that it’s “a well-child visit. The doctor will check on how you’re growing and developing, and also ask questions and examine you to make sure that your body is healthy. And you’ll get a chance to ask any questions you want to about your body and your health.” Also, stress that all healthy kids go to the doctor for such visits.

If the visit is to diagnose and treat an illness or other condition, explain — in very non-scary language — that the doctor “needs to examine you to find out how to fix this and help you get better.”

It’s wise to prepare kids by giving them advance notice of a visit so it’s not a surprise. When explaining the purpose of the visit, talk about the doctor in a positive way to help promote the relationship between your child and the doctor.

Address Any Guilty Feelings

A child who is going to the doctor because of an illness or other condition might have unspoken feelings of guilt about it. Discuss the illness or condition in neutral language and reassure your child: “This isn’t caused by anything you did or forgot to do. Illnesses like this happen to many kids. Aren’t we lucky to have doctors who can find the causes and who know how to help us get well?”

If you, your spouse, other relatives, or friends had (or have) the same condition, share this information. Knowing that others have been through the same thing can help ease a child’s guilt and fear.

If your child needs a doctor’s attention because of a condition that resulted in ridicule or rejection by other kids (or even by adults), you’ll need to double your efforts to relieve shame and blame. Head lice, embarrassing scratching caused by pinworm, and involuntary daytime wetting or bedwetting are examples of conditions that are often misunderstood by others.

Even if you’ve been very supportive, reassure your child again, before the visit to the doctor, that the condition is not his or her fault and that many kids have had it.

Of course, if your child has suffered an injury after disregarding safety rules, it’s wise to point out (as matter-of-factly as possible) the cause-and-effect relationship between the action and the injury. However, you should still try to relieve guilt. You could say, “You probably didn’t understand the danger involved in doing that, but I’m sure you understand now, and I know you won’t do it that way again.”

If your child repeatedly disobeys rules and becomes injured, speak to your doctor. This sort of worrisome behavior pattern needs a closer look.

In any of these cases, though, be sure to explain, especially to young kids, that going to the doctor for an examination is not a punishment. Help your kids understand that adults go to doctors just like kids do and that the doctor’s job is to help people stay healthy and fix any problems.

Tell Kids What to Expect During a Routine Exam

Children learn best during play, and this may be a time when they feel most comfortable asking any questions regarding fears they may have. You can use a doll or teddy bear to show a young child how the nurse will measure height and weight or demonstrate parts of the routine exam.

Many children’s books are available to help illustrate the doctor visit. It also helps to use role-playing to show how the doctor might:

• use a blood pressure cuff to “hug the arm”
• look in the mouth (and will need to hold the tongue down with a special stick for just a few seconds to see the throat)
• look at the eyes and into the ears
• listen to the chest and back with a stethoscope
• tap or press on the tummy to listen to or feel what’s inside
• look quickly to see that the “private areas” are healthy
• tap on the knees
• look at the feet

It’s important for parents to let their kids know that what they’ve taught them about the privacy of their bodies is still true, but that doctors, nurses, and parents must sometimes examine all parts of the body. Emphasize, though, that these people are the only exceptions. And reassure your child that you will be in the exam room with him or her.

Tell Kids What to Expect During Other Exams

If your child is going to the doctor because of an illness or medical condition or is going to visit a specialist, you might not even know what to expect during the exam.

When you’re calling to make the appointment, you can ask to speak to the doctor or a nurse to find out, in a general way, what will take place during the office visit and exam. Then you can explain some of the procedures and their purpose in gentle language, appropriate to your child’s age level. Your child will feel more secure understanding what’s going to take place and why it’s necessary.

Be honest, but not brutally honest. Let your child know if a procedure is going to be somewhat embarrassing, uncomfortable, or even painful, but don’t go into alarming detail.

Reassure your child that you’ll be there and that the procedure is truly necessary to fix — or find out how to fix — the problem. (Adolescents may prefer to be examined without a parent or with only a same-sex parent or same-sex chaperone present. That preference should be honored.)

Kids can cope with discomfort or pain more easily if they’re forewarned, and they’ll learn to trust you if you’re honest with them. If you don’t know much about the illness or condition, admit that but reassure your child that you’ll both be able to ask the doctor questions about it. Write down your child’s questions.

If a blood sample will be taken during or after the examination, be careful how you explain this. Some young kids worry that “taking blood” means that all their blood will be taken. Let your child know that the body contains a great deal of blood and that only a very little bit of it (usually no more than 1 or 2 teaspoons [about 10 milliliters]) will be taken for testing.

Again, make certain that your child understands that the visit, with its embarrassing or uncomfortable procedures, is not a punishment for any misbehavior or disobedience.

Involve Your Child in the Process

• Gathering information for the doctor. If the situation isn’t an emergency, let your child contribute to a list of symptoms that you create for the doctor. Include all symptoms you’ve observed, no matter how unrelated they may seem to the problem at hand. Also, before the visit, prepare a list of your child’s previous illnesses and medical conditions and a history of illnesses and medical conditions among close members of the family (parents, siblings, grandparents, aunts, and uncles).
• Writing down questions. Ask your child to think of questions to ask the doctor. Write them down and give them to the doctor. Or, if kids are old enough, they can write down and ask the questions themselves. If the problem has happened before, list the things that have worked and the things that haven’t worked in previous treatment. Kids will be reassured by your active role in their medical care and will learn from your example. And you’ll be prepared to give the doctor information vital to making an informed diagnosis.

Choose a Doctor Who Relates Well to Kids

Because your doctor is your best ally in helping your kids cope with health examinations, it’s important to carefully select a doctor. Of course, you want one who’s knowledgeable and competent. However, you also want a doctor who understands kids’ needs and fears and who communicates easily with them in a friendly manner, without talking down to them.

In the course of a physical exam, the doctor inspects, taps, and probes various parts of the body — procedures that may be embarrassing (or even physically uncomfortable) for kids. A good relationship between doctor and patient can minimize these feelings.

If your child’s doctor seems critical, uncommunicative, disinterested, or unsympathetic, do not be afraid to change doctors. Ask for recommendations from other parents in your area or from other doctors whose opinions you trust.

If your child’s illness or condition requires a specialist, ask your doctor to recommend someone who’s knowledgeable, experienced, and friendly. After all, adults want these characteristics in their own doctors, so as a parent you should be your child’s advocate in seeking medical care.

If you’ve seen a dentist or been treated for a broken bone, you’ve experienced radiation firsthand. In everyday life, radiation in the form of X-rays is used to create images of areas of the body that doctors can’t see, such as the inside of a tooth or the interior of the chest cavity.

In much higher doses, radiation is used to treat cancer. Radiation therapy (also called radiotherapy, irradiation, or X-ray therapy) works by preventing cells from growing or reproducing, and by destroying them. But parents whose kids need radiation therapy — one of the most common treatments for childhood cancer — often have many questions and concerns about it.

About Radiation Therapy

In radiation therapy, high-energy radiation from X-rays, gamma rays, or fast-moving subatomic particles (called particle or proton beam therapy) is used to kill cancer cells and shrink tumors. Types of childhood cancer treated with radiation therapy include brain tumors, Wilms tumor, and head and neck cancers.

But besides destroying cancer cells, radiation therapy also can harm normal cells. Normal cells are more likely to recover from its effects, though, and the health care team will take extensive measures to carefully monitor a child’s radiation doses to protect healthy tissue.

Because every case is different, each child’s cancer treatment is unique. Some kids receive radiation therapy alone, while others need both radiation and chemotherapy (the use of medicines to destroy cancer cells). And some kids require radiation therapy and surgery to remove tumors or cancerous areas.

How Radiation Is Given

Radiation therapy is administered two ways: externally or internally. Some kids may receive both external and internal radiation, depending on their needs.

External radiation therapy uses a large machine and special equipment that aims very specific amounts of radiation at cancerous tumors or diseased areas of the body. With internal radiation therapy (also known as brachytherapy, interstitial therapy, or implant therapy), a radioactive substance is injected or implanted into the body at the site of the tumor or cancer cells. In some cases, the material is swallowed.

Most kids receive only external radiation therapy, although those with cancers of the head and neck, uterus, cervix, thyroid, and testes may also undergo internal radiation therapy.

Other forms of radiation therapy can target cancer cells even better. One type is called intra-operative radiation therapy. After surgery, small amounts of cancerous cells can still remain in a child’s body. So, while the child is still in the operating room and the cancerous area is exposed, doctors use special machines to give a dose of radiation before the area is stitched closed. Another type, proton-beam radiation therapy, better focuses the radiation on the cancerous tissue with the goal of causing less harm to the surrounding healthy tissue.

A radiation oncologist (a doctor who specializes in radiation therapy) will work with other health care professionals to decide on the type and dose of radiation therapy that’s best for a child.

What Happens During External Radiation Therapy

Receiving radiation therapy for cancer treatment isn’t a one-time deal: Kids usually visit the hospital or treatment center as outpatients 4 to 5 days a week for several weeks, coming in just for the treatment and going home right after. Receiving small daily doses of radiation helps to protect the normal cells from damage, while weekend breaks help them recover from the trauma of radiation.

Before the first radiation treatment, a planning session called simulation will help a family prepare. The child will lie on an X-ray table while a radiation therapist uses an X-ray machine (called a simulator) to define the treatment area. Some X-rays or CT scans might be taken, and an area on the skin is marked with ink to highlight the treatment area. This “tattoo” should not be wiped off because it helps to position the radiation for each treatment.

At each external radiation appointment, the child will wear a hospital gown or robe and enter the radiation treatment room, where the radiation therapist will settle the child into position. The therapist will leave, and a large machine will then deliver the exact amount of radiation needed to kill the cells in the cancerous area. Most of the time that a child spends on the radiation treatment table involves proper positioning — the treatment itself takes only minutes.

Younger kids may have trouble being still during treatment — in these cases, kids may wear a custom body cast or be sedated to help immobilize them. To prevent unnecessary radiation exposure, parents aren’t allowed in the treatment room, but can still be there for their child during therapy. Some hospitals have two-way communication devices so mom or dad can talk with and reassure their child, and some even use closed-circuit TVs that allow parents to watch the procedure.

What Happens During Internal Radiation Therapy

Internal radiation treatment usually requires a child to stay in the hospital for several days for careful monitoring. The radioactive material may be in small tubes that are put into the cancerous tumor or a body cavity, or swallowed or injected into the bloodstream. This can require a minor surgical procedure and anesthesia (for example, when inserting something into the uterus, esophagus, or airways).

Parents may wonder whether the radiation their child receives will rub off on them or other family members — and whether they can touch, hug, and care for their child during and after treatment. If the treatment is external radiation therapy, there’s no need to worry. Kids getting external radiation are not radioactive after treatment, so contact with family members does not need to be restricted.

Kids and teens receiving internal radiation therapy, though, may have some restrictions. The radiation in the implant may send high-energy rays outside the patient’s body, so visitors must be protected from exposure. The child will be in a private room, and nurses and visitors can enter only for short periods of time. The child will have all the necessary care, but the nurses will work quickly to reduce exposure.

Common Side Effects of Radiation

If your child has cancer, you’re not only coming to terms with that diagnosis, but probably also worrying about the physical and emotional effects of radiation therapy.

Although the main purpose of radiation is to destroy cancer cells, it also can damage healthy cells. It’s this damage to normal cells that causes radiation side effects, most of which are related to the area being treated. The physical side effects of radiation therapy depend on the dose of radiation, the location where it was received, and whether the radiation was internal or external.

Many patients have no side effects at all. For those who do, most will go away in time, generally aren’t serious, and can be controlled with proper treatment.

A child who receives radiation therapy may experience side effects shortly after beginning treatment (called early side effects), such as:

Fatigue

One of the most common side effects of radiation treatment, both during treatment and after, fatigue (tiredness) often begins within a few weeks of the start of treatment and lasts for 4 to 6 weeks after it’s completed. Encourage your child to rest and sleep as often as possible, even if it doesn’t immediately result in more energy. In the long run, rest helps the body recover from radiation treatment.

Skin Damage or Changes

Skin damage is another very common side effect of radiation treatment, but only in the area receiving the radiation dose. This area may be red, sensitive, or easily irritated in the days, weeks, and months during and after treatment. The skin may swell or droop or the texture may change. The doctor might prescribe ointments or cream to speed healing and reduce irritation, which should go away 2 to 3 weeks after treatment ends.

Also, this skin may be more sensitive to sun exposure for months after treatment. There also might be some permanent changes to the color and elasticity of the skin.

How can you help? Dress your child in loose-fitting, soft clothes (such as cotton fabrics) to avoid skin irritation in the treatment area. It’s also important to protect the delicate skin from sunlight. During treatment, the irradiated skin should not be exposed to sunlight. After treatment, you should always apply a sunscreen with a sun protection factor (SPF) of at least 30 on the affected area.

When it comes to skin care, gentleness is key. Be careful not to irritate the treated skin, and wash it gently with only lukewarm water and mild soap. Avoid rubbing and scrubbing; simply pat the skin dry after bathing. Discourage your child from scratching the area. Also avoid applying any powders, creams, or lotions to the treated area.

Common Side Effects of Radiation (continued)

Hair Loss

Radiation therapy to the head and neck may cause hair thinning or hair loss shortly after treatment begins. It’s important to remember, though, that radiation anywhere else but the head and neck will not cause the hair on the head to fall out.

Losing hair can be scary for kids, especially if they’re at an age where it’s hard to be different. Getting a shorter haircut might make it less upsetting for a child once hair loss starts. Kids also may feel more comfortable wearing hats, bandannas, baseball caps, scarves, or wigs until the hair grows back — which may happen within 3 months after treatment ends. Although hair loss usually is temporary, it can be permanent.

Sore Mouth and Tooth Decay

The tissues of the mouth may be sore and sensitive and there may be an increased risk of tooth decay if a child received radiation therapy to the head and neck. These side effects usually happen during the second or third week after therapy begins and disappear within a month or so after it ends. The doctor may prescribe a mouth rinse to reduce pain and irritation. Kids should go for regular dental checkups and follow the dentist’s advice during radiation therapy.

Gastrointestinal Problems

In the hours following treatment, kids may have gastrointestinal problems (such as loss of appetite, diarrhea, nausea, and vomiting) if they received radiation treatment to the pelvis or abdomen. Some who receive radiation therapy to the head and neck also may have nausea and vomiting.

Even if your child doesn’t feel like eating, it’s still important to try to make sure he or she gets good nutrition. Offer foods high in nutrients and talk to your doctor about medicines or dietary changes that may ease stomach upset and prevent weight loss. Eating small meals throughout the day rather than several larger ones may be easier for your child, and bland foods (such as crackers, broth, and rice) can be easier to digest.

Blood Changes

Radiation therapy may cause low levels of platelets, red blood cells, and white blood cells (the cells that prevent bleeding and help the body fight infection). The doctor will monitor your child’s blood counts regularly and prescribe medicine or transfusions if needed.

Long-Term Side Effects

Some kids who have radiation therapy also have long-term or chronic side effects that can occur months to years after the treatment. These late effects — which can be temporary but usually are permanent — can include problems with bone growth, fertility, skin changes, and new tumor development, depending on where the radiation was received, the age of the child, and the dose given. Radiation on the brain may affect learning and memory.

Your doctor can offer advice and may prescribe medications to make your child more comfortable during radiation treatment. Make sure you avoid giving your child any medicines, including herbal medicines or over-the-counter (OTC) drugs, without the doctor’s OK.

Caring for Your Child

Its side effects can be unpleasant, but radiation therapy itself is painless and causes no discomfort. To ease your child’s fears before treatment, it may help to take a tour of the radiation department to see the radiation technologists and equipment.

When your child asks questions about cancer or treatment, be honest. Use age-appropriate terms and encourage your child to share his or her feelings. And remember that you’re not alone: Doctors, nurses, psychiatrists, psychologists, social workers, child-life therapists, and other members of the cancer treatment team are there to reassure you and your child before, during, and after radiation therapy.

Once radiation treatment is done, it’s still important for the doctor to monitor your child’s health and progress in follow-up appointments. During these checkups, the doctor will ask if there are continuing side effects or any signs of the cancer returning.

Coping with childhood cancer can be frightening for kids and parents alike, but remember that many kids treated with radiation therapy go on to live healthy, full lives.

Don’t hesitate to discuss your questions and concerns with the doctor. The more you know about how radiation therapy will affect and help your child, the better prepared you’ll be.

Getting health care for your child can be complicated. Many doctors only offer appointments during the school day, and their offices might be far from school. To see the doctor, your child might have to miss school and you might have to leave work — which isn’t always an option.

School-based health centers make going to the doctor as simple as walking down the hall.

Staffed by health care workers like nurses and doctors, school-based health centers provide a range of services to meet kids’ and teens’ health care needs. Services can include check-ups, lab tests, prescriptions, counseling, and regular visits for problems like asthma and diabetes.

About 2,300 school-based health clinics operate in 49 states and Washington D.C., serving more than 2 million students in preschool through 12th grade. Centers usually are inside a school building or right next door. Some school-based health centers serve more than one school or even a whole school district.

Most school-based health centers are run by a local health care group, such as a community health center, hospital, or health department. A few are run by the school district itself. Centers often get money from charities and the government so they can give care to families who cannot afford to pay.

You can find out if your child’s school has a health center by contacting your child’s teacher or the school office. Most school-based health centers also let parents know about their services by sending details when the student enrolls through school newsletters or websites or at parent-teacher events like back-to-school nights.

Why Have Health Centers at Schools?

When students aren’t feeling well, they have a harder time learning. They may miss class a lot — and when they are in class, they might have trouble paying attention. Giving kids and teens access to health care at school puts them in a better position to learn.

Students who use school-based health centers benefit in many ways. They spend more time in class because they tend to be sick less often and don’t have to take as much time off school to get to appointments. According to data from the School-Based Health Alliance, school-based health centers:

• help students do better in school
• increase high school graduation rates
• decrease school discipline cases

Studies show that teens, who might resist going to a doctor, are more willing to get help for problems like depression and weight issues at a school-based health center. This might be because they see the health center’s staff at school each day, which helps build trust.

What Services Do They Offer?

Services at school-based health centers vary based on local needs. Some have one or two health professionals who offer basic care and check-ups. Others offer a complete range of services, including mental health care. Centers may even have nurse practitioners, medical students, doctors, social workers, drug counselors, or dietitians on staff.

Services can include:

• tests for strep throat
• flu shots
• sports physicals
• tooth and eye exams
• scoliosis screenings
• medicine and check-ups for chronic conditions, like asthma and diabetes
• teaching students about healthy eating and exercise
• counseling for mental health and emotional issues
• referrals to specialists, if needed
• help applying for health insurance
• behavioral health care to help students with attention deficit hyperactivity disorder (ADHD) focus in class, or enable stressed or anxious students to talk privately with a therapist without leaving school

Besides one-on-one care, some school-based health centers lead small-group and classroom activities, like lessons on active lifestyles.

Most school-based health centers are open whenever school is in session. They often have rules to keep kids from visiting during core classes unless it’s an emergency. Some are also open after school, at night, or on weekends. As well as serving students, they may provide care to family members, such as younger siblings.

Although a student can get many health care needs met at a school-based health center, it is not meant to replace the child’s regular doctor. If your child already has a doctor outside school, the health center will work with that doctor to offer consistent care. For kids and teens who don’t have a regular doctor, school-based health centers can offer care during the school year and link students to a doctor or other health center when school isn’t in session.

How Do Health Centers Keep Parents Informed?

School-based health centers work hard to keep parents in the loop about their children’s health. You might be invited to participate in your child’s appointments via phone, email, or computer — or even in person, if your schedule allows. Between appointments, centers follow up with parents and guardians in a range of ways, such as written letters, phone calls, notes on secure websites, or even home visits.

And of course, school-based health centers only provide care to children with parents’ written permission. Most often, you will have the option to sign a permission form at the beginning of each school year saying that your child can get treatment at the school-based health center. Or you can give your consent on a visit-by-visit basis.

How Much Do Services Cost?

Many school-based health centers offer care on a sliding scale based on family income. Depending on the center and your situation, care could be free. Most also accept health insurance, such as Medicaid, a state-run child health insurance plan (CHIP), or private health insurance. Your school-based health center or insurance provider can give you more information.