Leukemia

The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). Leukemias, as a group, make up about a quarter of all pediatric cancers. Luckily, with treatment, most children with leukemia will be free of the disease without it coming back.

Leukemias start in the bone marrow — the soft tissue found inside bones that produces blood cells. When a child is diagnosed with leukemia, it’s because the white blood cells in the body are producing abnormally. These cells (also known as blasts) start to crowd out the healthy cells in the bone marrow. Eventually, the healthy cells have no place to go, so they stop producing. When a child's body no longer produces enough healthy white blood cells it can cause anemia, swollen lymph nodes, and other symptoms of leukemia in children.

Leukemia is classified as being either acute (meaning it’s rapidly developing) or chronic (meaning it’s slowly developing). About 98% of pediatric leukemias are acute.

 
Types of Pediatric Leukemia
Types of leukemia in children include:
  • Acute lymphoblastic leukemia (ALL): This happens when too many lymphoblasts (a certain type of white blood cell) are produced.
    This is the most common type of leukemia, affecting nearly 60% of kids with leukemia.
  • Acute myelogenous leukemia (AML): This occurs when too many immature white blood cells (called myeloid blasts) are made.
    These leukemia cells are abnormal and can’t mature into normal white blood cells.
  • Chronic myelogenous leukemia (CML): This rare form of pediatric leukemia happens because there are too many mature white blood cells.

 
Signs and Symptoms of Leukemia in Children

Although the symptoms of leukemia in each individual child can vary, common symptoms of leukemia in children include:

  • anemia  (when the level of healthy red blood cells in the body becomes
    too low)
  • bleeding and/or bruising
  • frequent or reoccurring infections
  • bone and joint pain
  • abdominal pain
  • swollen lymph nodes (also called “swollen glands”)
  • difficulty breathing
  • excessive fatigue (more tired than usual)
  • poor appetite

IMPORTANT NOTE: Instances of the symptoms of leukemia in children listed above, either together or on their own, do not automatically mean that a child has leukemia or any other kind of cancer. Any or all of these symptoms could be a sign of something else.

 
Diagnosing Leukemia in Children

One of our Nemours pediatric hematologists-oncologists (doctors who treat blood disorders and cancers) will conduct a physical examination on your child to check for symptoms of leukemia in children such as signs of infection, anemia, abnormal bleeding, and swollen lymph nodes.

The doctor will also feel your child's abdomen to see if the liver or spleen is enlarged. We’ll also take a complete medical history by asking about your child’s symptoms, past health, your family's health history, any medications your child is taking, allergies, etc.

After this exam, the doctor will order a CBC (complete blood count) to measure the numbers of white cells, red cells, and platelets in your child's blood. Your child’s blood chemistries will also be checked.

Then, depending on what we find in the exam and blood tests, your child also may need a:

  • bone marrow biopsy and aspiration (when marrow samples are taken for testing, usually from the back of the hip)
  • lymph node biopsy (when lymph nodes are removed and examined under a microscope to look for abnormal cells)
  • lumbar puncture (also called a spinal tap, when a sample of spinal fluid is taken from the lower back and examined for evidence of abnormal cells. This test will show if the leukemia has spread to the brain and spinal cord.)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric leukemia care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Leukemia in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, treatment may include one or a combination of the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, as well.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your pediatric leukemia journey – and to strive and hope, with you, for a better tomorrow.

Taking Care of You: Support for Caregivers

If your child has a serious illness, the caretaking that falls to you is undoubtedly intense. But of course you do it willingly. After all, you'd do anything for your child, including switching places in a minute if only that were possible.

Instead you give all that you can, in every other imaginable way. It's harder than anything you've ever done, and honestly, there are moments when the sheer magnitude of what you're up against is so overwhelming that you just want to run and hide.

Ask any parent who's done this before and you'll find out something very important: You're not alone.

The Caregiver's Dilemma

When you're the caregiver of a child who is seriously ill, it can feel as if the whole world is on your shoulders. Your sick child needs you. You may have other children who need you. Your spouse needs you. Your job — however pointless work might seem right now — needs you.

Yet there's only so much you can give before you will feel mentally, emotionally, and physically drained. That's why it's a necessity — not a luxury — to spend some time taking care of yourself so that you can recharge and feel empowered to continue to support and care for your child.

Tips for Caregivers

Many of these tips might seem easier said than done at first, and a few may seem downright frivolous. But to make it through the long haul, consider the wisdom of that air-safety rule about putting your own oxygen mask on first before helping others. Here are some ways to do that:

Take breaks. It's essential to regularly schedule a few times each week — even for just an hour or two — when you can get away while a family member, friend, or a health aide stays with your child. Once away, that time is yours, so don't feel guilty about how you spend it. Nap, read, have coffee with a friend, go shopping, whatever allows you to relax. While you're out, your child will probably enjoy having someone else to talk to and you'll feel refreshed when you get back.

Eat right. It's no surprise that living on coffee and picking at hospital leftovers can leave you feeling tired and run down. If you know you're going to be out, carry nutritious snacks with you, like fruit, granola bars, sandwiches, or nuts. And if friends offer to bring homemade meals to your home to help out, take them up on it.

Exercise. Whether through a brisk walk, a bike ride, or yoga, most people find that exercise helps clear the mind, boost energy levels, and improve sleep. Even 20 minutes can do the trick, so save a bit of time every day to get moving.

More Tips

Stay organized. Keep all the information you've accumulated about your child's illness in one place, including medication schedules, important phone numbers, and insurance information. When you think of questions for your doctor, write them down immediately so you won't forget. And since dealing with insurance companies can often seem like a full-time job in itself, enlist the help of your spouse or another trusted family member or friend to help keep it all straight. Use a notebook to keep all of the information in one place.

Ask for help. Your friends and family likely want to help you, but might not be sure about what you need. If someone says, "If there's anything I can do…" — and there is — say so. You'd be surprised at how running an errand, doing some laundry, or just sitting and listening to you talk about the day can not only benefit you, but also can make a loved one feel useful.

Find a support group. Ask your child's doctor, nurse, or social worker for information on local support groups related to your child's condition or caregiving in general. If you feel more comfortable sharing anonymously online, then look there. The important thing is to get beyond the feeling of isolation by reaching out to others who've been in your shoes.

Acknowledge your feelings. Your child is sick — of course you have feelings of anger and frustration, and days when you wish you didn't have to deal with it all. Does this make you a bad parent? No, it makes you human. Accept these negative feelings and the often painful fact that no matter how much time or energy you invest in your child's care, you can never be completely in control of your child's health and happiness.

Be aware of the signs of "caregiver burnout." Caregiver burnout is a true state of exhaustion, both physical and emotional. It tends to happen when caregivers try to "do it all" without getting the help or rest they need.

Because caregivers tend to be on autopilot, they're not usually quick to recognize burnout in themselves. Other people might notice the symptoms first, which can include changes in appetite and sleep patterns, withdrawal from social activities, increased anxiety, or emotions that are either heightened (such as excessive crying or irritability) or decreased (feeling empty or unconcerned). Take it seriously if someone you trust notices any of these things in you.

Getting Help

If you feel like you may be experiencing caregiver burnout, depression, or anxiety, explain your feelings and symptoms to your doctor, who may recommend that you see a counselor or therapist (especially one who specializes in caregiver needs).

Your doctor also may encourage you to take a temporary break from your duties by looking into respite care (the kind needed would depend on how ill your child is). Medications for anxiety or depression could be an option, too.

Finally, remember that you are not superhuman. You're a parent doing your best. So give your child your time, your encouragement, your attention, and your unconditional love. Just be sure to save a little bit for yourself.

Reviewed by: Joanne Quillen, MSN, PNP-BC
Date reviewed: May 2012