CareTalk Blog: Nemours Center for Cancer and Blood Disorders

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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.

Caring for Siblings of Seriously Ill Children

Caring for a seriously ill child takes a tremendous toll on the whole family, and healthy siblings are no exception.

As parents, our exhaustion, stress, and uncertainty about how to respond to the needs of other kids can leave us feeling guilty and drain our reserves — and might tempt us to downplay or ignore the impact a child's illness may have on his or her brothers and sisters.

By being aware of what healthy siblings are going through and taking a few steps to make things a little easier, parents can address many issues before they unfold.

How Kids Might Feel

Family routines and dynamics naturally change when a child is ill, which can confuse and distress healthy siblings. In addition to fear and anxiety over the illness, they often experience the feeling of loss of a "normal" family life, and loss of their identity within the family.

It's normal for healthy siblings to:

  • worry that the sister/brother will die
  • fear that they or other loved ones will catch the sibling's disease
  • feel guilty because they're healthy and can enjoy activities that the sibling cannot
  • be angry because parents are devoting most of their time and energy to the sick sibling
  • feel neglected and worried that that no one in the family cares
  • resent the sibling who never has to do chores
  • resent that the family has less money to spend now because the sibling is sick
  • be nostalgic for the past (wishing things could be like they were before the illness)
  • feel residual guilt for being "mean" to the sibling in the past
  • experience generalized worry or anxiety about an uncertain future

The way siblings express their needs will vary considerably — some may act out, some may try be the perfect child, and many will do both. Most studies find that siblings of children with cancer are not at any increased risk for mental illness, although they may be at greater risk for behavioral and emotional manifestations of their distress.

What to Look For

Pay attention to any changes in kids' behavior, and talk to them frequently about how they're doing and what they're feeling. The more room kids have to express their emotions, the less emotional turmoil and fewer behavioral problems they're likely to have.

Signs of stress in kids can include any changes in sleep patterns, appetite, mood, behavior, and school functioning. Younger children may pick up on parental stress and show regressed behaviors (doing things they did when they were younger and had already outgrown).

Even if you don't see any signs in your kids, you can be pretty sure that changes to their routine and seeing their parents and other family members upset is likely to be causing them stress.

Ways to Help

While you may not be able to take away the source of your kids' emotional pain, you can help alleviate their stress and make them feel secure, cared for, and supported.

These suggestions might help, but it's also helpful to seek support (for example, through counseling or a hospital group) to help you take better care of all your children.

First, look forward. If you find yourself feeling guilty for not being a perfect parent to your healthy children, don't beat yourself up — dwelling on the past is not productive. Instead, try to make a point of recognizing your kids' feelings and needs now, and move on from there.

Keep the lines of communication open. Pay attention to siblings' needs and emotions. Encourage them to talk about their feelings — the good, the bad, and the guilt-inducing — and try to read between the lines of their actions. This can be difficult when you're exhausted, stressed, and away at the hospital or clinic for long periods of time, but a little attention and conversation can let your healthy kids know that they're important and their needs matter.

Keep it "normal" as much as possible. Try to maintain continuity and treat your kids equally. Stick to existing rules and enforce them; in addition to minimizing jealousy and guilt, this also can send a strong optimistic message about your sick child's recovery. And try not to fall into the trap of relying on healthy kids as caregivers before they're ready. Accept help so that your healthy kids can stick to their typical routines as much as possible.

Say yes to help. Accepting help with transportation, meals, childcare, and other daily activities can take some pressure off of you so that you have the emotional reserves to be there for your family. You'll also be teaching your kids a valuable lesson about accepting generosity from others.

It's OK to have fun. Enjoying yourself and having fun (for a change) can go a long way toward relieving stress and recharging your battery. In addition to trying to maintain a normal schedule of activities, whenever feasible set aside some time for your kids to spend with friends and family without focusing on the illness. You also can set aside one-on-one time with your healthy kids where the focus is on them and everything that's going on in their lives other than their sibling's sickness.

Be patient with regressive behavior, especially on the part of healthy kids, who may have trouble making sense of emotions. At a time when parents' nerves are frazzled, it can be hard to stay patient and attentive, but it's essential for siblings. However, it's not a good idea to let kids — healthy or sick — behave inappropriately or get away with behaviors that you would not have allowed before the illness. Rather than make a child feel relaxed, this can increase anxiety, jealousy, or feelings of abandonment.

Include siblings in the treatment and care. Including healthy kids in some of the doctor visits and hospital sessions can help demystify the illness. They also can benefit from connections to other patients' siblings. In addition, giving healthy kids specific, non-threatening "jobs" can help them feel like an important part of the treatment process. Encourage their involvement in a variety of ways, and let them tell you how they'd like to be involved — maybe helping with physical therapy, for example, or making cards, books, or videos to keep a hospitalized child connected to life at home and school. Many hospitals offer sibling counseling groups, workshops, and other programs that can help your healthy kids feel less alone.

Reviewed by: Michelle New, PhD
Date reviewed: April 2012