Sunday, April 19, 2009

Possible Late Effects of Your Child's Transplant

Growth problems
Doctors will check your child's height and weight regularly after transplant to see if he or she is growing as expected. If your child does not grow at a normal rate, an endocrinologist (doctor who is a hormone specialist) can assess your child. Some drugs common after transpant can affect growth. If tests show your child's body is not making enough growth hormone, growth hormone therapy may help. If your child does not have the growth spurt that comes with puberty, treatment with sex hormone replacement therapy may be an option. Doctors are still learning more about who may or may not benefit from each kind of hormone therapy. Although some children do not grow as tall as expected, most grow to within the normal adult range.


InfertilityMost people treated with a bone marrow or cord blood transplant become infertile. The treatments your child receives before transplant and your child's age at treatment affect the chances he or she will be infertile. Before transplant, talk with your child and your child's doctor about this risk. Older children who have gone through puberty may be able to take steps to provide options for having a child in the future. Before transplant, older boys may be able to have sperm frozen. Older girls may be able to have eggs frozen. However, these methods are not an option for everyone and do not always work. You can ask your child's doctor whether these or other options are available for your child.

Your child will also need to know that not everyone who has a transplant becomes infertile. Some transplant survivors have gone on to have children. When your child is ready to think about these questions, encourage him or her to talk with a doctor, either with or without you present. You can get more information from the non-profit organization Fertile Hope at www.fertilehope.org.

Changes in memory or learning
For many children, transplant has no effect on learning. However, some children have changes in the ways they can learn or remember information. Children who are older at transplant have a low risk of such changes. The risk may be higher for very young children. [1, 2] The risk may also be higher for children who had disease in the central nervous system or had radiation treatments. Changes in learning can appear soon after transplant, but often do not surface until years later. For example, a memory problem may not appear until a child tries to learn multiplication tables.

If your child's learning is affected, you can work with the school to meet your child's needs. Watch for drops in your child's grades or increased feelings of frustration with school. Other signs you and your child's teacher can watch for include problems with:

Understanding what he or she reads
Needing much more time and effort to complete work than other children do
Math, such as remembering multiplication tables or organizing math problems
Remembering, understanding and using information that he or she reads or sees, while having an easier time with information that is heard
Paying attention in class
Short-term memory
Planning and organizing

If your child shows changes in learning ability, he or she can be assessed so you can create a plan to meet your child's needs. At your child's regular follow-up visits to the transplant center, doctors will monitor your child's development and watch for changes. See Returning to School after Transplant for more information.

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