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# The child with cancer: neutropenic precautions, mucositis, nausea, the central line and the family

- Safe practice

During chemotherapy a fever can be an emergency; the nurse prevents infection, cares for the mouth and the central line and supports the family.

Updated Nov 13, 2026

## Key points

- Fever of 38 °C or more during chemotherapy: tell the oncology team at once, even at night.
- Hand hygiene is the single most important measure for everyone around the child.
- Mouth care: soft brush and fluoride toothpaste 2 to 3 times a day, bland rinses (salt or baking soda), no alcohol-based mouthwash.
- Avoid crowds and sick visitors; safe food and water; someone else cleans pet litter.
- Ley 1388 de 2010 includes yearly influenza vaccination for the child's family and household, given at the childhood cancer unit.

## What it is

Chemotherapy lowers the white cell count, so a child can develop a serious infection with few signs other than fever. Nursing care centres on preventing infection, acting fast on fever, mouth care to prevent and ease mucositis, managing nausea and nutrition per the team's plan, caring for the central line, and supporting the child and family through a long treatment. In Colombia, Ley 1388 de 2010 guarantees integral care for children with cancer; nurses also help spot the early warning signs that AIEPI lists.

## What it requires

- Know when the child's count is expected to be lowest and watch more closely then.
- Central line care per protocol (see the central line page).
- Bleeding precautions when platelets are low, per order.
- Psychosocial and school support for the child and family.

## How it is applied (and why)

- Wash hands before and after every contact and teach visitors to do the same — infection spreads mainly by hands.
- Take the temperature whenever the child seems warm, flushed, chilled or unwell — fever may be the only sign of infection.
- Report fever or any infection sign at once and follow the protocol — infection can progress to sepsis within hours.
- Inspect the mouth daily and help with gentle brushing and rinses — clean mouths develop fewer infected sores.
- Give anti-sickness medicines as prescribed and offer foods with enough protein and calories — nausea and sores reduce intake.
- Care for the central line exactly per protocol and look at the site each shift — the line is a direct route for germs.
- Follow bleeding precautions when platelets are low, as ordered — report any bleeding promptly.
- Keep visitors with colds away and advise avoiding crowds — fewer exposures, fewer infections.
- Involve the family, the school and the social worker early — Ley 1388 provides social, psychological and school support.

## In nursing practice

- Common at home: mouth sores, nausea, diarrhoea, fatigue and poor appetite.
- Call for persistent or bloody diarrhoea, inability to eat or drink, redness or discharge at the line, new rash, severe headache or breathing difficulty.
- Mucositis from chemotherapy usually heals in 2 to 4 weeks if it is not infected.
- AIEPI warning signs of childhood cancer include fever over 7 days, worsening or night headache, bone pain, pallor, bruising, a white pupil, masses and enlarged nodes.

## Common mistakes

- Waiting until morning to report a fever.
- Letting visitors with colds or other infections see the child.
- Using alcohol-based mouthwash on a sore mouth.
- Forgetting the siblings and the parents' own needs during a long treatment.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is a fever during chemotherapy an emergency?

A low white cell count means infection can become severe quickly, and fever may be its only early sign.

## What mouth care helps prevent and ease mucositis?

Gentle brushing with a soft brush and fluoride toothpaste, bland salt or baking-soda rinses, and no alcohol-based mouthwash.

## Which measure protects a child with neutropenia the most?

Hand hygiene by everyone who has contact with the child.

## Which cancer warning signs does AIEPI ask about?

Prolonged fever, worsening or night headache, bone pain, pallor, bleeding or bruising, eye changes such as a white pupil, masses and large hard nodes.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/the-child-with-cancer-neutropenic-precautions-mucositis-nausea-the-central-line/)

## Connections

## Related 3

- [Central venous catheter care](https://durgical.com/en/nursing/central-venous-catheter-care/)
- [Transmission-based precautions: contact, droplet and airborne](https://durgical.com/en/nursing/transmission-based-precautions-contact-droplet-and-airborne/)
- [Palliative and end-of-life care for children and their families](https://durgical.com/en/nursing/palliative-and-end-of-life-care-for-children-and-their-families/)

## Related conditions 7

- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)
- [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/)
- [Childhood brain tumours (medulloblastoma, pilocytic astrocytoma, craniopharyngioma)](https://durgical.com/en/conditions/childhood-brain-tumours/)
- [Wilms tumour (nephroblastoma)](https://durgical.com/en/conditions/wilms-tumour/)
- [Neuroblastoma](https://durgical.com/en/conditions/neuroblastoma/)
- [Retinoblastoma](https://durgical.com/en/conditions/retinoblastoma/)
- [Osteosarcoma](https://durgical.com/en/conditions/osteosarcoma/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Information for Patients Who Are Getting Chemotherapy (Preventing Infections in Cancer Patients)](https://www.cdc.gov/cancer-preventing-infections/patients/index.html) (Centers for Disease Control and Prevention, 2025); [After chemotherapy - discharge](https://medlineplus.gov/ency/patientinstructions/000012.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Oral mucositis - self-care](https://medlineplus.gov/ency/patientinstructions/000047.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/cuadro-procedimientos-atencion-integrada-enfermedades-prevalentes-infancia.pdf) (Ministerio de Salud y Protección Social de Colombia, 2016).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/the-child-with-cancer-neutropenic-precautions-mucositis-nausea-the-central-line/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-child-with-cancer-neutropenic-precautions-mucositis-nausea-the-central-line/