For school-age children, returning to school after a bone marrow or cord blood transplant (also called a BMT) is an important step in getting back to a normal routine. School helps children feel normal and have a sense of belonging and hope for the future. Most children can return to school between 6 and 12 months after transplant.
Early months — schoolwork at home
After a transplant, most children do schoolwork at home until they are able to attend school in the classroom. You may be able to arrange lessons with a tutor a few hours a week through your child's school. Talk with your child's teacher to plan how your child can keep up with classwork and stay in touch with classmates.
Meeting with teachers
Before your child returns to school, meet with your child's teacher and other school staff. Your transplant center social worker or child life specialist may be able to help with this meeting. Depending on your child's age, he or she may attend as well. Explain your child's illness, level of readiness to re-enter the classroom and the status of your child's health.
Talk about possible changes in learning or school performance that sometimes develop after transplant and what signs to watch for. Many children show no changes in learning ability after transplant. If your child does show changes, he or she can be assessed so you can create a plan to meet your child's needs. Some effects of transplant do not surface until years later. At your child's regular follow-up visits to the transplant center, doctors will monitor your child's development and watch for any late effects of transplant.
Being an advocate for your child's education rights
Your child may not need special help in school, but he or she has a legal right to such help if needed. In the United States, your child is eligible for certain federal programs for disabled children under the Other Health Impaired category. Your child may benefit from an Individualized Education Plan (IEP). For example, an IEP may include home tutoring until your child can return to school or allowing more time for tests. There are also programs to help babies, toddlers and preschoolers who have learning problems after treatment. Ask your transplant center social worker whether these programs are offered through the school or the state health department in your area.
Find out your child's rights and what your responsibilities are. You may need to be assertive to get your child the help he or she needs. For help understanding education plans and how to work with your child's school, talk to your transplant center social worker. We can also help answer your questions. Be The Match® has a team dedicated to supporting patients, caregivers, family members and friends. Our patient services coordinators offer confidential one-on-one support and financial guidance. We also offer free educational resources — DVDs, booklets, online tools and more. You can contact Be The Match Patient Services.
Helping your child rejoin classmates
Returning to school means reconnecting with friends and being part of a group of peers again. It can be both exciting and frightening. Your child may feel awkward at first. He or she might have hair loss or look different due to medications. Classmates may not know how to respond to how your child looks. Your child could be embarrassed as well. Make plans for your child's first day back in the classroom. Depending on your child's age, you or your child's best friend could go along, so your child does not have to walk into school alone. You may also arrange for a child life specialist or nurse from the hospital to visit the class before your child's return to talk about the transplant and answer questions. Older children may prefer to answer questions themselves.
You can help your child plan how to answer questions from classmates. He or she might want to use a straightforward approach, such as, "I know this mask makes me look different, but it keeps out germs that could make me sick." Many children use humor, such as jokes to answer questions.
Health concerns
It is important to have good communication between you, your child's doctor and the school. When you meet with your child's school, explain any ongoing health concerns your child has. Explain your child's risks for infection. If your child will need to take medications during the school day, plan how this will be managed. Talk about whether your child can take part in gym, sports and other activities. Talk about any symptoms that you would need to know about right away.
You may also consider getting your child a MedicAlert tag. If an emergency arises when you are not with your child, the MedicAlert emblem would alert a health care team to your child's medical situation. You can learn more at www.medicalert.org.
Schools will ask for immunization records, but your child cannot get new immunizations for at least a year after transplant. Your child's doctor can provide any documentation your school needs and answer questions. Make sure your child's school officials know they need to notify you of any diseases at the school, such as measles or chicken pox. Even if your child was immunized for these diseases before, being exposed to them now could pose a risk to your child. The transplant has wiped out previous immunizations. Your child's transplant doctor will determine when your child can be re-immunized, usually one year after transplant or later.
Contributing editors
K. Scott Baker, M.D., Director, Pediatric Blood and Marrow Transplantation and Survivorship Programs, Fred Hutchinson Cancer Research Center, Seattle, Wash.Nancy J. Bunin, M.D., Director, Blood and Marrow Transplantation, Children’s Hospital of Philadelphia, Philadelphia, Pa.Eva C. Guinan, M.D., Associate Professor of Pediatrics, Harvard Medical School, Dana-Farber/Children’s Hospital, Boston, Mass.
Mary Jo Kupst, Ph.D., Professor of Pediatrics, Medical College of Wisconsin; Director, Program in Pediatric Psychology, Milwaukee, Wis.