No abstract

ABSTRACT. In this study of the effects of death of a child from malignancy on the immediate family, it was found that 62 of 93 families wished to participate and that, in 50%, there was evidence of family dysfunction. Factors that appeared to be associated with dysfunciton included older parental age, lower educational achievement, previous social and psychological disturbances, poor family communication and lack of support from within the family by one or other of the parents. In 45% of the families, one or other sibling showed an abnormality of behaviour which was usually transient. The deceased children in the study had not been informed of their imminent death. In those families in which the parents perceived that their child knew that he was dying, there was a significantly higher incidence of family disturbance. In the absence of prospective clinical trials on the effects on the child and the family of informing the child that he was dying, it is not possible to draw conclusions on the above finding.

A randomized study of intestinal decontamination was undertaken in 68 children with leukemia and solid tumours. Framycetin, colymycin, nystatin, and metronidazole were given in 35 neutropenic episodes in 33 children, while co-trimoxazole and lactobacilli preparation were administered in 35 episodes in 35 children. The diseases, severity of neutropenia, and incidence of infection at entry into study were comparable in the two groups. There was no significant difference in the incidence of infections developing during the phase of neutropenia. The median and range of time required to recover from neutropenia were also not different. Co-trimoxazole and lactobacilli were significantly better tolerated, there being no nausea and vomiting, no refusal to take medication, no dose reduction or change to an alternative regimen. We conclude that co-trimoxazole and lactobacilli preparation improve quality of life during a neutropenic episode and have the additional advantage of being relatively inexpensive.