Caring for the Child After a Pediatric Liver Transplant

Many children have high blood pressure after their pediatric liver transplant. Anti-rejection medicine may increase blood pressure. It is vital for your child to take blood pressure medicines as ordered by the pediatric liver transplant doctor.

When you get home, you may be asked to keep a daily record of your child’s blood pressure, weight and temperature. Call the Children’s Liver Transplant coordinator if the reading is not normal for your child. If there is a problem, the Children’s Liver Transplant coordinator may ask for your child’s recent vital signs. Bring the record with you when you visit the Children’s Liver Transplant Clinic.

  • Immunizations
  • Pediatrician
  • Car Seats
  • Medical Alert Identification
  • Nutrition
  • Exercise

 

  • Sunscreen
  • Dental
  • Piercings and Tattoos
  • School and Day Care
  • Travel Tips

 Immunizations (Vaccines)

When possible, your child should receive all needed vaccines before the liver transplant. Talk with your child’s doctor about the vaccines your child needs. In general, your child should receive these vaccines before a liver transplant:

  • Diphtheria, pertussis and typhoid (DPT)
  • Polio
  • Measles, mumps and rubella (MMR)
  • Influenza type B (inactivated)
  • Haemophilus flu type B
  • Chicken pox
  • Hepatitis B

Teen Vaccines

Vaccines plan an important role in keeping your child healthy before, during and after transplant. For transplant patients there are special guidelines and recommendations. Download a copy of our brochure and learn what vaccines are safe for your teen.

After liver transplant, your child cannot receive any live vaccines because his immune system is weak. He could get the disease the vaccine is trying to prevent.

  • Live vaccines include the measles, mumps and rubella (MMR), smallpox and chicken pox.
  • Infants, children and family members who have weakened immune systems should receive the inactivated polio vaccine (IPV).
  • You, your child and family members older than 6 months should receive a flu shot each year.
  • If your child is exposed to chicken pox or shingles, call the pediatric liver transplant doctor or the Children’s Liver Transplant coordinator right away. Your child might need intravenous (IV) medicine. If your child has not had chicken pox or a chicken pox vaccine and is exposed, he will need a varicella zoster immunoglobulin (VZIG) shot within 72 hours of exposure.

 Pediatrician

After a pediatric liver transplant, make an appointment for your child with your local pediatrician or family doctor. This gives your local doctor a chance to check your child and update his chart with new medicines.

Have your local pediatrician keep your child’s vaccines up to date and give him a flu shot each year. This doctor can also treat your child for any routine problems such as ear infections, colds or rashes.

 Car Seats

All states have laws that require infants and toddlers to be properly restrained in a car safety seat that is correct for their age and weight. Have them ride in the backseat. Use your seat belt to set a good example.

 Medical Alert Identification

Your child will need a medical identification (I.D.) bracelet or necklace. In case of a car accident or other emergency, health workers will know he has had a liver transplant. Ask your child’s doctor or nurse for this order form. Please complete and mail this form right away.

 Nutrition

Eating healthy food helps your child’s body grow and heal. The body needs protein, carbohydrates, fats, vitamins and minerals. Your child’s appetite can change after a liver transplant. Be sure to listen to your child and make changes based on his appetite. The dietitian will check your child’s nutritional status. She will teach your family about the right foods or formulas for your child’s special needs. The dietitian will also check your child’s diet and growth after the liver transplant.

Before a liver transplant, most children are on special diets. Your child’s diet may be restricted in sodium, potassium, protein or phosphorus. These restrictions may change over time. We will review changes with you if they are needed.

After the liver transplant:

  • Have your child avoid any uncooked or raw foods such as clams, oysters or sushi.
  • Help your child eat a balanced diet that includes fruits and vegetables. Stay with a “no added salt” rule.
  • Avoid chips, sodas, excess fruit juice and other snack foods. They are empty calories and do not provide good nutrition.
  • Have your child eat more healthful foods by eating them yourself and setting a good example.
  • Your child’s weight will be checked during the Children’s Liver Transplant Clinic visits to make sure he is growing well. Our goal is for your child to reach his ideal body weight for his age and height.
  • Avoid force-feeding your child any food. This may cause your child to dislike food, even after treatment.
  • Your child may dislike foods he once enjoyed. He may begin to like new foods. Be sure to support your child during this time of change.
  • If your infant is bottle-fed, give him formula or milk in his bottles. Do not give your baby soda and juice in the bottle.  

 Exercise

As your child feels better, his activity level will increase. He can do any activities he feels up to, except contact sports such as football, wrestling and dodgeball. Please feel free to call the Children’s Liver Transplant office or ask us questions during the Children’s Liver Transplant clinic visits about your child’s activity or energy level.

 Sunscreen

Sun exposure happens all year, not just during the summer. The best way to prevent skin damage is to limit the time spent in the sun. Because of side effects with your child’s medicine, he must use sunscreen. Choose one with SPF 15 or higher. Use it freely and often, even if your child will only be in the sun a short time. To prevent sunburn, your child should:

  • Wear clothing that protects his skin, such as a hat, long pants and long sleeves.
  • Put sunscreen on exposed skin 30 minutes before going outdoors. Put it on again as the package directs. This usually means you need to put it on every two hours and after playing in the water.
  • Use sunscreen for children of all ethnic backgrounds, regardless of skin color.

 Dental

Medicine such as cyclosporine can cause overgrowth of gum tissue. Keep your child’s teeth, mouth and gums clean. This helps reduce the chance of an infection.

  • Make sure your child brushes and flosses his teeth twice a day.
  • Use a soft toothbrush and gently brush up and down. This may help keep his gums from overgrowing.
  • Your child should also see a dentist regularly. He will need prophylaxis (preventative antibiotics) before all dental procedures.

 Ear/Body Piercing and Tattoos

Your child should not get any ear or body piercing or tattoos until you talk to the pediatric transplant doctor. This is not a needed medical treatment, and we cannot advise this procedure.

 School and Day Care

Talk to your child’s liver transplant doctor about when your child will be ready to return to school, preschool or day care. He can also advise you of any special plans that may be needed. The goal for all liver transplant children is to attend school full-time. This helps your child keep up with learning, socializing and physical activities.

Children’s also offers a Hospital School program to help with studies when your child is in the hospital. Your child’s liver transplant coordinator, social worker or hospital school program coordinator can help you with plans for your child’s return to school. This may include letters, guidelines and options to help explain why your child may:

  • Need to return to school part-time.
  • Not be able to receive certain vaccines that are needed to enroll in school.
  • Have limits on contact sports.
  • Need home care school options for when he is ill or unable to attend school full time.

 Travel Tips

As your child feels better and returns to a regular schedule, your family may want to travel or take a vacation. Please call your child’s liver transplant coordinator before travel.

  • If you to fly, take your child’s medicines with you in your purse or carry-on bags. This is helpful in case your checked luggage gets lost in flight.
  • Bring extra medicine in case of travel delays.
  • Carry an up-to-date list of all of your child’s medicine in case of an emergency.
  • Have your child wear a medic alert bracelet and carry an identification (I.D.) card.
  • Include the phone number of the Children’s Liver Transplant team.
  • Talk with the Children’s Liver Transplant coordinator before your child goes to an amusement park. There are certain rides, such as roller coasters, that are not advised for pediatric transplant patients.