Acute lymphoblastic leukaemia (ALL) for young children

Physiotherapy and occupational therapy advice for younger children.

We know there are many benefits from keeping physically active after a diagnosis of acute lymphoblastic leukaemia (ALL). There are things which can make moving and being active more difficult for you during treatment for ALL. These can include side effects of medications, or limited opportunities to socialise with friends, attend school or take part in sports activities.

Physiotherapy and occupational therapy team

We aim to meet all children, young people and their families who have a new diagnosis of ALL within the first month after diagnosis, to introduce our team and let you know how to contact us for support. We also check in in how your child is managing with staying physically active.

You can ask to see a physiotherapist at reception, or speak to your doctor or nurse.

Physiotherapists

Physiotherapists

will assess, treat and manage any difficulties a child or young person has with their movement, strength, balance and co-ordination so they can play and develop.

Occupational therapists

Occupational therapists help children and young people to carry out activities they want or need to be able to do. We assess and give advice on activities of daily living and self-care, access to school and can support people to participate in leisure activities, play or activities that are meaningful for them.

Therapy assistants

Therapy assistants work very closely with occupational therapists and physiotherapists to help carry out the treatment plan. We support families and help the patient meet their goals.

Effects of treatment

The first few months of treatment often have the biggest impact your child’s movement. They may feel tired and not be interested in activities they used to enjoy.

You may notice differences during weeks with steroids and after certain chemotherapies like vincristine. If you notice your child is struggling to move, tripping, falling or struggling with activities they used to be able to do, please contact our office, or ask to see a physiotherapist in clinic.

We also know that physical activity is very important in keeping healthy during treatment and want to keep children as active as possible.  Being active will allow them to return to school and activities as soon as they are able to.

Ideas to keep moving

Keeping physically active is important during treatment. Your child is likely to have good days and bad days. Keeping moving is key, every bit of activity helps. Even just standing up whilst getting dressed, walking to the toilet or walking up the stairs helps.

Some ideas to help your child stay active:

• standing or kneeling at the sofa to play with toys
• sand or water tables
• popping or stamping on bubbles
• balloon tennis (keeping the balloon in the air)
• obstacle courses in the house
• ride on toys and trikes
• playing on the floor with you and their siblings
• sticker hunt, placed high and low to encourage squatting down low and reaching up high
• outdoor toys such as rockers and slides
• nursery thymes with actions such as ‘heads shoulders knees and toes’, ‘the grand old Duke of York’, ‘if you’re happy and you know it clap stamp your feet’
• games like musical statues
• online resources such as Cosmic Kids Yoga on YouTube, GoNoodle on Youtube, and Tiny Happy People on BBC.

Research shows that children are more likely to exercise with the support of their family and getting physically active together has benefits for the whole family. Sometimes, families are not sure what their child is allowed to do on treatment. It is worth asking your doctor whether you are able to meet with friends, attend school or go to a playground.

Looking after parents and carers

We want children to have the opportunity to move, so please try and let them do as much of the moving as the can, or with as little help as they need. Every movement counts in keeping strong.

Lifting and carrying older children can also put strain on your back and increase the risk of injury to yourself and your child.

Speak to your therapist about adapting ways to move, for example if it is difficult getting up stairs then try going up or down on their bottom.

Bathing can be difficult if a child is struggling to stand and move. Occupational therapists can assess your child’s needs and provide equipment to help with bathing or using the toilet.

Wheelchair or buggy

We can refer you child for a wheelchair if you are struggling to walk. However there may be a wait to receive this. British Red Cross can provide short term loans during this time, for around £25 per week.

Sling libraries

Baby slings or carriers can be useful if you have younger siblings who would normally use a pushchair if you need a wheelchair. They can also help you get outdoors as a family to places like woodland or beaches which are not easily accessible. There is a charge for this service, although there is help for families in financial need. The Sheffield sling library.

Hydrotherapy

We have access to a hydrotherapy pool at Sheffield Children’s Hospital and can offer sessions for children and young people who would benefit. Hydro can help increase your strength and stamina. Speak to your physiotherapist if you would like more information.

School or nursery

Many children carry on attending school throughout their treatment. Check in with your consultant as it will depend on your child’s blood counts.  The Paediatric Oncology Outreach Nurses (POONs) can help with talking to school about your child’s health needs. Some children attend part time, or may need a reduced timetable.

If mobility is a problem, physiotherapists and occupational therapists can liaise with school.

Later in treatment and end of treatment

By the time you get into the later (maintenance) phase of treatment, the chemotherapy is usually less intense and most children and young people with ALL be able to return to school or college and activities they enjoy, like swimming and sports teams.

Problems with fatigue (tiredness), mobility and getting back to sports are not uncommon at this point and if you do not feel back to normal for you, this is a good time to speak to a physiotherapist or occupational therapist to address these issues. We want you to be able to enjoy life to the full, now and in the future and the team will work with you towards your goals.