Tiredness also may happen because normal resting and sleep habits are disrupted. It may happen because the person with cancer is feeling depressed.

You should not "push" your child into doing more than what he or she feels is reasonable. On the other hand, let your child be the guide as to how much he or she can do. Don't excessively restrict activity. If other symptoms occur with increased fatigue, then it's important to talk with the doctor or nurse.

Your goals are for the person with cancer to:

• experience as little tiredness as possible
• use energy as effectively as possible
• keep regular schedules of sleep and rest

When To Get Professional Help

The first question you should ask is whether help from medical professionals is needed because of an emergency that goes along with feeling tired. The problems that need immediate help are ones that indicate an unexpected physical problem.

You should call the clinic, doctor, or nurse immediately if any of the following are true:

• Dizziness. Dizziness and feeling a loss of balance can happen when walking or getting out of bed or going from a standing to a sitting position. Dizziness can also happen without moving or changing one's position. This symptom can happen to anyone occasionally. When it is severe and frequent, you should get medical help.
  
• Falling, followed by an injury, bleeding, mental confusion or unconsciousness. Report all bad falls so the doctor or nurse can judge what caused the falling, and what follow-up is needed. Sometimes they'll recommend using other measures for prevention.
  
• Unable to wake up. This is a sudden and unexpected change in level of consciousness or alertness. You should call right away if you cannot awaken your child. You will probably have to take him or her to a medical facility for tests to determine the cause of this problem.
  
• Feeling out of breath, breathing rapidly while at rest, or rapid heartbeat while at rest; also, sudden severe headache. Breathlessness usually happens because the body is not getting the right amount of air and oxygen because of anemia (low red blood cell count). Less commonly, this can be caused by some problem with the lungs and respiratory system.

You should call the clinic, doctor, or nurse during regular office hours if any of the following are true:

• Persistent ringing in the ears. This can be caused by a reaction to medication, a change in blood flow to the brain or other physical changes. Medical tests are usually required to determine its cause.
  
• Recurrent headache. Recurrent headaches can also signal anemia or infection.
  
• Excessive sleepiness. When a child or adolescent is more interested in sleep than in normal activities such as eating or playing, it signals a lack of energy that can be due to anemia or depression.
  
• Extreme pallor. Indicates anemia.

The doctor or nurse may ask the following questions when you call:

1. How clear are your child's thoughts?
   
2. Has any confusion appeared or increased since fatigue increased?
   
3. Is your child feeling depressed or "blue"?
   
4. Has any new medicine been started, such as pain medicine or sleep medicine?
   
5. How is the child's activity level? Is the child sleeping instead of participating in normal waking-hours activities?
   
6. Have you noticed any change in sleep and nap duration?
   
7. Any fever?
   
8. How is the child's color?

Here is an example of what someone might say when calling:

"I am Karen Anderson, Christopher Anderson's mother. My son is Dr. Bhat's patient, and he has been diagnosed with ALL. The home care plan for fatigue says that I should call if he takes naps so much that he's skipping meals and playtime."

What You Can Do To Help

If you decide that tiredness is not an emergency, you can try the following strategies to help solve this problem.

1. Help the person get the most out of the day
2. Promote rest and sleep

Help the person get the most out of the day

• Plan the day so social activities or trips happen when he or she feels most refreshed and awake. Plan activities during the time of day or evening when your child feels best. Allow time for rest between events so the day and evening are not packed with people and events.
  
• Rest between bathing, dressing, and walking.
  
• Conserve energy by doing things only for a short time. When fun or distracting events are planned, encourage resting ahead of time.
  
• Agree on what's most important to do. Discuss what brings the most enjoyment or what is necessary to do. Encourage doing the things at the top of this list.
  
• Avoid dizziness or falls by getting up or moving very slowly. Dizziness can result from fatigue. When your child is getting up from lying down, remind him or her to sit on the bedside and dangle the feet and legs for a few minutes before standing up. If this problem happens often, ask about safety equipment. Also see Safety Measures in the homecare plan section on Bleeding.
  
• Plan regular exercise to reduce fatigue. Plan activities to do every day despite the fatigue, even if it's something as small as getting dressed or walking out to sit on the porch. Short walks also are very helpful.
  
• Serve regular snacks and meals. Serve a well-balanced diet from the four food groups. Meat and dairy products provide needed protein. If finances are a concern, ask your dietician or social worker about nutrition programs such as WIC, which can help provide high protein foods. Another important food group is nutritious carbohydrates, which will give the most energy. Serve pasta, bread, fruit, and potatoes.

Promote rest and sleep

• Keep as active as possible during the day so that normal fatigue sets in at night. If your child remains active throughout the day, then sleep may be easier at night.
  
• Resume usual patterns of rest and sleep as much as possible. A regular schedule of naps and bedtime helps the child's body, because it comes to expect a routine. Regular habits help sleep.
  
• Read the homecare plan on Parents' Anxiety if nervousness or anxiety interrupt sleep. Anxiety interrupts rest and sleep. The homecare plan has some good ideas on handling anxiety. Talking to, touching, and listening to the child or adolescent also help manage anxiety.
  
• Encourage rest when tired by going to bed earlier, sleeping later, and taking naps during the day. If naps are a habit, then longer ones allow more rest and help to reduce fatigue.
  
• Play relaxing music before sleep. Use whatever helped to promote sleep before. Music can be very soothing. So can the voice of the television or of someone reading.
  
• Drink warm milk at bedtime. Milk contains trytophan, an amino acid, which naturally promotes sleep.
  
• Give a warm bath or back rub at bedtime.

Possible Obstacles

Think of ideas or attitudes that might stop you from trying to solve a problem with tiredness and fatigue.

1. "The fatigue comes with the treatments. There's nothing we can do to help it."
   
   Response: Cancer treatments often do result in fatigue, but you can control how tiredness affects your child's life. Showing this homecare plan to others will remind them that rest and sleep are very important now. You can try many techniques to help your child reduce a feeling of fatigue.
   
2. "There are many things to worry about. No wonder I can't sleep."
   
   Response: Although this is less common in children than adults, sleep will help to reduce some of the anxiety in the long run because physical fatigue can add to feeling anxious and jumpy. Set a goal of better rest as one of your child's top priorities.

Carrying Out and Adjusting Your Plan

Keep track of how much of the day your child spends in bed. Ask him or her to assign priorities to activities and choose those that are important and rewarding. Check on whether current patterns of sleep and rest are similar to those before the illness.

If your plan doesn't work

If your plan does not seem to be working or the tiredness is getting worse, you can do several things. Ask yourself if you are expecting change too fast. It usually takes time for tiredness to go away. You can also develop a new plan by repeating the steps in this homecare plan.

If tiredness is increasing and of major concern to your child, ask the doctor or nurse for help. Tell them what you have done and what the results have been.

Back