Pediatric kidney transplantation part 152

Call your doctor if:

• You have questions about sex
• Your period is more than a week late and you had sex with someone
• You know the condom broke, or you didn't use one, and no other method of birth control is being used
• You think you might need emergency contraception (The morning-after pill)

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Emergency contraceptions ("Morning-after pill)

This may be used in an emergency. It can't prevent all pregnancies, but it does prevent most. The morning-after pill must be started within 72 hours (less than three days) after having sex, and the sooner the better. If you can't reach your own health care provider, call your local emergency clinic. Remember to tell the doctor about the medications you take  for your transplant. You may find it helpful to tell an adult you trust that you're worried about being pregnant and what happened. Then you need to decide what birth control method will work best for you in the future.

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Birth control methods that don't work well

• The "withdrawal" method
• The "rhythm" method

Pediatric kidney transplantation part 149

Birth control methods used most often by young people

Barrier methods

These include the condom  and diaphragm. The condom is a popular method. It blocks the sperm from getting to the egg. Used the right way, condoms prevent pregnancy 60% to 85% of the time. Condoms are the only good protection against sexual transmitted diseases.
Along with using a condom each time, many young woman and their male partners want more protection from pregnancy. The condom is very good at preventing sexual transmitted diseases. The hormonal methods are better for preventing pregnancy. The best protection is to use both together

Pediatric kidney transplantation part 148

Important things to tell your doctor:

• The medications you take for transplant
• If you have migraines, in particular, the kind with flashing  lights or that make parts of your body numb or weak
• If you have had problems with blood clots. These can be clots in your dialysis fistula or catheter, in your legs or lungs, after surgery, or at any other time. If anyone in your family has had clots and became very sick or died from them (especially if they were  young  when it happened)

Pediatric kidney transplantation part 147

Birth control methods used most often by young people

Hormonal methods

These include birth control pills and Depo-Provera shots. The hormone stop the egg from leaving the ovary. The hormone also make the mucus in the vagina  to thick for sperm to move in. They prevent pregnancy berween 90% and 99% of the time when taken as directed. Hormonal oral contraceptives can increase blood pressure and increase the risk of blood clots so careful consideration of this form of birth control and monitoring of blood pressure is essential.

Implant devices can have increased risks of infection in transplant  patient who are on immunosuppression medications and at times the effectiveness of these devices can be decreased in transplant patients. Intra Uterine Device (IUD) are not absolutely contraindicated in transplant and therefore you should have a conversation with your transplant doctors if you are considering this method of birth control.

All medicines have side effects. You need to speak to your health provider doctor to find out which pill is best for you. A specialist in gynecology or adolescent (teen) medicine can be very helpful.

Pediatric kidney transplantation part 146

Prevention of pregnancy

If you're thinking  about having sex, you probably want to know about preventing an unplanned pregnancy. There are types of birth control teenager's use most often. Even if most methods depend on the girl to do or take something, it's really important for guys to understand and support their girlfriends. Don't forget only a condom can prevent sexual transmitted diseases.

No method of birth control works perfectly. There is always some risk of pregnancy. However, the risk can be quite small with correct use of the birth control methods described. Remember, though, that many sexual activities such as holding hands, hugging, touching, and kissing are almost always safe without any special precautions.

Pediatric kidney transplantation part 145

Facts:

• Almost any young woman can get pregnant. Never assume you can't!
• Almost any young man can make a girl pregnant. Never assume you can't!
• Fertility isn't an "all or none" thing. Some medical conditions may reduce fertility, but all that is needed for pregnancy to occur is one egg and one sperm
• Having a baby before you're ready can make your life very difficult. Think about it carefully
• Real friends don't pressure you to do  things you don't feel right about
• Even if someone looks great, you can't be sure they don't have sexual transmitted diseases or even HIV. Anyone can get sexual transmitted diseases if they don't protect themselves, whether they 're gay or straight, fertile or infertile.

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Myths:

• I can't get pregnant now that I've  had a transplant. THIS IS NOT TRUE
• I look younger than my friends, so I can't get pregnant. THIS IS NOT TRUE
• The disease I had before transplant affected my fertility. I don't need to worry. THIS IS NOT TRUE
• I'm tired of being treated like a child because I'm small. If I have a baby or have sex, people will start to treat me like an adult. THIS IS NOT TRUE
• I want to be accepted by my friends, and the only way is to have sex. THIS IS NOT TRUE
• Sexual transmitted diseases affect others, not people like me. THIS IS NOT TRUE

Pediatric kidney transplantation part 143

Safe sex

Important things to think about before deciding to have sex are the possibilities of pregnancy and sexual transmitted disease. Hugging, kissing, caressing and massaging; They are all part of safer sex. If you decide to do more, you and your partner need protection.

Pediatric kidney transplantation part 142

Deciding to have sex

Sex is loving experience between two people, something to cherish. The first time should be particularly special. Decide ahead of time when and what is right for you.

There is plenty of pressure on your people to have sex. TV and movies might make you think there is a lot you are missing. Remember, most TV shows and movies exaggerate. Don't feel pressured. Your sex life is your own business. When, with whom, and how you make to love are your choices. You have the right to say no any time you want. If you want to put it off until later, it's up to you to say what you want.

If the decisions are troubling you, take time to talk to an adult you trust: your parents, a friend, your nurse, your doctor, a school councelor, a religious leader. These things can usually be discussed privately. You have the right to ask in advance if your conversation will stay private. All health proffesionals must keep talks with patients confidential. They can't tell your parents what you've been talking about unless you give them permission.

Even if you're not yet ready to start having sex, it's important to know about safe sex. That way you'll be prepared to make  good choices when the time is right.

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Sexuality and reproductive health for teenagers and young adults with kidney transplants

The question regarding medications affecting the baby is a very important question since some medications will possibly harm a fetus or cause birth defects. More information about the risk to a fetus of medications prescribed to transplant patients. For example, mycophenolate mofetil or anti-hypertensive medications (ACE inhibitors, lisinopril, enalopril) are commonly prescribed medications for patients with transplants and are potentially harmful during pregnancy. It is always a good idea to talk your transplant team specifically about this concern.

Pediatric kidney transplantation part 140

Question that often arise with teenagers who have had kidney transplants include the following:

• What if I don't want to have sex and my partner is pushing me? How can I say NO?
• What is safe sex?
• Can I get pregnant?
• Can I father a child?
• Will the medications I take affect my baby?
• Will the disease that affected my kidney be passed on to my children?
• Will I lose my transplanted kidney if I get pregnant?
• What about sexually transmitted disease? Do they mean the same for me as others?
• I know safe sex is important, but my partner doesn't agree. What should I do?

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Sexuality and reproductive health for teenagers and young adults with kidney transplants  to discuss:

• Common questions about sexuality and the transplant recipient (including safe sex, birth control, sexually transmitted disease and pregnancy)
• Some myths and  facts
• Regular sexual health checkups

Pediatric kidney transplantation part 138

Your teen will have a chance to discuss with your transplant team about:

• Capacity to consent or assent to treatment
• Their home situation
• Education
• Their body image
• Any substance use
• Their history of following the treatment plan
• How puberty is going
• Their sexual history
• Their mood, including any suicidal thoughts
• Coping skills
• Death and dying

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Adolescence issue

Adolescence or "the teenage years" are challenging even for children without health problems. Children with a chronic illness can have even greater difficulties when they become teenagers. In addition,  behaviors that are a "normal" or "expected" part of the teenage years can put kidney transplant patients at risk for rejection or other medical problems.

The teen years are a struggle for most of the transplant team, but it can be more difficult if transplant occurs at this time in a person's life. Some of the normal teen milestones might be delayed, such as driving, exploring sexuality, and  experimenting with moral guidelines (or what some might call "rebelling"). Separation from their peers, isolation, and loss are all part of the teen transplant experience.

The kidney transplant team is very aware of these challenges. Visits to the team include evaluation, ongoing support, and guidance to foster healthy teenage development , coping skills, and the ability to follow the treatment plan.

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Life of the kidney and the need for future transplants

The use of new transplant drugs to keep body from rejecting the kidney has made it possible to keep a new kidney for a long time. A key point in keeping the kidney working well is staying on a strict medication schedule and following medical advice. Some kidneys can work for many years. The average life of a kidney transplant is about 10-15 years but they can last as long as 30 years. Some can keep working for a longer time. Children may need  a second or even a third kidney transplant if the first one fails. Remember that many new advances and new medications are being introduced every day.

Pediatric kidney transplantation part 135

Keeping a kidney transplant healthy means  a change in lifestyle. Keeping a kidney healthy can sometimes be very stressfull. Please talk to your transplant team about your concerns.

• If you have a crisis in your life, please contact your transplant team at once for help. They are there to help and support you
• Taking your medications regularly every day and on time is very important. It is the only way to keep your body from rejecting your kidney. This can happen even after many years of having a stable transplant if you stop taking your transplant drugs suddenly or if you do not take them as instructed
• If medications get the way of your daily activity, or you having bad side effects, please talk to  the transplant team. There may be changes in your medications that can be made to help you. Do not stop or change medication on your own
• If your insurance coverage is running out, please talk to your transplant team. They will help you find a way to get the medications you need without a break in your treatment. Many children can stay on their parents insurance until they are 26 years of age
• Keep your regular doctors appointments
• If you are close to 18 years of age and worry about being switched to adult nephrology care, please discuss your concerns with your regular transplant doctor. Sometimes this transfer can be delayed or done slowly until you get to know your new adult nephrologist
• Always remember that if you lose your kidney because of non-adherence you will go back on dialysis. You may be on it for a long period of time before you can get another kidney because your body may have developed antibodies during the rejection that makes it harder to accept easily another kidney. Dialysis is not a good alternative to transplant. You will still need  to take a lot of medications for your kidney failure

Pediatric kidney transplantation part 134

Kidney test

Kidney ultrosound

Your child will have had a renal ultrasound before the transplant. This test uses sound waves to:

• Check the size, shape and structure of the transplanted kidney
• Determine blood flow to the kidney and rule out thrombosis (blood clots) or urine leak
• Identify if there is any fluid around the kidney (hematoma, lymphocele)

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Laboratory tests

Most transplant patients have regular blood, urine, or other lab tests. Some things are tested include:

• A patient's blood cell count, to show any possible infection or side effects from transplant medications
• The level of waste products, such as creatinine and blood urea nitrogen, to show how well patient's kidneys and liver are working
• "Levels", which is short for how much immunosuppresant medication stays in a patient's bloodstream and for how long (high level could be toxic or suppress the immune system too much and low levels may cause a patient to reject the new kidney)
• Urine analysis and culture to make sure there are no signs of urinary infection and to check for protein in the urine which can be abnormal
• The amount of glucose (sugar), or lipids (cholesterol and other fats) in the blood (some transplant medications can make them too high)
• Signs of any recent viral infections
• The level of HLA antibodies in the blood, to check if the body might start to reject the donor kidney

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Clinic visit

Immediately after their transplant, your child will usually visit the clinic once or twice a week. Over time, these visits will often become less frequent, once your child does not have any problems. Many centers eventually cut down appointments to once every six months for patients who are doing well.

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Importance of adherence with medical care
Non-adherence  can happen in different way:

• Not taking medicine on time or as instructed
• Not keeping up with medical appointments
• Not getting needed blood tests
• Not taking medical advice about diet, activity, or other issue

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Importance of adherence with medical care

Non-adherence means failure to follow up or to adhere to  a treatment plan suggested  by your transplant team. It happens most often in children  and teens between 11 and 20 years of age and even in young adults up to 24 years of age. In cause loss of the kidney transplant. The teen years are times when feelings about independence, body image, and acceptance by peers are very strong. Some of the transplant drugs causes changes in how a person looks and can create a problem with body image. Taking medicine throughout the day may become socially akward as well. It can all be very frustating for a teen.

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Importance of adherence with medical care

Kidney transplant is a major procedure. It can be very challenging at times and hard to manage. It means your child has to take a number of medications. Your child will have to change their lifesyle as well. It can be overwhelming at times, especially for teenager. It is very important to keep working closely with the transplant team to keep your kidney healthy. The team is there to help you during the hard times.

Pediatric kidney transplantation part 129

Importance of adherence with medical care

Kidney transplant is a major procedure. It can be very challenging at times and hard to manage. It means your child has to take a number of medications. Your child will have to change their lifesyle as well. It can be overwhelming at times, especially for teenager. It is very important to keep working closely with the transplant team to keep your kidney healthy. The team is there to help you during the hard times.

Pediatric kidney transplantation part 128

What are the side effects of growth hormone therapy in children?
Growth hormone can do the following:

• Possibly stimulate the immune system. This means your child's kidney function must be closely checked while on the growth hormone
• Increase in serum creatinine suddenly for no reason. This is blood test used to measure kidney function
• Increase in acute rejection in children who had more than one rejection in the past (found in some studies). This does not seem to happen in stable patients
• Make kidney function worse. It could do this by increasing the body's attempts to reject the kidney
• Require changes in some medications (such as prednisone)
• Cause high blood sugar, diabetes, and headache after transplant
• Spur cancer growth (has been reported in patients receiving growth hormone treatment)
• Cause high blood pressure

Pediatric kidney transplantation part 127

Your child was on growth-hormone treatment before kidney transplant. Can she or he continue on it?

Some children grow very well after transplantation, especially if the kidney works well. Your child may or may not need growth hormone after transplantation. If your child id not growing enough, please talk to your transplant doctor about the growth hormone. Your child should have stable kidney function with no rejection under way before going back on the growth hormone and typicaly it is not used in the first 6 to 12 months after transplant. It is best to give growth hormone to children before they go through puberty. Bone x-rays are done before starting growth hormone treatment to see how much the child might be able to grow.

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Will your child grow normally after kidney transplant with good kidney function?

Children can grow well after kidney transplant. Many transplant programs now use minimal or no corticosteroids after transplant, wich permits better growth in children. Steroids are the main medications that can slow growth in children after kidney transplant. Younger children tend to have the best growth rates after transplantation. If your child is not growing well after transplant, discuss the problem with your doctor to assess if your child is taking in enough calories for growth of if the dose of prednisone he or she is on should be lowered. Your doctor may even want to start treatment with growth hormone although growth hormone is not typically used in the first 6 to 12 months after transpalnt and also not in children who are having difficulty with rejection of their transplanted kidney

Pediatric kidney transplantation part 125

Growth after kidney transplant

Children with chronic kidney disease have problem with growth and are shorter then their peers. One of the main causes of poor growth in kidney failure is that the body does not respond optimally to its own growth hormone. Children with kidney disease can grow if they are given growth hormone.

Pediatric kidney transplantation part 124

Can your child go out in the sun as usual?

Transplant patients are more likely to develop skin cancers, so it is extremely important that you protect your child's skin.

• Avoid the sun between 10 am and 2 pm. This is when ultraviolet rays are strongest
• Have your child wear protective clothing outdoors, including hat
• Encourage your child to sit or play in shaded areas
• Apply sunscreen and lip balm daily to uncovered areas of your child's body. Remember to re-apply sunscreen avery few hours-more often if your child is swimming or sweating -because it wears off
• Use skin products at least 30 SPF (sun proctection factor)
• Check your child's skin for abnormal spots (irregular moles or growths) and report them to your doctor

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Your children had been on tube feeding for a long time. Should you stop the tube feeding after transplantation?

Some children, mostly those under the age of 5 years, have been on tube feedings before their transplants. Those children may have not eaten solid foods at all. Or they may have only nibbled food now  and then in the months or years before their transplants. The good news is that most children who have been on tube feedings are able to stop the tube feedings and go on to eat a normal diet after transplantation but this transition may be slow.

Pediatric kidney transplantation part 122

Your child was on fluid restriction before transplantation. Should your child drink more fluids now that the kidney is working well?

This is very, very important. Once your child has normal kidney function, your child will need to drink more fluid, preferably water, each day. The amount of fluid will depend on his or her weight. The more he or she weighs, the more he or she will need to drink: possibly up to 8 glassess of fluid a day. Your transplant doctors will advise you on how much fluid is ideal for your child to drink every day. The majority of fluid intake should come from water, fat-free or low-fat milk and sugar-free drinks.

Pediatric kidney transplantation part 121

Your doctor tell you your child's transplant kidney is still slow to start. What diet is good for your child?

If your child's new kidney is slow to start, your child may need to remain on his or her kidney diet. This means limit on sodium, potassium, phosphorus and fluid. But, as the kidney begins to work, your child will be able to have many more kinds of food. Your dietician will provide advice regarding the diet your child should follow after transplant.

Pediatric kidney transplantation part 120

Excessive weigh gain can be prevented. Try these strategies to help your child keep from gaining too much weight:

• Limit high-fat foods: fast food, fried foods, chips and other high-fat snacks, cakes, donuts, pastries
• Avoid "simple" sugars: sugar, sweets, soda pop, and drinking too much juice. Drink mostly water. This become even more important if your child gets high blood sugar, a possible side effect of prednisone  and other transplant medications
• Let your child eat three meals a day with average helpings. Serve many different kinds of food. Avoid too much snacking
• Have many kinds of healthy low-fat snacks on hand for when your child cannot control the "munchies". Some of these are raw vegetables, fruits, and unsalted, unbuttered popcorn
• Be active everyday. Regular exercise is very important part of keeping a healthy body weight. Any exercise should be discussed with your transplant nurse and doctor

Pediatric kidney transplantation part 119

Your child is gaining a lot of weight after transplantation. Is this healthy?

A common problem with transplant patients is gaining  too much weight. Babies, children, and teens are expected to gain weight as they get older. It is needed for growth. But too much  weight can easily happen.

• Your child can eat his or her favorite foods again
• Your child has much better appetite
• Prednisone can increase his or her appetite
• Food tastes better

Eating too much and lack of exercise lead to obesity. This leads to high blood pressure and diabetes, and may lead to heart attack and stroke. Even at normal weights, transplant patients are at higher risk of diabetes, high cholesterol, and heart disease for many reasons. Obesity adds to his or her risk. It is also hurt your child's self-image, especially in teenage years. A healthy life syle is the key to controlling your child's weight gain and reducing their risk for heart disease. It includes regular exercise and a healthy, well-balanced, low-fat diet.

Pediatric kidney transplantation part 118

Food safety

Transplant medications place your child at higher risk for infections, so it is very important to prevent illness  that comes from food.
Do not share utensils or food
Do not eat  these foods RAW: eggs, milk (unpasteirized), seafood, red meat and poultry

Pediatric kidney transplantation part 117

Safe food handling is a must:

• Wash  hands often
• Wash foods and vegetables under running water
• Separate foods to be eaten raw from raw meats-use separate cutting boards
• Sanitize sinks and chopping boards wth 1/2 teaspoon bleach in two cups of water
• Use a fast-check thermometer to check the temperature of cooked meats
• Hot dogs, hamburger, and sausage must be well cooked (160 degrees) even if they are irritated

Pediatric kidney transplantation part 116

Heart-healthy diet

Some transplant medications will raise your child's cholesterol levels. This, in turn, is known to increase the risk of getting heart disease.

To help lower cholesterol levels:

• Limit the total amount of fat in the diet as well as the saturated fat (fat from animals). Choose low-fat dairy products (skim or 1%milk, low fat-cheese, yogurt, ice milk) and lean meats
• Avoid fat listed as animal or vegetable shortening, lard, palm and coconut oil
• Choose olive and canola oil, and non-hydrogenated margarines
• Increase high-fiber helps keep cholesterol from being absorbed. Fresh fruits, vegetables and whole grain products are high-fiber foods

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SODIUM

In general, it is a good idea after transplant for your child to limit salt in their diet. Some of the medications increase the chance of having hypertension after transplant and also make it harder for your child to handle salt loads.

Some common foods that are high in sodium are:

• Salt
• Cured meats (bacon, ham)
• Canned or died soups
• Ethnic foods: Chinese, Japanese, Mexican and Italian
• Sauces and condiments
• Prepared casseroles
• Macaroni and cheese mixes

Ask your doctor if you need to restrict the salt in your child's diet. The dietitian will meet with you if this is needed.

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Potassium intake

Typically children after transplant will be able to have normal amounts of potassium-containing foods (potatoes, orange juice, bananas). Ask your doctor if your child has any restrictions on how much potassium they can have in their diet after the transplant.

Pediatric kidney transplantation part 113

General recommendations

Bone health

Long term use of prednisone may place your child at increased risk for osteoporosis (weakening of bones) and bone fractures. It is therefore very important to get enough vitamin D and calcium from food. Some good sources of calcium are:

• Milk
• Cheese
• Yogurt
• Canned salmon or sardines with bones
• Calcium-fortified orange juice

When possible, choose lower fat milk products. This will help control weight gain and promote a heart healthy diet.

Vitamin D deficiency is very common in children. Your transplant doctors will likely test for Vitamin D deficiency and possibly prescribe vitamin D supplements with or without a calcium supplement in order to keep your child's bone healthy.

You may need to increase the phosphorus in your child's diet particularly if your child was on a dietary phosporous restriction before the transplant. The best sources are:

• Dairy products
• Nuts and nut butters
• Dried beans, lentils and peas
• Seeds

Pediatric kidney transplantation part 112

Nutrition and diet after kidney transplant

Diet plays a very important role in promoting good health and wellbeing after a kidney transplant. This is done by eating a well-balanced, varied, and heart-healthy diet. Following transplant, children should follow heart-healthy food guidelines. These include:

• Eating fruits and vegetables
• Choosing whole grains, lean meats and alternatives, low-fat dairy products, and unsaturated oil
• Limiting foods high in salt, sugar, and saturated fat and low in nutrients

Some immunosuppressant medications, especially steroids, can make children very hungry, increase their cholesterol levels, and cause them to gain weight. To reduce  the risk of high cholesterol and unhealthy weight gain, have healthy foods and snacks available for your child. Consider fruits, chopped vegetables, low-fat yoghurt, or milk and cereal.

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Skin care

Transplant patients have a higher risk of developing skin cancer. The transplant immunosuppression medications that allow your child's kidney to work  and survive also increase the risk  of skin cancer.
It is very important that children with kidney transplants and their families know about how to protect themselves from the sun. This should be done both before  and after the transplant. Children with moles or unusual moles should be checked by a dermatologist before transplant and followed closely after transplant.

Prevention of skin cancer means daily use of a sunscreen with a sun protection factor (SPF) of 30 or more. Clothing with long sleeves and a tight fabric weave should be worn outdoors, as well as broad-brimmed  hat. Stay out of the direct sun between 10 a.m and 2 p.m as much as possible. Tanning beds should not be used.

Transplant patients could have problems with warts. Warts are caused by a virus (HPV). They may have more and larger warts that last longer and are harder to treat. Transplants medications may make it harder for your child to fight off the virus that causes warts. If your child has too many large or painful warts before transplant, he or she should be checked  by a dermatologist who has experience  dealing with warts in children. We do not have medicine to prevent warts but there is a vaccine to prevent genital warts. Genital warts can cause cancer  in both men and women and transplant patients have a higher risk of cancer than people who have never had a transplant. This vaccine is available and recommended for both boys and girls; since it works best before people become sexually active it can be given starting as young as 9 years of age.

Pediatric kidney transplantation part 110

Opthalmologic (Eye) care

Many children are prescribed prednisone after transplant as part of their immunosuppression regimen. Because of the risk of side effects affecting the eyes, the transplant team recommend monitoring eye health for cataracts and glaucoma by a professional. It is recommended that all children should have dilated eye examinations once  a year while they are on prednisone to monitor for the development of cataracts and/or galaucoma. If your child complains of blurry vision, eye pain or tearing he should be evaluated by a physician sooner.

Pediatric kidney transplantation part 109

DENTAL CARE

Why does your child need dental care before and after kidney transplant?

The mouth has a large number bacteria in it. The use of transplant medications after transplantation makes it harder for the body to fight infection. A bad dental cavity may turn into a tooth abcess if the immune system is low. Some of the drugs used after transplant, may cause gum swelling  and overgrowth. This, in turn can lead to gum disease. It is important for your child to be seen by a dentist before transplant. Have your child's  teeth cleaned and all cavities filled. Following transplant, twice-yearly dental  visits with cleanings are recommended.

Pediatric kidney transplantation part 108

PET SAFETY

Potential animals to avoid for they are considered high-risk animals for immunocompromised people (including organ transplant patients)

• Reptiles, including lizards, snakes and turtles
• Baby chicks and duckling
• Exotic pets,  including monkeys

All persons should avoid direct contact with wild animals. Do not adopt wild animals as pets or bring them into your home. Contact with these animals and their environtments should be avoided  by people with compromised  immune systems. If you do touch these animals or their environtment (their food or cage, for example), wash your hands thoroughly with running water and soap. Additionally organ transplant patients should be extra cautious when visiting farms and when in contact with farm animals.

Pediatric kidney transplantation part 107

PET SAFETY

Just like people, pets can get diseases from eating contaminated food. By protecting your pet from food borne disease, you can protect  you own health as well. Pets should be fed only high-quality commercial pet foods. If eggs, poultry, or meat products are given to your pet as supplements, they should be well cooked. Any dairy products given to your pets should be pasteurized. Additionally, pets should be prevented from drinking toilet bowl water and from having access to garbage. Do not let your pet scavange for food, hung, or eat other animal faeces.

Pediatric kidney transplantation part 106

PET SAFETY

Birdcage linings should be cleaned daily and gloves should be worn whenever handled items contaminated with bird dropping. Children who are transplant patients should not be exposed to bird droppings. Routine screening of healthy birds for zoonotic diseases is not recommended.

It is recommended that children with transplants avoid cleaning fish tanks.

It is recommended that children with transplants not clean a cat's litter box. If done, use careful hand washing afterwards.  You should consider not placing the litter box in kitchens, dining rooms or other areas where food is prepared or eaten.

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PET SAFETY

Patients who have received organ transplants are more likely than most people to get disease from animals. However, simple tips can be followed to reduce their risk of getting sick after contact with animals. These recommendations were originally made for bone marrow transplant patients, but they may also may be useful for other organ transplant patients.

First and foremost keeping clean is essential to minimize the risk of spread of disease from your pet to a child with a transplant. Through hand washing with water and soap after handling animals and their feces (stool) is essential, It is recommended that the transplant patient avoid direct contact with animal faces. adults should supervise the hand washing of children after they have contact with animals.

Caring for your pet to minimize transmission of illness to your child includes seeking veterinary care for an ill pet as soon as possible. You should consider having any cat or dog that has diarrhea checked by a  veterinarian for infection .

Pediatric kidney transplantation part 104

Smoking and second hand smoke exposure

Your child should not start to smoke after a kidney transplant. If you smoke , you should quit. If you are unable to quit, you should not smoke around your child. Talk to your transplant team for resources that may available to help you quit.