Materiały źródłowe

• #1 3.12 Aplastic Anemia – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/3-12-aplastic-anemia/

  Aplastic anemia is a relatively rare but serious medical condition characterized by a significant reduction or absence of all three major blood cell types: red blood cells (RBCs), white blood cells (WBCs), and platelets. […] Aplastic anemia can occur in any population, but is more common in young adults and adolescents. […] Early symptoms of aplastic anemia are related to fatigue, infections that last a long time, and easy bruising or bleeding. […] Nursing diagnoses for clients with aplastic anemia are formulated based on the clients assessment data, medical history, and specific needs. […] Nursing interventions for aplastic anemia address the reduced production of blood cells, manage symptoms, and prevent complications. […] Common nursing interventions for aplastic anemia include energy management, bleeding precautions, infection protection, medication management, health teaching, and supportive care. […] During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client.

• #1 Anemia Nursing Diagnosis and Care Plans – Nurseslabs

  https://nurseslabs.com/anemia-nursing-care-plans/

  Use this nursing care plan and management guide to help care for patients with anemia. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for anemia in this guide. […] Nursing priorities for patients with anemia involve addressing inadequate oxygenation, managing fatigue and activity intolerance, identifying nutritional deficiencies, administering prescribed medications, monitoring blood transfusions, providing education and support, and collaborating with the healthcare team for comprehensive care. […] The following are the nursing priorities for patients with anemia: Inadequate oxygenation, Fatigue and activity tolerance, Nutritional deficiencies, Medication management, Blood transfusion management, Education and self-care. […] Assess for the following subjective and objective data: Exertional discomfort or dyspnea, Inability to maintain the usual level of physical activity, Increased rest requirements, Reports fatigue and lack of energy, Verbal report of fatigue, Abnormal heart rate or BP response, Generalized weakness, Deconditioned state, Sedentary lifestyle, Inaccurate follow-through of instructions, Changes in vital signs, Diminished peripheral pulses and capillary refill, General pallor, Decreased mentation, restlessness, Palpitations, Tingling in extremities, intermittent claudication, Delayed wound healing.

• #1 Nursing care plan for aplastic anemia

  https://nursipedia.com/nursing-care-plan-aplastic-anemia/

  Aplastic Anemia is a condition that causes the bone marrow to produce insufficient amounts of red and white blood cells, as well as platelets. This can cause fatigue, increased risk of infection, and bruising. A nursing plan for this diagnosis should include assessments to identify any potential complications, nursing diagnosis for treatment, outcomes based on patient preferences, interventions tailored to their needs and capabilities, rationales for interventions and evaluation of goal attainment. […] Patients with aplastic anemia may experience excessive bleeding due to low levels of platelets. Evaluating any signs or symptoms of increased bleeding such as bruising, petechiae, and or epistaxis should be performed early to effectively treat the patient. […] Patient with aplastic anemia are at increased risk of infection due to decreased lymphocytes and immunoglobulin production. Assess for any signs of infection such as fever, chills, body aches, and increased respiratory rate.

• #1 Anemia Nursing Diagnosis and Care Plans – Nurseslabs

  https://nurseslabs.com/anemia-nursing-care-plans/

  Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with anemia based on the nurses clinical judgement and understanding of the patients unique health condition. […] Goals and expected outcomes may include: The client will verbalize understanding of the use of energy conservation principles, The client will verbalize the reduction of fatigue, as evidenced by reports of increased energy and ability to perform desired activities, The client will report the ability to perform the required activities of daily living, The client will have a reduced risk of infection as evidenced by an absence of fever, normal white blood cell count, and implementation of preventive measures such as proper hand washing, The client will demonstrate improved tissue perfusion as evidenced by stable vital signs, strong and palpable peripheral pulses, adequate urine output, and absence of pain.

• #1 Nursing Care Plan and Diagnosis for Activity Intolerance, Anemia, Low Hemoglobin, Sickle Cell Anemia, Iron Deficiency, Pernicious, Aplastic Anemia, Folic Acid Deficiency, and Thalassemia

  https://www.registerednursern.com/nursing-care-plan-and-diagnosis-for-activity-intolerance-anemia-low-hemoglobin-sickle-cell-anemia-iron-deficiency-pernicious-aplastic-anemia-folic-acid-deficiency-and-thalassemia/

  Nursing Diagnosis: Activity Intolerance related to verbal report of fatigue or weakness as evidence by imbalance between oxygen supply and demand. […] Patient will verbalize two signs and symptoms of anemia by discharge. […] The nurse will verbalize and provide printed education material on 4 signs and symptoms of anemia by discharge. […] The nurse will demonstrate and verbalized 4 energy conserving techniques within 12 hours.

• #1 Anemia Nursing Diagnosis and Care Plans – Nurseslabs

  https://nurseslabs.com/anemia-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with anemia may include: Assess manifestations of activity intolerance, Assess the specific cause of fatigue, Assess the clients ability to perform activities of daily living (ADLs) and the demands of daily living, Assess the risk of falling and enforce applicable strategies, Assess emotional response to limitations in physical activity, Monitor pulse oximetry; inform the healthcare provider O2 saturation is 92% or less, Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts, Encourage deep breathing techniques and administer oxygen as prescribed, Assist the client in developing a schedule for daily activity and rest, Educate energy-conservation techniques, Aid in a gradual increase of activities to tolerance as the clients strength progress, Allow time for the client to have undisturbed rest, Encourage the client to engage in physical exercise as tolerated, Instruct the client about medications that may stimulate RBC production in the bone marrow, Anticipate the need for the transfusion of packed RBCs, Observe and report for any signs of transfusion reaction, Administer packed RBC or erythropoietin replacement, Administer iron and other supplements such as cobalamin, and folate, Provide education about dietary adjustment and improvement, Provide the client with nutrition adequate for their needs, Provide information about alternative forms of activities that relieve fatigue, such as acupressure and yoga, Document response to activity, Educate the pregnant woman about the importance of physical activity against anemia, Refer the client and family to an occupational therapist.

• #1 Aplastic Anemia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/16747-aplastic-anemia

  Allogeneic stem cell transplantation. Providers replace damaged stem cells in your bone marrow with healthy stem cells from donated blood or bone marrow. […] You can take care of yourself by following your treatment plan and monitoring your symptoms. […] Avoid high-contact activities. Youre at risk for excessive bleeding if youre hit or injured. You may need to avoid sports like football, hockey or wrestling. […] Protect yourself from viruses and germs. Youre more vulnerable to infections. Ask your provider what vaccinations make sense in your situation. Wash your hands and stay away from people who may have infectious diseases such as colds, flu or stomach flu. […] Rest as needed. Anemia is a complication of aplastic anemia. You may feel weak, breathless and very tired just getting through your daily activities. Get enough sleep, and rest when you need to, not just when you can.

• #1 Aplastic Anemia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/16747-aplastic-anemia

  Aplastic anemia is a rare but serious blood disorder. It happens when something damages your bone marrow so it cant make enough new blood cells and platelets. Left untreated, aplastic anemia is a life-threatening condition. Healthcare providers can treat aplastic anemia, but a stem cell transplantation is the only cure. […] Aplastic anemia is a rare but serious blood disorder. It happens when your bone marrow cant make enough blood cells and platelets. People with aplastic anemia have an increased risk of serious infections, bleeding issues, heart issues and other complications. There are treatments to manage aplastic anemia symptoms, but a stem cell transplantation is the only cure. […] Treatments vary depending on your situation. For example, some people develop aplastic anemia because theyre receiving cancer or autoimmune disease treatments. In that case, providers may be able to treat aplastic anemia by changing the treatments.

• #1 Aplastic Anemia (Inpatient Care)

  https://www.drugs.com/cg/aplastic-anemia-inpatient-care.html

  Aplastic anemia is when your body stops making new red blood cells, white blood cells, and platelets. […] You may need to rest. Your healthcare provider will tell you when it is okay to increase your activities. Call your healthcare provider before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your healthcare provider. […] Reverse isolation is a safety measure used to protect you from outside germs. You may have a weak immune system or trouble fighting infection. With reverse isolation, you are given a private room. Everyone should wash their hands when entering and leaving your room. Healthcare providers and visitors wear gloves, a mask, and a gown when they enter your room. […] Medicines: Bone marrow stimulants, or growth factor medicines, help trigger your bone marrow to start making new red blood cells, white blood cells, and platelets. Immunosuppressants help prevent your body from attacking its own bone marrow. This may help the bone marrow make more blood cells.

• #1 Aplastic Anemia

  https://elsevier.health/en-US/preview/aplastic-anemia-co

  Infection prevention and management is crucial, including good hand hygiene and avoidance of sick contacts. […] Fever in the setting of a neutrophil count less than 0.5 10/L is treated as a medical emergency with hospital admission, obtaining cultures, and administration of broad-spectrum parenteral antibiotics. […] Further treatment will depend on severity of illness, patient age, and need for transfusion. […] Treatment of severe aplastic anemia, very severe aplastic anemia, and transfusion-dependent nonsevere aplastic anemia includes matched sibling hematopoietic stem cell transplant, if available. […] Immunosuppressive therapy is the first line treatment for adults older than 40 years and patients of any age who are medically unfit for hematopoietic stem cell transplant. […] The prognosis for acquired aplastic anemia has improved over past decades with better immunosuppressive therapies and deeper knowledge of hematopoietic stem cell transplantation.

• #1 Narrative review of aplastic anemia—the importance of supportive treatment – Urbanowicz – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/58521/html

  For any patient for allo-HSCT, transfusions should be used selectively to reduce the risk of immunization to donor antigens. […] The indication for the administration of red blood cell concentrate transfusions is a decrease in hemoglobin (HGB) concentration below 6 g/dL and prophylactic platelet transfusions should be performed when the patients platelet count (PLT) drops below 10109/L. […] Comprehensive therapy of a patient with AA, taking into account his causal treatment and the necessary supportive treatment, depending on the clinical condition, will guarantee the achievement of therapeutic success.

• #1 Supportive Care | Aplastic Anemia and MDS International Foundation (AAMDSIF)

  https://www.aamds.org/about/aplastic-anemia/treatment/supportive%20care

  Supportive care is a term used for treatments that help you manage the symptoms of aplastic anemia. This approach does not treat the cause of your aplastic anemia and is not a cure. This approach includes the use of: […] Blood transfusions involve putting blood from a donor into your body. These transfusions temporarily increase blood counts until other treatment can work. Aplastic anemia patients may get red blood cell transfusions or platelet transfusions. […] Iron chelation therapy reduces high levels of iron in your blood. High levels of iron can be caused by receiving many red blood cell transfusions. This condition is called iron overload and may cause damage to vital organs in your body if not treated. […] Growth factors cause your bone marrow to produce more blood cells. They may be helpful for some patients, but they do not replace immunosuppressive therapy. […] Antibiotics may be prescribed to help prevent and treat infection.

• #1 Anemia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/anemia-nursing-diagnosis-care-plan/

  Aplastic anemia is one of the types of anemia that nurses may encounter and treat. […] Nursing interventions and care are essential for the patient’s recovery. […] Prepare the patient for possible bone marrow and stem cell transplantation. For those with severe aplastic anemia, healthy stem cells from a donor replace the patient’s destructive bone marrow. […] Administer erythropoietin for patients with renal disease. With renal disease, the kidneys cannot produce enough erythropoietin (EPO), which is necessary to maintain healthy RBCs.

• #1 Childhood Aplastic Anemia | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-aplastic-anemia

  Aplastic anemia occurs when the bone marrow produces too few of these cells. […] Aplastic Anemia Treatment at Dana-Farber/Boston Children’s. […] Stem cell (bone marrow) transplant is currently the only cure for aplastic anemia.

• #1 Anemia Nursing Diagnosis and Care Plans – Nurseslabs

  https://nurseslabs.com/anemia-nursing-care-plans/

  For clients with aplastic anemia: Explain that blood transfusions from prospective marrow donors should be avoided, Explain the need for rapid human leukocyte antigen (HLA) typing, Explain that immunosuppressive therapy is the treatment of choice in clients without HLA-matched donors and/or older than 40 years of age, Explain that allogeneic hematopoietic stem cell transplantation is the standard treatment for clients younger than 40 years old with HLA-identical related donors, Explain the potential complications associated with immunosuppressive therapy. […] Administer intravenous solutions, such as normal saline, via an infusion pump. Hydration lowers the hemoglobin concentration, which decreases the sickling tendency and also reduces blood viscosity, which helps to maintain perfusion. […] Administer deferoxamine and vitamin C, as prescribed. Chelation therapy may be indicated to correct iron overload associated with regular, frequent transfusions.

• #1 Aplastic Anemia – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/stem-cell-transplantation/conditions/aplastic-anemia.html

  Before a stem cell transplant, your child will receive therapy to eliminate their immune system to permit the new donor stem cells to grow. Patients usually receive anti-thymocyte globulin (ATG) and cyclophosphamide to suppress their immune system. […] Your child will likely be discharged from the hospital 40 to 50 days after transplantation when his or her blood and immune systems are functioning at healthy levels.

• #1 Living With Aplastic Anemia | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/blood-disorders/aplastic-anemia/living-aplastic-anemia

  With prompt and proper care, most people who have aplastic anemia can be successfully treated, and some may be cured. […] It’s important to get ongoing medical care to make sure the disorder doesn’t worsen and to check for possible complications. […] Treatment for aplastic anemia may cause side effects or complications. Talk with your doctor about how to cope with these issues. […] People who have aplastic anemia may be at higher risk for infections due to low white blood cell counts. […] Know the signs of infection, such as fever. Call your doctor right away if you think you have an infection. […] Talk with your doctor about what types and amounts of physical activity are safe for you. […] You or your family members may find it helpful to know about resources that can give you emotional support and information about aplastic anemia. […] Your doctor or hospital social worker may have information about counseling and support services.

• #1 Caring for Yourself | Aplastic Anemia and MDS International Foundation (AAMDSIF)

  https://www.aamds.org/health-wellness/caring-yourself

  We help you cope with your battle against bone marrow failure disease. […] Ongoing fatigue is a major issue in the lives of most bone marrow failure patients. […] Patients have the ability to contribute to their overall health – as well as optimize the production of new blood cells by their bone marrow – when they eliminate unhealthy or overly-rich food and drink and follow a diet recommended by their doctor. […] No one is prepared for the shock of learning they have a serious disease. […] Nevertheless, intimacy is a quality-of-life issue that patients can and should discuss with their doctors if it becomes a problem. […] Some patients want to explore treatment options that are outside of the traditional medical profession.

• #1 Aplastic Anemia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/45071

  Supportive care includes infection prophylaxis/treatment and transfusions (leukoreduced red blood cells for Hb less than 7 mg/dL or platelets less than 10,000/microliters or less than 50,000/microliters for active blood loss). Monitor for secondary hemochromatosis and administer iron chelators as indicated. The use of growth factors such as erythropoietin or granulocyte colony-stimulating factors is not recommended because there are inadequate precursor cells to generate sufficient responses. […] The management of patients with aplastic anemia is an interprofessional team endeavor. The disorder can affect many organ systems, and besides the disease itself, many complications can occur following immunosuppressive therapy and hematopoietic cell transplantation. These patients need close monitoring for infections and bleeding. Because of the neutropenia, the diet has to be tailor-made and should exclude dairy products, raw meat, and most vegetables and fruits because of colonization by a number of microorganisms. All patients should avoid intense physical activity because they are at risk for bleeding. Premenopausal women can develop heavy periods and should be advised to be on hormonal therapy. Finally, all patients should be educated on the need to maintain good hand and personal hygiene because they are at a very high risk for infections.

• #1 Guidelines for the diagnosis and management of adult aplastic anaemia

  https://b-s-h.org.uk/guidelines/guidelines/guidelines-for-the-diagnosis-and-management-of-adult-aplastic-anaemia

  Pancytopenia with hypocellular bone marrow is the hallmark of aplastic anaemia (AA) and the diagnosis is confirmed after careful evaluation, following exclusion of alternate diagnosis including hypoplastic myelodysplastic syndromes. […] Supportive care with blood and platelet transfusion support, along with anti-microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. […] The standard first-line treatment for newly diagnosed acquired severe/very severe AA patients is horse anti-thymocyte globulin and ciclosporin-based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. […] Management of IBMF, AA in pregnancy and in elderly require special attention. […] In view of the rarity of AA and complexity of management, appropriate discussion in multidisciplinary meetings and involvement of expert centres is strongly recommended to improve patient outcomes.

• #1 Aplastic Anemia | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/aplastic-anemia/

  The blood disorders and bone marrow transplantation teams at UT Southwestern excel at diagnosing and treating children and adults with aplastic anemia and advancing care through clinical research. […] Our highly specialized program has been named a national center of excellence by all major national health insurance carriers and is accredited by the Foundation for the Accreditation of Cellular Therapy, which recognizes top-quality patient care. […] At UT Southwestern, we offer the full spectrum of diagnostic tools and treatments for aplastic anemia. Bone marrow transplantation often provides a cure for the disorder, and our providers are leaders in this medical treatment. […] At UT Southwestern, we provide comprehensive care for people with aplastic anemia, as well as education on how to prevent complications. Our doctors will determine the appropriate course of treatment, depending on the severity of the disorder, the patients age, and the cause of the disorder, if known.

• #1 Anemia Nursing Care Plan: Nursing Diagnoses, Interventions, and Management

  https://simplenursing.com/anemia-nursing-care-plan/

  Anemia affects multiple body systems, so nursing care addresses the root cause while managing symptoms. A well-structured nursing care plan for a patient with anemia ensures effective interventions to improve oxygenation, energy levels, and overall health. […] Managing an anemia-related nursing diagnosis requires nurses to address the most pressing issues that impact energy levels, oxygen delivery, and overall patient well-being. […] Implementing effective nursing care plans for anemia helps address these concerns early, preventing complications and improving patient outcomes. […] A thorough nursing assessment helps identify the cause of anemia and determine the best course of treatment. […] Nurses identify these issues to guide appropriate interventions and improve patient outcomes. […] Nursing interventions for anemia focus on reducing symptoms, correcting deficiencies, and preventing further complications. […] An effective nursing plan of care for anemia prioritizes restoring oxygen levels, supporting proper nutrition, and managing symptoms.

• #2 Aplastic Anemia – What You Need to Know

  https://www.drugs.com/cg/aplastic-anemia.html

  Rest as much as possible. Aplastic anemia can cause you to feel more tired than usual. […] Avoid people who are sick. The medicines and treatments for aplastic anemia decrease your ability to fight infection. Try to avoid large groups of people. This will decrease your chance of getting sick. […] Wash your hands often. This will help prevent the spread of germs. Encourage everyone in your house to wash their hands with soap and water after they go to the bathroom. Also wash hands after changing diapers and before preparing or eating food. […] Clean your mouth and gums every day. This will help prevent a mouth infection. Brush your teeth and rinse your mouth with water at least 2 times each day. Use a soft bristle toothbrush. Change the water in your denture cup every day. […] Avoid doing things that would cause you to bump or cut yourself. Do not play contact sports such as football or soccer. Use an electric razor to shave. Use nail clippers or a nail file to keep your nails short and smooth.

• #2 Aplastic Anemia – What You Need to Know

  https://www.drugs.com/cg/aplastic-anemia.html

  Aplastic anemia is when your body stops making new red blood cells, white blood cells, and platelets. […] Your other medicines or treatments may be stopped if they are causing your aplastic anemia. Ask for more information about these and other treatments you may need: […] Medicines may be given to help trigger your bone marrow to start making new red blood cells, white blood cells, and platelets. You may also need medicines to help prevent your body from attacking its own bone marrow. This may help the bone marrow make more blood cells. […] A blood transfusion may be needed to replace blood you have lost. You may need more than one transfusion. […] A bone marrow or stem cell transplant is a procedure used to replace your stem cells with healthy cells. Stem cells are the part of the bone marrow that make the red blood cells, white blood cells, and platelets. The transplanted stem cells return to the bone marrow, grow, and start producing red blood cells, white blood cells, and platelets.

• #2 Aplastic Anemia – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/stem-cell-transplantation/conditions/aplastic-anemia.html

  Before a stem cell transplant, your child will receive therapy to eliminate their immune system to permit the new donor stem cells to grow. Patients usually receive anti-thymocyte globulin (ATG) and cyclophosphamide to suppress their immune system. […] Your child will likely be discharged from the hospital 40 to 50 days after transplantation when his or her blood and immune systems are functioning at healthy levels.

• #2 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=160&contentid=1

  Regular exercise and playtime are important, and so is resting between activities. […] Make sure your child gets a flu shot every year and ask their provider about other preventive vaccines. […] Learn as much as you can about aplastic anemia and work closely with your child’s hematologist and treatment team. […] If you or your child is struggling with anxiety or depression, talk with a health care provider. Individual counseling, family counseling, or a support group can help.

• #2 Aplastic Anemia – Seattle Children’s

  https://www.seattlechildrens.org/conditions/aplastic-anemia/

  We care for your whole child. We dont just treat their disease. Your family has a full team behind you, with specialists in genetic counseling, nutrition, pain management, social work, physical therapy, psychology and emotional health. […] Our transplant team is very experienced in preparing children for transplant and helping them recover. […] Having a child with aplastic anemia can be stressful for the whole family. We help take positive steps right away by offering appointments within 3 days to new patients with urgent needs.

• #3 Living with Aplastic Anemia

  https://healthlibrary.chnola.org/library/PreventionGuidelines/160,1

  Preventing infection. Make sure your child gets a flu shot every year and ask their provider about other preventive vaccines. Stay away from crowds and sick friends or relatives, especially during cold and flu season. Remind your childand the rest of the familyto wash hands often. Regular dental care will help prevent tooth and gum infections. Keep your child out of public pools and hot tubs, especially if your childs skin has any open cuts or scrapes. Don’t let anyone smoke around your child. This includes in your home and car. […] Learn as much as you can about aplastic anemia and work closely with your child’s hematologist and treatment team. Also remember that a serious and recurrent illness like aplastic anemia is stressful for both you and your child. Make sure you both get the support you need. In an age-appropriate manner, include your child in the medical process. Educate them about aplastic anemia. Encourage them to write down questions about the condition and ask them during the medical appointments. If you or your child is struggling with anxiety or depression, talk with a health care provider. Individual counseling, family counseling, or a support group can help. Know how to contact your care team during and outside office hours if you have questions or concerns.

• #3 Living with Aplastic Anemia

  https://healthlibrary.chnola.org/library/PreventionGuidelines/160,1

  During and between treatments, its important to prevent complications of aplastic anemia caused by infections, bleeding, or extreme tiredness (fatigue). This is very important when blood cell counts are low. […] Here are some basic tips to keep in mind: Safe nutrition. Its important for your child to eat a healthy diet. Your child may be at risk for foodborne illness. Because of this, they may need to not eat aged cheeses or drink unpasteurized milk or juices. Your child should not eat undercooked or raw foods. Make sure to cook all foods fully. Wash and peel fresh fruits and vegetables before serving. Don’t let your child eat at salad bars or restaurant buffets. If you have dietary questions, ask the health care provider for a referral to a registered dietitian for additional support. […] Safe exercise. Regular exercise and playtime are important, and so is resting between activities. If your child gets short of breath when active, let your provider know. Because your child may be at risk for bleeding, infection, and fatigue, contact sports are usually discouraged. If your child is school-age, work with teachers and coaches so your child can take part safely in peer activities.

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