“90 percent of these children will be spontaneously cured, and the disease will be gone within 6 to 8 months.”

– Dr. Lonnie King, Emergency Pediatrics, Children’s Healthcare of Atlanta

Some childhood illnesses can appear without warning, scaring parents and doctors… and then, for no apparent reason, all the symptoms suddenly disappear.

That’s what seems to be happening to 10-yaer-old James, who came into the ER complaining of headaches, lethargy and bruising.

Doctor Lonnie King, of Children’s Healthcare of Atlanta examined James and notes that the bruises aren’t typical. They appeared spontaneously all over his body, and are signs of ‘ITP’.

Dr. King explains that ITP is, “ Idiopathic Thrombocytopenia Purpura. Idiopathic means: unknown case. We don’t know what causes it. And the thrombocytes are the small cells, or pieces of cells in the blood stream that help clot. Penia means low. And purpura is bruising. So he had bruising, because had had low platelet count of unknown cause.”

Discovering that your child has immune thrombocytopenic purpura (ITP), sometimes known as idiopathic thrombocytopenic purpura, can be very overwhelming. It can also lead to a lot of questions and concerns, some of which you may not think of immediately. Experts at the Platelet Disorder Support Association (PDSA) have developed the following list of questions you may want to ask your child’s pediatrician:

• How much experience have you had treating patients with ITP?
• How many ITP patients do you treat? How are they doing?
• Are you affiliated with any research group or hospital that specializes in ITP?
• Do you have an emotional support group or know of one for parents of children with ITP?
• Can you give me the names of other parents of children with ITP I can talk to?
• What is your treatment philosophy – conservative, moderate or aggressive?
• What are your usual treatment recommendations for ITP?
• What course of treatment do you suggest in my child’s case?
• What has been the record of success for this treatment and how was it measured?
• How long will my child need this treatment?
• How will the treatment be administered?
• What is the criteria for discontinuing the treatment?
• Is this treatment designed to raise my child’s platelet count temporarily or permanently?
• What will you recommend next if the treatment fails?
• What are the side effects of the treatment?
• For which side effects should I contact you?
• Are there any precautions that can be taken to minimize the side effects?
• Can you give me the name of someone else whose child had the treatment?
• Will my child develop other medical problems from this treatment?
• How will you monitor the treatment progress?
• Do you have or know of any articles or other sources of information about the treatment?
• What changes should I make to my child’s activities as a result of his/her ITP?

Always seek the recommendations of your child’s pediatrician in regards to dealing with his/her ITP. In addition to those recommendations, experts at PDSA have developed the following list of suggestions:

• Check your child’s skin for bruises or petechiae ( broken capillary blood vessels) during baths.
• Assist your child with using the restroom or stress to him/her the importance of reporting blood in bowel movements or urine immediately. Blood in the urine may be red or brownish (tea- or Coke®-colored). The same is true for blood in the vomit. Blood in the bowel movement may look red or black like tar.
• Watch for bleeding from the mouth or nose, especially during dry air season. Check the bed linen for signs of bleeding while sleeping. Encourage only gentle nose blowing, never closing off one side to blow the other. Use the softest toothbrush possible. Avoid dental floss until the platelet count is up.
• Report any blows to the head, belly or back to your doctor or hospital promptly.
• Avoid giving your child medications until discussed with your doctor or nurse practitioner. Many over-the-counter pain, cold and cough medicines can affect your child’s platelet function. Aspirin or any medicine containing salicylates (like Pepto-Bismol® or Alka-Seltzer®) should be avoided. Ibuprofen and strong antihistamines should also be avoided. Acetaminophen products (Tylenol®, Tempra®, etd.) are safe to give to your child for fever or pain while the platelet count is low.
• Encourage plenty of fruits, fruit juices, water and fiber foods to avoid constipation. Hard bowel movements, enemas or suppositories can cause rectal bleeding. If needed, a stool softener may be recommended by your doctor or nurse practitioner.
• Use plenty of toothpaste on a very soft bristled brush, and brush slowly and gently. You may need to assist or supervise your child. For infants, use a soft cloth or swab without toothpaste.
• Use lip balm to keep lips from drying and cracking. Use saline nose spray (Ocean Spray® etc.) if needed to moisten nasal passages during dry weather to help prevent nosebleeds. Room or house humidifiers can also be helpful.
• It can be helpful to run a soft washcloth under water and stick it in a bag in the freezer so you will always have an ‘instant cold pack’. For nosebleeds, run the frozen cloth under cold water until soft and apply it with firm pressure to the nostrils.
• Use lotion on dry skin to avoid your child’s itching and scratching that could lead to bruises and petechiae.

For parents of active children, ITP can be especially worrisome. Experts at PDSA suggest the following for parents of busy, active children:

• Do not allow your child to play roughly. This includes any contact sports such as wrestling, boxing, karate, soccer, and, possibly, basketball or baseball. A good rule of thumb when deciding if an activity is okay for your child is to allow anything within reason where the child’s feet never leave the ground. This usually excludes bikes, motorcycles, skates, swings, etc.
• Avoid toys with sharp edges, drinking straws or popsicle sticks.
• Pad the sides of cribs. For older children who may fall out of bed, put their mattress on the floor or put a side rail between the mattress and box spring.
• For small children, pad the corners of furniture and counters. Use a gate at the top or bottom of stairs. Clear obstacles such as tables or chairs that you frequently have to go around.
• Take up loose rugs. Use rubber no-slip mats in the shower or bath.
• Older children should avoid shaving with razor blades. Electric shavers used gently are usually okay.
• Always put a seatbelt around you and your child. Use a car seat for smaller children.
• Avoid travel in non-pressurized aircraft.

Children’s Healthcare of Atlanta
Children’s Healthcare of Atlanta Emergency Services
Platelet Disorder Support Association

“How long have you
noticed the spots on your ankles?” Dr. Goo asks 15 year-old
Ashley Riley. For two days she has had what’s called petechiae.

“ Petechiae are tiny red spots on your skin that don’t
go away when you put your finger over them or stretch the skin,” explains
Dr. Goo, “They are actually broken blood vessels.”

But those spots are symptoms of a rare disorder called ITP or, “Immune
Thrombocytopenic Purpura. Explained more simply as a problem with
your platelets,” says Dr. Goo.

Platelets are proteins that help blood clot. Too few and the
child can hemorrhage. A normal count should be 150,000. Ashley’s
is 11,000.

“There’s some type of immune response where your
blood is attacking your platelets, causing your platelets to go
down,” Dr. Goo tells Ashley.

Normally, they would give her a plasma medicine called Win Rho,
but, “each of the times they’d given her this medicine,
she’d have some type of reaction to the treatment, which
caused her to have vomiting,” the doctor explains.

So, they won’t risk that medicine again. Instead they send
her home in hopes that her platelet count will go up, she’ll
get better all by herself. “The main thing, just to make
sure she’s quiet, that she’s not engaging in any significant
physical activity,” the doctor tells Ashley’s aunt.

For most children, ITP occurs once, goes away and never comes back,
but Ashley has had it three times, and according to Dr. Goo, her
future is unclear. “Once you start having recurrent episodes
of ITP, it’s much more difficult to decide what to do in terms
of therapy and what your long term prognosis is gonna be.”

Discovering that your child has immune thrombocytopenic purpura (ITP),
also known as idiopathic thrombocytopenic purpura, can be very overwhelming.
It can also lead to a lot of questions and concerns, some of which you may
not think of immediately. Experts at the Platelet Disorder Support Association
(PDSA) have developed the following list of questions you may want to ask your
child’s pediatrician:

• How much experience have you had treating patients with ITP?
• How many ITP patients do you treat? How are they doing?
• Are you affiliated with any research group or hospital that
  specializes in ITP?
• Do you have an emotional support group or know of one for parents
  of children with ITP?
• Can you give me the names of other parents of children with
  ITP I can talk to?
• What is your treatment philosophy – conservative, moderate
  or aggressive?
• What are your usual treatment recommendations for ITP?
• What course of treatment do you suggest in my child’s
  case?
• What has been the record of success for this treatment and how
  was it measured?
• How long will my child need this treatment?
• How will the treatment be administered?
• What is the criteria for discontinuing the treatment?
• Is this treatment designed to raise my child’s platelet
  count temporarily or permanently?
• What will you recommend next if the treatment fails?
• What are the side effects of the treatment?
• For which side effects should I contact you?
• Are there any precautions that can be taken to minimize the
  side effects?
• Can you give me the name of someone else whose child had the
  treatment?
• Will my child develop other medical problems from this treatment?
• How will you monitor the treatment progress?
• Do you have or know of any articles or other sources of information
  about the treatment?
• What changes should I make to my child’s
  activities as a result of his/her ITP ?

Always seek the recommendations of your child’s
pediatrician in regards to dealing with his/her ITP. In addition to those
recommendations, experts at PDSA have developed the following list of suggestions:

• Check your child’s skin for bruises or petechiae ( broken capillary
  blood vessels) during baths.
• Assist your child with using the restroom or stress to him/her
  the importance of reporting blood in bowel movements or urine immediately.
  Blood in the urine may be red or brownish (tea- or Coke ®-colored).
  The same is true for blood in the vomit. Blood in the bowel movement
  may look red or black like tar.
• Watch for bleeding from the mouth or nose, especially during
  dry air season. Check the bed linen for signs of bleeding while
  sleeping. Encourage only gentle nose blowing, never closing off
  one side to blow the other. Use the softest toothbrush possible.
  Avoid dental floss until the platelet count is up.
• Report any blows to the head, belly or back to your doctor or
  hospital promptly.
• Avoid giving your child medications until discussed with your
  doctor or nurse practitioner. Many over-the-counter pain, cold
  and cough medicines can affect your child’s platelet function.
  Aspirin or any medicine containing salicylates (like Pepto-Bismol ® or
  Alka-Seltzer ®) should be avoided. Ibuprofen and strong antihistamines
  should also be avoided. Acetaminophen products (Tylenol ®,
  Tempra ®, etd.) are safe to give to your child for fever or
  pain while the platelet count is low.
• Encourage plenty of fruits, fruit juices, water and fiber foods
  to avoid constipation. Hard bowel movements, enemas or suppositories
  can cause rectal bleeding. If needed, a stool softener may be recommended
  by your doctor or nurse practitioner.
• Use plenty of toothpaste on a very soft bristled brush, and
  brush slowly and gently. You may need to assist or supervise your
  child. For infants, use a soft cloth or swab without toothpaste.
• Use lip balm to keep lips from drying and cracking. Use saline
  nose spray (Ocean Spray ® etc.) if needed to moisten nasal
  passages during dry weather to help prevent nosebleeds. Room or
  house humidifiers can also be helpful.
• It can be helpful to run a soft washcloth under water and stick
  it in a bag in the freezer so you will always have an ‘instant
  cold pack’. For nosebleeds, run the frozen cloth under cold water
  until soft and apply it with firm pressure to the nostrils.
• Use lotion on dry skin to avoid your child’s itching and scratching
  that could lead to bruises and petechiae.

For parents of active children, ITP can be especially worrisome.
Experts at PDSA suggest the following for parents of busy, active
children:

• Do not allow your child to play roughly. This includes any contact
  sports such as wrestling, boxing, karate, soccer, and, possibly,
  basketball or baseball. A good rule of thumb when deciding if an
  activity is okay for your child is to allow anything within reason
  where the child’s feet never leave the ground. This usually excludes
  bikes, motorcycles, skates, swings, etc.
• Avoid toys with sharp edges, drinking straws or popsicle sticks.
• Pad the sides of cribs. For older children who may fall out
  of bed, put their mattress on the floor or put a side rail between
  the mattress and box spring.
• For small children, pad the corners of furniture and counters.
  Use a gate at the top or bottom of stairs. Clear obstacles such
  as tables or chairs that you frequently have to go around.
• Take up loose rugs. Use rubber no-slip mats in the shower or
  bath.
• Older children should avoid shaving with razor blades. Electric
  shavers used gently are usually okay.
• Always put a seatbelt around you and your child. Use a car seat
  for smaller children.
• Avoid travel in non-pressurized aircraft.