Common symptoms of leukemia

Leukemia

Published: December, 2014

Leukemia is a type of cancer that harms the body’s ability to make healthy blood cells. It starts in the bone marrow, the soft center of various bones. This is where new blood cells are made. There are three main types of blood cells:

  • red blood cells carry oxygen from the lungs to the body’s tissues and take carbon dioxide to the lungs
  • platelets help blood to clot
  • white blood cells fight infections, viruses, and diseases

Leukemia usually refers to cancer of the white blood cells. It tends to affect one of the two major types of white blood cells: lymphocytes and granulocytes. These cells circulate through the bloodstream and the lymph system to help the body fight off viruses, infections, and other invading organisms. Leukemia arising from cancerous lymphocytes is called lymphocytic leukemia; leukemia from cancerous granulocytes is called myeloid or myelogenous leukemia.

Leukemia is either acute (comes on suddenly) or chronic (lasts a long time). Acute leukemia affects adults and children. Chronic leukemia rarely affects children.

Leukemia can occur due to

  • genetic abnormalities
  • exposure to radiation and chemicals such as benzene (found in unleaded gasoline) and other hydrocarbons
  • exposure to agents used to cure or control other cancers, including radiation

Leukemia is usually not inherited. It tends to happen to people without any family history of the disease. Some forms of leukemia, though, such as chronic lymphocytic leukemia, strike close relatives in the same family.

Acute leukemia

In people who develop acute leukemia, immature white blood cells multiply quickly in the bone marrow. Over time, they crowd out healthy cells. This can cause unexpected or excessive bleeding or infections. When the cancerous white blood cells reach high numbers, they can spread to other organs, causing damage. This is especially true in acute myeloid leukemia.

The two main types of acute leukemia involve different types of blood cells:

  • Acute lymphocytic leukemia is the most common type of leukemia in children. It mainly affects those under age 10, although adults sometimes develop it. Acute lymphocytic leukemia occurs when primitive blood-forming cells called lymphoblasts reproduce without developing into normal blood cells. These abnormal cells crowd out healthy blood cells. They can collect in the lymph nodes and cause swelling.
  • Acute myeloid leukemia accounts for half of leukemia cases diagnosed in teenagers and in people in their 20s. It is the most common acute leukemia in adults. Acute myeloid leukemia occurs when primitive blood-forming cells called myeloblasts reproduce without developing into normal blood cells. Immature myeloblasts crowd the bone marrow and interfere with the production of normal blood cells. This leads to anemia, a condition in which a person does not have enough red blood cells. It can also lead to bleeding and bruising (due to a lack of blood platelets, which help the blood to clot) and frequent infections (due to a lack of protective white blood cells).

Both acute lymphocytic leukemia and acute myeloid leukemia have many subtypes. The treatment and prognosis may vary somewhat, depending on the subtype.

Chronic leukemia

Chronic leukemia is when the body produces too many blood cells that are only partially developed. These cells often cannot function like mature blood cells. Chronic leukemia usually develops more slowly and is a less dramatic illness than acute leukemia. There are two main types of chronic leukemia:

  • Chronic lymphocytic leukemia is rare in people under age 30. It is more likely to develop as a person ages. Most cases occur in people between ages 60 and 70. In chronic lymphocytic leukemia, abnormal lymphocytes can’t fight infection as well as normal cells can. These cancerous cells live in the bone marrow, blood, spleen, and lymph nodes. They can cause swelling, which appears as swollen glands. People with chronic lymphocytic leukemia can live a long time, even without treatment. Most often, chronic lymphocytic leukemia is discovered when a person has a routine blood test that shows high levels of lymphocytes. Over time, this type of leukemia can require treatment, especially if the person has infections or develops a high white blood cell count.
  • Chronic myeloid leukemia occurs most often in people between ages 25 and 60. In chronic myeloid leukemia, the abnormal cells are a type of blood cell called myeloid cells.

Both chronic lymphocytic leukemia and chronic myeloid leukemia have subtypes. They also share some characteristics with other forms of leukemia. The treatment and prognosis may vary depending on the subtype.

Rarer forms of leukemia

Lymphatic and myelogenous leukemias are the most common. However, cancers of other types of bone marrow cells can develop. Megakaryocytic leukemia arises from megakaryocytes, cells that form platelets. (Platelets help blood to clot.) Another rare form of leukemia is erythroleukemia. It arises from cells that that form red blood cells. Like chronic and acute leukemias, rare forms of the disease can be categorized into subtypes. The subtype depends on what markers the cells carry on their surface.

Symptoms

Early symptoms of leukemia include

  • fever
  • fatigue
  • aching bones or joints
  • headaches
  • skin rashes
  • swollen glands (lymph nodes)
  • unexplained weight loss
  • bleeding or swollen gums
  • an enlarged spleen or liver, or a feeling of abdominal fullness
  • slow-healing cuts, nosebleeds, or frequent bruises

Leukemia can sometimes take a while to diagnose because many of its symptoms accompany the flu and other common medical problems.

Diagnosis

Your doctor may not suspect leukemia based on your symptoms alone. However, during your physical examination, he or she may find that you have swollen lymph nodes or an enlarged liver or spleen. Routine blood tests, especially blood cell counts, may yield abnormal results.

At this point, your doctor may order other tests, including

  • blood tests to check for abnormal cells
  • a bone marrow biopsy (a sample of bone marrow is removed and examined)
  • tests for genetic abnormalities

Genetic tests can help determine exactly what type of leukemia you have. These sophisticated tests may also offer clues as to how you will respond to a particular therapy.

Treating leukemia

The treatment of leukemia aims to wipe out the cancerous white blood cells. But this usually means killing healthy white blood cells and harming the body’s ability to fight infection.

The treatment of acute leukemia does not depend on how far the disease has advanced but on the person’s condition. Has the person just been diagnosed with the disease? Or has the disease come back after remission (a period when the disease is controlled)?

For acute lymphocytic leukemia, treatment generally occurs in phases:

  • phase 1 uses chemotherapy in the hospital to try to control the disease.
  • phase 2 continues chemotherapy, but on an outpatient basis, to keep the disease in remission. This means that person returns to the hospital for treatment, but does not stay overnight.
  • phase 3 uses different chemotherapy drugs to prevent the leukemia from entering the brain and central nervous system. Chemotherapy may be combined with radiation therapy.
  • phase 4 involves regular physical exams and laboratory tests after the leukemia has been treated to be sure that it has not returned.

If acute lymphocytic leukemia returns, different doses of various chemotherapy drugs are used to combat the disease. Several years of chemotherapy may be needed to keep the leukemia in remission. Some people may receive a bone marrow transplant.

With acute myeloid leukemia, treatment generally depends on the person’s age and overall health. It also depends on his or her blood cell counts. As with acute lymphocytic leukemia, treatment usually begins with induction therapy in an effort to send the leukemia into remission. When leukemia cells can no longer be seen, consolidation therapy begins. Bone marrow transplantation may also be considered in the treatment plan.

Treatment for chronic lymphocytic leukemia begins with determining the extent of the cancer. This is called staging. There are five stages of chronic lymphocytic leukemia:

  • stage 0: too many lymphocytes in the blood but no other symptoms
  • stage I: lymph nodes are swollen because too many lymphocytes are being made
  • stage II: lymph nodes, spleen, and liver are swollen because too many lymphocytes are being made
  • stage III: anemia has developed because lymphocytes are crowding out red cells in the blood.
  • stage IV: there are too few platelets in the blood. The lymph nodes, spleen, and liver may be swollen. Anemia may be present.

Treatment of chronic lymphocytic leukemia depends on the stage of the disease, as well as on the person’s age and overall health. In stage 0, treatment may not be needed, but the person’s health will be monitored closely. In stage I or II, observation (with close monitoring) or chemotherapy is the usual treatment. In Stage III or IV, intensive chemotherapy with one or more drugs is the standard treatment. Some people may need a bone marrow transplant.

For chronic myeloid leukemia, drugs known as tyrosine kinase inhibitors have become standard therapy, especially for people in the early stages of the disease. They correct the chemical defects in the cancer cells that had allowed them to grow in an uncontrollable fashion. The use of these targeted therapies has dramatically improved the prognosis for many people with chronic myeloid leukemia.

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    Chemotherapy is the main treatment for childhood leukemia. The dosages and drugs used may differ based on the child’s age and the type of leukemia.

    Other treatments include:

    • radiation therapy: high-energy X-rays that kill cancer cells
    • targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
    • stem cell transplants: putting healthy stem cells into the body

    Looking Ahead

    With the proper treatment, the outlook for kids and teens with leukemia is quite good.

    Most childhood leukemias have very high remission rates, with some up to 90%. Remission means that doctors see no cancer cells in the body. Most kids are cured of the disease. This means that they’re in permanent remission.

    Having a child being treated for cancer can feel overwhelming for any family. But you’re not alone. To find support, talk to anyone on the care team or a hospital social worker. Many resources are available to help you and your child.

    You also can find information and support online at:

    • National Cancer Institute
    • American Childhood Cancer Organization
    • American Cancer Society

    Reviewed by: Jonathan L. Powell, MD Date reviewed: September 2019

    Dyspnea is a feeling of breathlessness. Many people with advanced cancer may experience it. People with earlier-stage cancers who have other conditions that affect the heart or lungs, such as a blood clot, may also have dyspnea.

    Common symptoms of dyspnea include:

    • Uncomfortable breathing

    • Shortness of breath

    • Not being able to get enough air

    • A feeling of smothering, tightness, drowning, or suffocation

    Finding the cause of shortness of breath

    A person may have dyspnea even though the actual levels of oxygen are within a normal range. It is important to understand that people do not suffocate or die from dyspnea. But tell your health care team right away if you have any of these symptoms or if they get worse. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care.

    To learn more about your symptoms, your health care team will:

    • Review your medical history

    • Ask you to describe your symptoms and what makes them worse

    • Ask you to rate your symptoms on a scale

    Causes of shortness of breath

    Dyspnea may be caused by a tumor or another condition related to cancer. But many of these causes can be treated. Some common causes of dyspnea include:

    • Blocked airway, such as by a tumor

    • Anxiety

    • Stress

    • Narrowing of the airway, called a bronchospasm

    • Shortage of oxygen in the blood, called hypoxemia

    • Fluid between the lungs and the chest wall

    • Pneumonia or infection

    • Inflammation of lungs after radiation therapy, called radiation pneumonitis

    • Low red blood cell count, called anemia

    • A blood clot

    Treating shortness of breath

    An important step in managing dyspnea is treating the cause, such as the tumor or a blood clot. Your doctor may also recommend the following to help relieve your symptoms:

    • Receiving extra oxygen

    • Sitting in front of a fan

    • Breathing cooler air by lowering the temperature in a room

    • Breathing cleaner air by opening a window, using a humidifier, or getting rid of smoke and pet dander

    • Getting a sense of open space by seeing a view of the outside, opening windows, or being in an empty room

    • Keeping your head lifted, for example, by using pillows so that you are nearly sitting

    • Practicing techniques that take your focus away from the problem, such as relaxation and meditation

    • Taking pain medications, such as morphine, that help control the central nervous system

    • Taking anti-anxiety drugs to manage the pain and anxiety

    • Doing strength and conditioning exercises, physical therapy, or pulmonary rehabilitation.

    Related Resources

    When to Call the Doctor During Cancer Treatment

    More Information

    National Cancer Institute: Dyspnea During Advanced Cancer

    What Are Common Symptoms of Leukemia?

    Some people with leukemia won’t experience symptoms for a long time, while others will have problems early on. Suriya Siritam/Alamy

    Signs and symptoms of leukemia will vary depending on the type of leukemia you have.

    All people with leukemia will experience some degree of cytopenia, which is a deficiency in mature blood cells. This is because, as abnormal leukemia cells grow in the bone marrow, they crowd out the cells normally produced there.

    Patients may not have enough normal red blood cells, a condition called anemia. Common symptoms include:

    • Fatigue
    • Weakness
    • Feeling cold
    • Dizziness or light-headedness
    • Headache
    • Shortness of breath

    A shortage of white blood cells, which are designed to ward off or fight infection, may result in infections that don’t go away.

    Low blood platelet counts are another common problem people with cytopenia face. Having a shortage of platelets can cause excessive bruising or bleeding; frequent or severe nosebleeds; and bleeding gums.

    People with acute forms of the cancer usually notice more symptoms because the disease progresses faster. Those with chronic leukemias may not know they have cancer until they take a routine blood test.

    Some symptoms of leukemia are vague and general, making it a somewhat difficult cancer to detect. (1,2)

    Common Symptoms of Leukemias

    The symptoms you experience will depend on whether your disease is chronic or acute and the type of blood cells it affects. But certain symptoms overlap and are common in all forms of the cancer.

    Some general symptoms of leukemia include:

    • Fever
    • Night sweats
    • Unexplained weight loss
    • Fatigue
    • Loss of appetite

    Most of the time, these symptoms are caused by another illness, and not leukemia (3)

    Symptoms of Acute Lymphocytic Leukemia (ALL)

    Most symptoms of ALL occur because a person lacks an adequate amount of normal blood cells. Problems due to low blood cell counts include:

    • Feeling tired or weak
    • Dizziness or light-headedness
    • Shortness of breath
    • Fever
    • Infections that come back or don’t go away
    • Easy bruising or bleeding

    If leukemia cells build up in the liver and spleen, you may feel full after only eating a small meal or notice swelling in your belly.

    Sometimes, leukemia can cause bone or joint pain from the cells growing in the bone marrow.

    If ALL spreads to other places in your body, you may experience symptoms such as:

    • Enlarged lymph nodes (if the cancer spreads to lymph nodes)
    • Headaches, weakness, seizures, vomiting, facial numbness, blurred vision, or balance issues (if the cancer spreads to your brain or spinal cord)
    • Fluid buildup and breathing difficulties (if the cancer spreads to your chest)

    A subtype of ALL can affect the thymus, a small organ in the middle of your chest. An enlarged thymus can cause coughing or trouble breathing. It can also press on the superior vena cava (SVC) — a large vein in your body. If this happens, blood can back up in the veins and cause a serious condition that’s characterized by swelling in the face, neck, arms, and chest; headaches; dizziness; and a change in consciousness.(4)

    Symptoms of Acute Myelooid Leukemia (AML)

    If the AML cancer cells, called blasts, become very high in number, they can cause a serious condition known as leukostasis, which literally means slowing of the normal blood flow due to congestion. This can lead to symptoms such as:

    • Headache
    • Slurred speech
    • Weakness on one side of the body
    • Confusion
    • Sleepiness
    • Shortness of breath
    • Blurry vision or loss of vision

    Some people with AML may have bone or joint pain if the leukemia builds up in the bone marrow in these areas.

    If AML spreads to the skin, it can cause spots that look like a rash. Certain types of AML may affect the gums, causing pain, swelling, and bleeding. Enlarged lumps under the skin of the neck, groin, underarms, or collarbone are a sign that the cancer has spread to your lymph nodes.

    When cancer cells collect in the liver or spleen, the organs may enlarge and cause swelling of the abdomen or a feeling of fullness.

    People with a certain type of AML, known as acute promyelocytic leukemia (APL), may have bleeding and clotting problems.

    If AML spreads to your brain or spinal cord, it could cause:

    • Weakness
    • Headaches
    • Vomiting
    • Seizures
    • Balance difficulties
    • Blurred vision
    • Numbness in the face

    (5)

    Symptoms of Chronic Lymphocytic Leukemia (CLL), Also Known as Small Lymphocytic Lymphoma (SLL)

    People with CLL may not have any symptoms when the cancer is diagnosed. Over time, they may gradually notice certain issues.

    Anemia can affect someone with CLL, causing weakness, tiredness, and shortness of breath.

    CLL is a cancer of B lymphocytes, which usually work to help fight infections. People with CLL may also have a high or low white blood cell count. Because their bone marrow is producing too many abnormal white blood cells, they don’t have enough normal cells. As a result, they may experience frequent infections that don’t go away on their own.

    Bruising, bleeding, frequent nosebleeds, and bleeding gums may occur when you have a shortage of platelets in your blood.

    If CLL affects your liver or spleen, you may feel full after only a small meal or experience swelling in your belly.

    Enlarged lymph nodes are another sign of CLL. (6)

    Symptoms of Chronic Myeloid Leukemia (CML)

    People with CML often experience many of the same symptoms as those with CLL.

    The most common sign of CML is an abnormal white blood cell count on a blood test. Very high or low white blood cell counts can lead to frequent infections that are hard to fight off.

    A shortage of red blood cells can cause weakness, tiredness, and shortness of breath.

    Too few platelets in the blood can trigger nosebleeds; easy bruising or bleeding; or bleeding gums. Some people with CML have too many platelets in their blood, which can also cause bleeding and bruising issues because the platelets don’t work properly.

    A feeling of unusual fullness after eating or swelling in the abdomen are also common symptoms if the cancer affects your spleen or liver.

    Additionally, some people with CML may complain of bone or joint pain if leukemia cells spread from the marrow to the surface of the bone or joint. (7)

    What to Do if You Have Symptoms

    It’s a good idea to see your doctor if you have signs or symptoms that are unusual, severe, or don’t go away.

    Leukemia symptoms are often overlooked because they can mimic those of other common illnesses, such as the flu.

    If your physician suspects leukemia, he might perform a physical exam, routine bloodwork, or a bone marrow test (a procedure to remove a sample of bone marrow from your hip). (8)

    Leukemia in Children

    • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test is done to see if cancer (leukemia) cells are in the bone marrow.
    • Lab tests of blood and bone marrow samples. Tests like flow cytometry and immunohistochemistry. These tests determine the exact type of leukemia. DNA and chromosome tests may also be done.
    • X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
    • Ultrasound (sonography). This test uses sound waves and a computer to create images.
    • Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells.
    • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.

    When leukemia is diagnosed, the doctor will find out the exact type of leukemia it is. Leukemia is not assigned a stage number like most other cancers. Instead, it’s classified into groups, sub-types, or both.

    ALL (acute lymphocytic leukemia) is the most common leukemia in children. It’s separated into 2 groups based on the type of lymphocyte the leukemia started in. That would be B cells or T cells. About 8 out of 10 cases of ALL in children are B-cell ALLs. These can be further classified into sub-types. The other 2 out of 10 cases are T-cell ALLs.

    AML (acute myelogenous leukemia) is the other kind of leukemia that’s common in children. Doctors use 2 different systems to classify AML. The French-American-British (FAB) system divides AML into 8 sub-types based on how the cells look under the microscope. The World Health Organization (WHO) classification system is newer. It groups AML into many groups based on things like the details of the gene changes in the cancer cells as well as the FAB sub-types.

    Classifying leukemia is very complex. But it’s an important part of making treatment plans and predicting treatment outcomes. Be sure to ask your child’s healthcare provider to explain the stage of your child’s leukemia to you in a way you can understand.

    How is leukemia treated in children?

    Your child may first need to be treated for low blood counts, bleeding, or infections. Your child may receive:

    • Blood transfusion with red blood cells for low blood counts
    • Blood transfusion with platelets to help stop bleeding
    • Antibiotic medicine to treat any infections

    Treatment will depend on the type of leukemia and other factors. Leukemia can be treated with any of the below:

    • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV) or spinal canal, injected into a muscle, or taken by mouth. Chemotherapy is the main treatment for most leukemias in children. Several medicines are often given at different times. It’s usually done in cycles, with rest periods in between. This gives your child time to recover from the side effects.
    • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. Radiation may be used in certain cases.
    • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
    • Targeted therapy. These medicines may work when chemotherapy doesn’t. For example, it may be used to treat children with chronic myeloid leukemia (CML). Targeted therapy often has less severe side effects.
    • Immunotherapy. This is treatment that helps the body’s own immune system attack the cancer cells.
    • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
    • Clinical trials. Ask your child’s healthcare provider if there are any treatments being tested that may work well for your child.

    With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

    • Getting medical treatment right away is important for the best prognosis.
    • Ongoing follow-up care during and after treatment is needed.
    • New treatments are being tested to improve outcome and to lessen side effects.

    What are possible complications of leukemia in a child?

    A child may have complications from the tumor or from treatment. They may also be short-term or long-term.

    Treatment may have many side effects. Some side effects may be minor. Some may be serious and even life-threatening. Your child may take medicines to help prevent or lessen side effects. You’ll be given instructions about what you can do at home.

    Possible complications of leukemia can include:

    • Serious infections
    • Severe bleeding (hemorrhage)
    • Thickened blood from large numbers of leukemia cells

    Possible long-term complications from the leukemia or the treatment can include:

    • Return of the leukemia
    • Growth of other cancers
    • Heart and lung problems
    • Learning problems
    • Slowed growth and development
    • Problems with the ability to have children in the future
    • Bone problems such as thinning of bones (osteoporosis)

    What can I do to prevent leukemia in my child?

    Most childhood cancers, including leukemia, can’t be prevented. The risk from X-rays and CT scans is very small. But healthcare providers advise against them in pregnant women and children unless absolutely needed.

    How can I help my child live with leukemia?

    A child with leukemia needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the cancer returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the cancer or from treatment.

    You can help your child manage his or her treatment in many ways. For example:

    • Your child may have trouble eating. A dietitian may be able to help.
    • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
    • Get emotional support for your child. Find a counselor or child support group can help.
    • Make sure your child attends all follow-up appointments.

    When should I call my child’s healthcare provider?

    Call the healthcare provider if your child has:

    • Fever
    • Symptoms that get worse
    • New symptoms
    • Side effects from treatment

    Key points about leukemia in children

    • Leukemia is cancer of the blood. The cancer cells develop in the bone marrow and go into the blood. Other tissue and organs that may be affected include the lymph nodes, liver, spleen, thymus, brain, spinal cord, gums, and skin.
    • When a child has leukemia, the bone marrow makes abnormal blood cells that do not mature. The abnormal cells are usually white blood cells (leukocytes). And with leukemia, the bone marrow makes fewer healthy cells.
    • Common symptoms of leukemia in children include feeling tired and weak, easy bruising or bleeding, and frequent or long-term infections.
    • Leukemia is diagnosed with blood and bone marrow tests. Imaging may be done to look for signs of leukemia in different parts of the body.
    • Chemotherapy is the main treatment for most leukemias in children.
    • A child with leukemia may have complications from the leukemia and from the treatment.
    • Ongoing follow-up care is needed during and after treatment.

    Next steps

    Tips to help you get the most from a visit to your child’s healthcare provider:

    • Know the reason for the visit and what you want to happen.
    • Before your visit, write down questions you want answered.
    • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
    • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
    • Ask if your child’s condition can be treated in other ways.
    • Know why a test or procedure is recommended and what the results could mean.
    • Know what to expect if your child does not take the medicine or have the test or procedure.
    • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
    • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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