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My child is on chemotherapy or has low immunity - which signs are emergencies?

Emergency numbers: 108 ambulance · 112 national emergency · Poison centre (AIIMS, 24x7): 1800-116-117

Quick answer: For a child on chemotherapy or with low white blood cells, any elevated temperature is a prompt-medical-care event - call your child's cancer team or go to the treating hospital immediately, day or night, even if your child looks otherwise well. Do not wait to see if the fever settles, and do not give fever medicine before calling the team unless they have told you to. Their number should be saved in every caregiver's phone.

🟢 GREEN - Reassuring, with precautions

  • No fever, and your child is eating, drinking, playing and acting normally - keep up the routine precautions your team has given you.
  • The AAP's reassurance for families: common viral colds are usually not a significant risk for children with low neutrophils and usually need no specific treatment - but fever is still a call-the-team event, because no one can tell a cold from something serious without checking.

🟡 YELLOW - Call the cancer team today (even without fever) if

  • Redness, swelling, pain or discharge around the port or central line.
  • New mouth ulcers, white patches in the mouth, or pain on swallowing.
  • Unusual tiredness, poor appetite, or anything that is simply not normal for your child.
  • Exposure to someone with chickenpox, measles or another contagious illness - tell the team even before symptoms.
  • Loose motions, vomiting, or pain while passing urine.

🔴 RED - Call the team / go to the treating hospital NOW if

  • Any fever or elevated temperature - this is the rule that comes first, always. The team will usually want a blood count and cultures immediately; some children need IV antibiotics and admission.
  • Shaking chills or rigors, with or without a measured fever.
  • Fast or difficult breathing, cough, or bluish lips.
  • Confusion, unusual drowsiness, or your child being hard to wake.
  • Bleeding that does not stop - from the gums, nose, or into the skin (purple spots).
  • A fever while the line or port looks infected - say both when you call.

🆘 SOS - What to do right now

  • Take the temperature properly and write it down with the time.
  • Call the cancer team or your treating hospital's emergency line first - they know your child's counts, port and protocol, and they will tell you exactly where to come.
  • Go to the treating hospital when possible: infection in a low-immunity child is managed fastest by the team that knows the case. If your child is collapsing or blue, call 108 and go to the nearest ER, telling them your child is on chemotherapy.
  • Carry the treatment file, the list of medicines, and the last chemotherapy date.
  • On the way, keep your child away from crowds; a simple mask is reasonable.

❌ DO NOT

  • Do not give paracetamol or any fever medicine before calling the team - it can mask the fever they need to see (unless your team has given you a standing instruction).
  • Do not wait until morning, the next OPD day, or "to see if it repeats" - infection in a low-immunity child can move in hours.
  • Do not give any live vaccines, and do not let anyone give your child any injection or medicine without the treating team's knowledge.
  • Do not use home remedies or antibiotics left over from before - the choice of antibiotic depends on the child's counts and cultures.
  • Do not let visitors with any illness near your child during low-count periods.

What is happening and why

Chemotherapy fights cancer by killing fast-dividing cells - and the bone marrow's white blood cell factories divide fast too, so counts drop predictably after each cycle. Neutrophils are the white cells that fight bacteria and fungi; when they run low (doctors call this neutropenia), the body can lose its usual early-warning battles against infection, and an infection that an ordinary child shrugs off can spread into the blood. Fever with low neutrophils - febrile neutropenia - is the emergency every cancer team drills its families on, precisely because it is so treatable when caught early with blood tests and IV antibiotics.

This is also why your team wants the call rather than a home remedy: whether your child needs admission and which antibiotic to start depends on the day's counts and cultures. The precautions between fevers are ordinary and livable - handwashing, food hygiene, keeping sick visitors away, and checking in before any medicine or vaccine - and most children on treatment spend most of their days being simply children.

This page is for first-aid education and does not replace examination by a doctor. In an emergency, call 108 or 112.

Sources (last checked 13 Sep 2026)

Approved for publication by Dr Anjana Alekhya, MD (Paediatrics) · Based only on AAP/IAP guidance · Published 13 September 2026