Case Report: Staged multidisciplinary nursing management of grade 4 oral mucositis after pediatric hematopoietic stem cell transplantation.

Severe oral mucositis (OM) after pediatric hematopoietic stem cell transplantation (HSCT) becomes especially challenging when complicated by pancytopenia, platelet transfusion refractoriness, bleeding, and high nutritional risk, which also make oral care hard to deliver. We report a 13-year-old girl with transfusion-dependent α-thalassemia who developed OM on day +6 after unrelated-donor HSCT and progressed to World Health Organization grade 4 on day +17, with severe ulceration, pseudomembrane, trismus, inability to eat, bleeding, and anxiety. The case focuses on how a staged, multidisciplinary nursing pathway kept essential oral and supportive care feasible and safe through continuous assessment, phase-specific intervention, and team coordination. Behavioral techniques (Tell-Show-Do, music and animation distraction, caregiver-assisted care) enabled mouth rinsing and ultraviolet (UV) treatment despite severe pain. OM improved to grade 1 at discharge (day +32) and grade 0 at day +84; pain fell from a Numeric Rating Scale (NRS) score of 8 to 0, anxiety from a Self-Rating Anxiety Scale (SAS) score of 56 to 39, and nutritional risk from a Pediatric Yorkhill Malnutrition Score (PYMS) of 4 to 2 by discharge, with no fatal bleeding, sepsis, catheter-related infection, or recurrence. Because many interventions were delivered concurrently, recovery cannot be attributed to any single measure; the staged pathway was temporally associated with clinical improvement and may have supported recovery.