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Treating Cancer in Children: Managing Mucositis

Child standing at bathroom sink preparing to rinse mouth. Bottle of rinse is on counter next to sink.
Encourage your child to rinse his mouth with recommended non-alcohol rinses, antibacterial rinses, saline, or plain sterile water. These can help soothe sore gums and mouth lining.

Your child has a condition called mucositis. This is a common, short-term side effect of cancer treatment. Though painful, it usually goes away over time after treatment ends. It often gets better between treatment cycles, too. Here are answers to some questions you may have, as well as tips to help ease your child’s discomfort.

What is mucositis?

Mucositis happens when the cells that line the digestive tract become irritated and inflamed. This happens because they're damaged by cancer treatment. The digestive tract starts at the mouth, runs through the body, and ends at the rectum. With mucositis, painful sores can form anywhere inside the digestive tract.

What causes mucositis?

Chemotherapy and radiation therapy can cause mucositis. These treatments are used to kill cancer cells. But they also damage healthy cells, especially ones that grow quickly. These include the cells that make up the lining of the digestive tract. Mucositis happens when treatment injures these cells.

Who gets mucositis?

Anyone getting cancer treatment can be affected by mucositis. It's mostly linked to certain chemotherapy drugs and how well the immune system is working. It often starts about 3 days after treatment, and peaks  7 to 10 days after treatment. It lasts about 5 to 7 days. After that, the healthy cells begin to heal and mucositis goes away. 

Children with blood cancers (leukemia or lymphoma) seem to have a higher risk for mucositis.

What are the symptoms?

  • Pain in mouth, throat, or stomach

  • Redness, swelling, or wounds in the mouth, throat, or rectum

  • Sores in the mouth or genital area

  • Drooling

  • Refusing to eat or drink

  • Diarrhea

How is mucositis treated?

Mucositis can be very painful, so your child may not want to eat or drink. But it’s important that your child does eat and stay hydrated. Your child's healthcare provider will likely give your child pain medicine to make it easier for your child to drink and eat. Your child may also be given medicine to fight infection. Ask your child's healthcare provider about treatments that might be used to help prevent or treat mucositis.

There are other steps you can take to help ease your child’s pain and to help them eat. Use the tips below and keep encouraging your child to do so.

Keep the mouth clean

  • Have your child clean their teeth and mouth exactly as instructed by the healthcare provider. If mucositis gets worse, ask the healthcare provider if your child should clean their teeth and mouth more often.

  • Give your child a soft-bristle toothbrush to brush with.

  • Make sure to replace the toothbrush often.

  • Have your child brush gently.

  • If the mouth is too sensitive for a toothbrush, your child can use a special sponge to clean teeth.

  • Have your child rinse their mouth with non-alcohol rinses, antibacterial rinses, saline, or plain water. These products help remove particles and bacteria, help keep sores from crusting, and soothe sore gums and the lining of the mouth. Ask your child’s healthcare team for suggestions.

Manage pain and infection

  • Give any pain medicine prescribed for your child as instructed.

  • Don’t give your child over-the-counter medicines such as aspirin, ibuprofen, or acetaminophen unless the healthcare provider tells you to. These medicines can mask a fever, which is an important sign that there's a problem with your child’s health. They can also make it harder for the blood to clot. This raises your child’s risk of bleeding.

  • Have your child use a prescription mouthwash as instructed by the healthcare provider. These mouthwashes can help to numb the area and prevent infection. They're sometimes called "magic mouthwashes." 

  • Your child may be given antibiotics to treat infected sores. Make sure your child takes these as instructed.

  • Encourage your child to brush and floss regularly to clear away bacteria.

Maintain good nutrition

If your infant has mucositis, they will likely get IV treatments at the hospital. If your child is older, they may also get IV fluids or nutrition if eating or drinking is a problem. But if your child can eat and drink, do the following:

  • Encourage your child to drink smoothies and other cool foods.

  • Purée food with a blender if needed.

  • Serve foods cool or at room temperature.

  • Make sure foods are cooked until tender and cut into small pieces.

When mucositis happens, your child's sense of taste may change. This is expected. Be understanding if your child tells you this and is less enthusiastic about eating.

Other tips

  • Talk with your child’s healthcare provider about getting dental work done before treatment begins.

  • Moisturize your child’s lips with petroleum jelly or balm, such as lanolin.

  • Help your child stay away from citrus fruits and spicy or acidic foods. But it’s OK to allow them if your child wants them. The most important thing is that your child eats.

  • Have an overnight bag ready in case you have to go to the hospital.

  • If you do go to the hospital, bring your child’s medicine and chemotherapy information.

When to call the healthcare provider

Call the healthcare provider right away if your child has any of the following:

  • A fever in an infant or child with cancer is an emergency. Take your child's temperature by mouth or under the arm. Call the healthcare provider as instructed.

  • A seizure caused by the fever

  • Refusing to drink or urinating less than normal

  • Constipation

  • Diarrhea

  • Pain

Be sure you know what number to call and how to get help at any time, day or night.

Online Medical Reviewer: Adam Levy MD
Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham
Date Last Reviewed: 5/1/2019
© 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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