Children undergoing anticancer treatment may experience side effects associated with their therapies. Treatment of many childhood cancers includes chemotherapy or targeted therapies. Although each type of therapy has its own safety profile, there are some similar and common symptoms that may occur. For chemotherapy, this includes mucositis, hair loss, diarrhea, loss of appetite, and nausea or vomiting.1 Side effects associated with targeted therapies are typically mild, but may also include diarrhea, nausea, and fatigue, and rash.2

The following are some approaches to help relieve symptoms at home among children undergoing anticancer treatment. However, all symptoms should be reported to the oncology care team, and parents should call the clinic if symptoms are new, if they worsen, or if they are severe.

Mucositis

Mucositis is a term for oral mouth sores, which can occur with chemotherapy and radiation therapy.3 Mucositis can be painful and severe enough that patients may not be able to eat. These sores can become infected, and may require an interruption in treatment. For patients whose mucositis is more mild, there are some at-home approaches that can prevent mucositis or reduce severity, and some treatments that can bring pain relief.


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The most important approach is adopting a comprehensive oral care routine, including a mouth rinse, brushing teeth, and flossing.3 Bland mouth rinses, such as those with saline or baking soda, can help maintain oral hygiene by clearing debris from the mouth, and sometimes they can provide some pain relief.

Chewing on or dissolving ice chips in the mouth, or eating popsicles, can also provide relief and potentially reduce severity of mucositis.4 Children may enjoy ice cubes that are flavored with fruit juices or made into different shapes by using a silicone ice cube tray.

Hair Loss

Hair loss, or alopecia, can occur with some types of chemotherapy. Although hair loss is generally not preventable, there is some evidence that cooling cap systems may help with the amount of hair loss seen.5 These caps are devices that the patient wears during chemotherapy infusion that circulate a cooled liquid, thus causing the scalp to decrease in temperature. Several different types have been cleared by the US Food and Drug Administration and can be rented or purchased, although insurance may not cover the cost. The use of a cooling cap is something that should be discussed with the oncology care team.

Diarrhea

Diarrhea, which is defined as frequent, loose, and watery bowel movements, is a common side effect of many anticancer treatments.6 Diarrhea can be dangerous when it’s severe due to dehydration and lack of absorption of nutrients from food. Probiotics or antidiarrheal medications should not be used without consulting the oncology care team.

For mild diarrhea, children should drink a lot of liquids. And, 6 to 8 small meals a day that are high in potassium and sodium may be helpful, such as diets including bananas, potatoes, apricots, and peaches. The bananas, rice, applesauce, and toast (BRAT) diet can be used for several days, but is not recommended for longer because it lacks some important nutrients. Other examples of foods that may be helpful include oats, low-sugar cereals, crackers, pasta, and soft fruits. Foods that should be avoided include spicy or greasy foods, raw fruits and vegetables, and fruit juices.

Anxiety can also stimulate bowel activity.6 Mindfulness or relaxation apps may be helpful to guide children through relaxing activities.

Skin irritation around the anus can occur.6 It is important to keep the area clean and use a barrier cream or ointment to help reduce irritation and provide comfort.