Treating Cancer in Children: Managing Mucositis

Child standing at bathroom sink preparing to rinse mouth. Bottle of rinse is on counter next to sink.Your child has a condition called mucositis. This is a short-term side effect of cancer treatment. Though painful, it usually goes away soon after treatment ends. Below are answers to questions you may have as well as tips to help ease your child’s discomfort.

What Is Mucositis?

Mucositis occurs when the cells that line the digestive tract become inflamed due to damage caused by cancer treatment. The digestive tract begins 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 the treatments can also attack healthy cells, especially ones that grow quickly. These include the cells that make up the lining of the digestive tract. Mucositis results when treatment kills these healthy cells.

Who Gets Mucositis?

Anyone getting treatment, especially chemotherapy, can be affected by mucositis. The condition often occurs about 7 to 10 days after the last day of treatment. It typically lasts about 5 to 7 days. After that, the cells begin to heal and mucositis goes away. 

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

  • Refusal 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. So the health care provider will likely prescribe pain medication. Medication to fight infection may also be given. There are other steps you can take to help ease your child’s pain. Use the tips below or encourage your child to do so.

Keep the Mouth Clean

  • Have your child clean his or her teeth and mouth exactly as instructed by the health care provider. If mucositis gets worse, ask the healthcare provider if teeth and mouth cleaning should be done more often.

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

  • Make sure the toothbrush is replaced 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 his or her mouth with non-alcohol rinses, antibacterial rinses, saline, or plain sterile water. These products help remove particles and bacteria, prevent crusting of sores, and soothe sore gums and mouth lining. Ask your child’s health care team for suggestions.

Manage Pain and Infection

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

  • Don’t give your child over-the-counter medications, such as aspirin, ibuprofen, or acetaminophen, unless you are told to do so by your child’s health care provider. These medications can mask a fever, which is an important sign that there is 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 health care provider. These mouthwashes can help to numb the area and prevent infection because they often contain numbing agents and antifungal agents. They are sometimes called "magic mouthwashes." 

  • Antibiotics may be prescribed to treat infection of 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, he or she will get IV treatments at the hospital. If your child is older, he or she 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 milk shakes and other cool foods

  • Purée food with a blender if necessary

  • Serve foods cool or at room temperature

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

Other Tips

  • Talk to your child’s health care provider about getting dental work done before treatment begins. Moisturize your child’s lips with petroleum jelly or balm, such as lanolin.

  • Have your child avoid citrus or 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 medication and binder with chemotherapy information.

Call the Health Care Provider

Call your health care provider if your child has any of the following:

  • In an infant under 3 months old, a temperature of 100.4°F (38°C) or higher

  • In a child 3 to 36 months, a rectal temperature of 102°F (39°C) or higher

  • In a child of any age who has a temperature of 103°F (39.4°C) or higher

  • A fever that lasts more than 24 hours in a child under 2 years old, or for 3 days in a child 2 years or older

  • Your child has had a seizure caused by the fever

  • Refusal to drink or decreased urination

  • Constipation (inability to release stool)

  • Diarrhea

  • Pain