Managing Mucositis in Children

What is mucositis?

Mucositis is the swelling, irritation, and ulceration of the cells that line the digestive tract. Mucositis can occur anywhere along the digestive tract from the mouth to the anus. It can be a very troublesome and painful side effect of chemotherapy. Anticipating mucositis may help to manage some of the symptoms.

What causes mucositis?

The cells that line the digestive tract are rapidly reproducing. In other words, the life span of these cells is very short compared to other cells in the body. Chemotherapy medicines cannot tell the difference between healthy cells and cancer cells. Because the digestive tract cells grow rapidly, the chemotherapy medicines can destroy them quickly, breaking down the protective linings, and leaving these linings at risk for irritation, and swelling. Mucositis can be even further complicated by nausea and vomiting that often occur with treatment.

What are the symptoms of mucositis?

The following are the most common symptoms of mucositis. However, each child may experience symptoms differently. Symptoms may include:

• Redness and swelling of the gums with symptoms possibly leading to ulcers in the mouth and throat, white patches, or pus
• Trouble eating or swallowing
• Diarrhea
• Abdominal cramping and tenderness
• Rectal ulcerations or redness

The symptoms of mucositis may resemble other medical conditions. Always consult your child's doctor for a diagnosis.

What can be done to manage the symptoms of mucositis?

Mucositis may occur a week or longer after completion of therapy. Unfortunately, symptoms may not be preventable. There are things, however, you can do for your child to manage the pain including the following:

For oral mucositis:

• Keep your child's mouth moist by encouraging him or her to drink plenty of fluids. Try ice chips or popsicles. It may help to have him or her try drinking through a straw.
• Inspect your child's mouth daily with a flashlight to see if any ulcers have developed or worsened.
• Mouth care should be done as often as four times a day: after each meal and before bedtime.
• Use lip balm to keep your child's lips from peeling or cracking.
• Teeth should be brushed gently with a soft toothbrush.
• Mouthwashes that contain alcohol should be avoided. Your child's doctor may prescribe a special mouthwash for your child.
• Avoid food with extreme temperatures, both hot and cold. Try soft foods that are easy to swallow.
• Older children should not drink alcohol or smoke tobacco products.
• If the sores become very painful, your child's doctor may be able to prescribe a numbing solution for the mouth or other analgesics (pain relievers).
• Give pain medicines before meal times.

For diarrhea or rectal irritation:

• If your child has severe diarrhea, maintain adequate fluid intake to prevent dehydration.
• Keep the rectal area clean and dry.
• Change diapers frequently.
• Clean your child's skin with a mild soap.
• Your child's doctor may recommend several barrier ointments or creams.

When should you call the clinic (during the weekdays) or the on-call fellow (at nights and on weekends):

• If your child is drinking much less than normal
  • It is OK if his/her appetite for solid foods is less than normal for a few days but we want to make sure liquid intake is good enough
• If s/he is urinating less than normal which suggests dehydration
• If the pain of the mouth sores is too great for you to manage at home- unfortunately some children may need to be admitted for IV pain medications while their mouth is healing
• If your child has a temperature greater than 100.4 degrees