Chemotherapy-Related Mouth Mucositis in Children

What is chemotherapy-related mouth mucositis in children?

Chemotherapy is the use of medicines to treat cancer. The medicines can cause an inflammation of the lining of the mouth. The mouth is lined with mucous membranes. When these are inflamed, it’s called mouth mucositis. The mucous membranes may be red, swollen, painful, irritated, and have sores. The mucositis can affect any part of the digestive system, from the mouth to the anus. Mouth mucositis can be very painful. It can cause problems with eating, talking, and swallowing. It can also lead to serious infections and other problems.

What causes chemotherapy-related mouth mucositis in a child?

Chemotherapy kills cells that grow fast, such as cancer. Mucous membrane cells also grow fast, so some types of chemotherapy may harm them.

Which children are at risk for chemotherapy-related mouth mucositis?

Children are more likely to get mouth mucositis than adults. Type, dose, and length of time of chemotherapy treatment are factors. A child may also be at higher risk of mouth mucositis due to: 

• Poor dental and mouth care
• Loss of body fluid (dehydration)
• Being underweight
• Other long-term (chronic) health problems
• Cancer of the blood
• Smoking, using chewing tobacco, or drinking alcohol

What are the symptoms of chemotherapy-related mouth mucositis in a child?

Mouth mucositis may start 5 to 10 days after starting chemotherapy. It may last for weeks. Symptoms can also occur a bit differently in each child. They may include:

• Red, shiny, swollen mouth, tongue, or gums
• Bleeding in the mouth
• Sores in the mouth
• Pain in the mouth or throat
• Trouble eating, talking, or swallowing
• Thickened saliva or mucus in the mouth
• Dryness
• A covering or membrane over the mouth sores (pseudomembrane)

The symptoms of mouth mucositis can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is chemotherapy-related mouth mucositis diagnosed in a child?

The healthcare provider will ask about your child's chemotherapy treatment and mouth symptoms. He or she will examine your child’s mouth, gums, and tongue. The healthcare provider may note how severe the problem is with a grading system. The mucositis may be graded from 1 to 4. This can help guide treatment. If needed, your child may be tested for other conditions. Some mouth conditions can have similar symptoms, such as oral candidiasis (thrush).

How is chemotherapy-related mouth mucositis treated in a child?

There are many ways to treat mouth mucositis. Some treatments are simple and may help with mild symptoms. More severe symptoms may need to be treated with prescription medicines. In some cases, your child may need to spend some time in the hospital. Your child's oncologist will work with you to make your child as comfortable as possible. 

To help ease mild symptoms, try the below:

• Give your child ice pops or ice water to cool and numb his or her mouth.
• If your child is old enough, give him or her ice chips, hard candy, throat drops (lozenges), or chewing gum.
• Don’t let your child eat spicy, hot, or rough foods.
• An older child can use mouth rinses after eating and at bedtime. Your child's oncologist or nurse can suggest rinses to try.
• Brush your child’s teeth very gently with a soft toothbrush.
• Use lip balm to keep your child’s lips moist. Don’t use petroleum jelly.

For more severe symptoms, your child's oncologist may advise:

• Cleaning sores with solutions that you mix or with other products
• Using pain relievers that are applied to the mouth or taken by mouth (oral)
• Time in the hospital if your child has an infection, or can’t eat or drink

What are possible complications of chemotherapy-related mouth mucositis in a child?

Possible complications of mouth mucositis include:

• Loss of fluid (dehydration) 
• Weight loss
• Infection in the mouth
• Infection spreading to the blood, which is very serious

What can I do to prevent chemotherapy-related mouth mucositis in children?

Mouth mucositis can’t be fully prevented.  But there are medicines that can help prevent mucositis from happening. Talk with your child's oncologist about these medicines. You can also help lessen the chance and the severity of the condition by making sure your child:

• Is up to date on all dental care
• Has dental problems fixed before starting chemotherapy
• Has excellent mouth care every day, including brushing with a soft toothbrush and mild toothpaste, rinsing, and very gentle flossing
• Drinks extra liquids
• Has healthy protein in his or her diet every day
• Doesn’t smoke, chew tobacco, or drink alcohol, which can all increase the chance of mouth mucositis

How can I help my child live with chemotherapy-related mouth mucositis?

You can help your child during treatment with the below tips:

• Use a flashlight to check your child's mouth every day. Look for redness, swelling, irritation, and sores.
• Make sure your child takes excellent care of his or her mouth. This helps to prevent and lessen the symptoms of mouth mucositis. Make sure your child brushes and rinses after eating and at bedtime. Or make sure you clean your child's mouth.
• Don’t let your child use any mouthwashes or rinses with alcohol. Ask your child's oncologist or nurse what rinse you should use.
• If your child is taking medicine for pain, give the medicine before your child eats. This can make it easier for your child to eat. 

When should I call my child’s healthcare provider?

Call your child's healthcare provider if he or she has the below:

• Redness or shininess in the mouth that lasts for more than 2 days
• Bleeding gums
• A cut or sore in the mouth
• A fever of 100.4 or higher 
• White patches in the mouth
• Trouble eating, drinking, or taking medicines because of mouth sores

Key points about chemotherapy-related mouth mucositis in children

• Mouth mucositis is inflammation of the lining of the mouth (mucous membranes). 
• Anti-cancer medicines (chemotherapy) may cause mucositis. 
• Symptoms of mucositis include redness, swelling, irritation, pain, and sores in the mouth. 
• A child with mucositis may have trouble eating, drinking, swallowing, and talking.
• There are things you can do to help prevent mucositis from developing, including daily mouth care.
• Treatment for mucositis may include rinses, medicines by mouth, and staying away from certain foods and products.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.