Radiotherapy for children with head and neck cancers
Radiotherapy is sometimes used to treat children with head and neck cancers. We have separate information for children having radiotherapy to the chest area, or to the abdomen and pelvis (tummy) area.
Radiotherapy can be a worrying experience for both children and their parents, but understanding what it involves can help reduce your anxiety.
It is helpful to read this information alongside our section on children’s cancers, which contains more information about cancers in children, their diagnosis and treatment, and the support services available. Our information about radiotherapy for people of all ages may also be of interest.
We hope this information answers your questions. If you have any further questions, you can ask a nurse, radiographer or doctor involved in your child's treatment.
Animation for children about radiotherapy
If your child is about to have radiotherapy, it may help to watch the short video ‘One of a Kind’, produced by Aardman Animations and funded by a partnership of eight charities. The animation shows children what to expect on a visit to the radiotherapy department. A young girl explains what happens when she goes for treatment. The images are friendly and the words are simple and easy to understand. Perhaps watch it yourself first to prepare for any questions your child may have and then have a look together.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells in one area of the body, while doing as little harm as possible to normal cells. The treatment is painless and is given in the hospital radiotherapy department, normally as a series of short daily sessions.
The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes only a few minutes. Your child’s doctor will discuss the treatment and possible side effects with you. The number of sessions will depend on the type of tumour your child has, but treatment may last for several weeks.
Planning the radiotherapy treatment
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In order for radiotherapy to be as effective as possible, it must be carefully planned.
Preparing your child
Before planning starts, your child will be assessed to make sure they’re able to cope with treatment and the way it’s given. This will be done either when your child first meets the doctor who plans the radiotherapy (clinical oncologist), or on their first visit to the radiotherapy department.
To help your child prepare the radiotherapy, a hospital play specialist, paediatric specialist radiographer, nursery nurse, or specialist nurse may spend some time with them. Through fun and play, they will help explain the treatment to your child, and this may take several visits. You may be given games and exercises to play with your child at home. This is to help them overcome any fears or anxieties they may have, and to get used to what radiotherapy involves.
Many parents are surprised at how cooperative their child can be during radiotherapy, once they’ve been given plenty of time to prepare with the hospital play specialist.
For planning and for the treatment itself, your child will need to be able to lie still in a particular position for a few minutes, and feel comfortable being alone in the treatment room. If your child can’t lie still for long enough, or finds it difficult to be in the treatment room alone, they will need a daily general anaesthetic to have radiotherapy. Most children under the age of three will need an anaesthetic; most aged four or over will not need it.
Your child’s treatment is planned by a cancer specialist (clinical oncologist). Treatment planning may take a few visits and will involve your child having a CT scan to create detailed images of the area to be treated. Marks may be drawn on your child’s skin to help make sure treatment is given to exactly the right area each time. Sometimes, small permanent dots (tattoos) are also used. Your doctor or specialist nurse will explain this process to you.
At the beginning of each radiotherapy session, the radiographers will position your child carefully on the couch, and make sure they're comfortable. During treatment, your child will be alone in the room, but they will be able to talk to the radiographers (who will be watching from the next room) over a communication system. You can stay with the radiographers, so that you can see your child and talk with them. Music, story tapes or CDs can be played for your child, or you can read stories to them.
If your child is having treatment under a general anaesthetic, they can't eat or drink for at least four hours before being given their anaesthetic. Because of this, your child will usually have a morning appointment. The anaesthetic is given in the radiotherapy department by an anaesthetist, who is trained in giving anaesthetics to children.
Older children may take a while to get used to the size and sound of the machines, but this should become easier once they get to know the staff and surroundings.
Possible general side effects of radiotherapy
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The immediate side effects of radiotherapy are usually very mild.
Tiredness is a common side effect during radiotherapy and for a few weeks afterwards. It may take a few months for your child’s energy levels to get back to normal once treatment has ended.
Loss of appetite
Your child may lose their appetite. It may be easier for them to have small, frequent snacks throughout the day, rather than main meals.
Possible local side effects during radiotherapy
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Only the treated area will be affected by local side effects, and your child is unlikely to experience all the side effects listed here.
Effects on the skin
Some children develop a skin reaction, similar to sunburn, while having radiotherapy. This normally happens after 3-4 weeks. In children with pale skin, the skin in the treatment area becomes red and sore, or itchy. In children with dark skin, it becomes darker. The severity of the reaction depends on a number of factors, and some children have no skin problems at all. The radiographers will look for these reactions, but you should also let them know if your child feels any soreness.
Radiotherapy staff will advise you on how to look after your child’s skin in the treated area. This varies according to the part of the body being treated and the dose of radiotherapy being given. You may be asked to wash the area only with warm water, and then to gently pat it dry with a soft towel. Try not to rub the area, as this may make it sore.
It's important not to use soaps or talcum powder on the treated area of skin. Hospital staff may suggest that you gently apply unperfumed moisturisers. Always check with your child’s nurse, radiographer or doctor before applying anything to your child’s skin.
These restrictions only apply to the affected area; the rest of your child’s skin can be treated normally. The skin may peel after the redness has faded, but it should heal quickly. Skin reactions usually settle down 2-4 weeks after the radiotherapy has finished, but the treated area may remain slightly darker than the surrounding skin.
Loose-fitting clothes, preferably made of natural fibres (such as 100% cotton) rather than man-made materials, are more comfortable for your child and less irritating to the skin.
Taking care in the sun
Because skin in the treated area is very sensitive, it should not be exposed to the sun or cold winds. It's very important to cover the treated area if your child goes out in strong sunshine, for at least the first year after their radiotherapy. They should wear a hat or cotton scarf when out in the sun. The treated skin will always be sensitive to sun damage, so extra care should be taken. Your child should use a suncream of at least factor 30. It's also important to remember that skin can burn in strong sunlight, even through clothing. We have more information on taking care of your skin in the sun.
It's fine for your child to swim as soon as any skin reaction has settled down, which is usually within a month of finishing treatment. But if they're swimming outdoors in strong sunlight, they should use a waterproof sunblock and should not stay in the water too long.
Other side effects of radiotherapy
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Effects on the mouth
Radiotherapy to the mouth may make your child more likely to get tooth decay. They will need to see a specialist dentist before treatment begins, to make sure their teeth and gums are as healthy as possible. Once treatment has finished, your child will need more frequent check-ups at the dentist. Fluoride treatment can often help to protect their teeth against the effects of radiotherapy. Your doctor may refer your child for special dental treatment before radiotherapy starts.
Your child’s mouth may become sore, as the cells that line it are sensitive to radiation. The glands that produce saliva may also be affected by the treatment, causing them to produce little, or no, saliva. This can make it uncomfortable for your child to chew or swallow. Radiotherapy may also make your child more prone to getting mouth infections, such as thrush. Mouth infections can be treated with medicines. The staff in the radiotherapy department can advise you on how to look after your child’s mouth, and about foods that can help them.
Your child’s taste buds may also be affected by treatment. They may notice changes in the way food tastes. Some people describe it as having a ‘metallic’ taste, while others say that all foods taste the same. As the effects of treatment fade away, things will return to normal, but it may take up to a year for your child’s sense of taste to return to normal.
Support with eating and drinking
If eating and drinking become too painful, or your child loses a lot of weight, it may be necessary for them to be fed in special ways. Staff can explain what this involves, and will include you in decisions about the best way to feed your child.
Radiotherapy only causes hair to fall out in the treated area. This can happen where the radiation beam leaves the body (for example on the back of the neck), as well as where it enters the body. Ask your child’s doctor to show you exactly where their hair will fall out. Hair often begins to fall out after 2-3 weeks and then usually starts to grow back within 2-3 months of treatment ending. Sometimes it grows back a slightly different colour or texture, and it may be more patchy than before. If high doses of radiotherapy are needed, it may result in a bald patch. You will be told if this is likely to happen.
Losing hair can be very distressing for children, but there are many ways of dealing with it, including wigs, hats and head coverings.
If your child has radiotherapy to their head, about 4-6 weeks after treatment has ended, they may start to feel extremely sleepy and drowsy. They may be sleepy in the daytime as well as at night. Some children also lose their appetite. These symptoms are to be expected, and are known as ‘somnolence syndrome’. They gradually get better over about 2-3 weeks.
Possible long-term side effects
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Radiotherapy can cause some long-term side effects, which may start months or sometimes years after treatment. These effects are difficult to predict and, unfortunately, when they do occur, they are permanent. We’ve given some examples of these below. Your child’s doctor will discuss with you in detail any possible long-term side effects.
Effect on growth
With time, the effects of radiotherapy on growing tissues may become more noticeable. This may lead to asymmetry (unevenness) in the muscles or bones in the treated area. If this happens, it may cause the muscles in the neck to develop unevenly, or the face to become asymmetrical. The degree of asymmetry depends on the age of the child at the time of treatment and the dose of radiotherapy given.
Radiotherapy given to the head or neck can sometimes affect the endocrine system. The endocrine system is a network of glands that makes hormones, which circulate around the body in the blood. The pituitary gland in the brain (which produces hormones that control other endocrine glands in the body), and the thyroid gland in the neck, may be affected by radiotherapy. If the pituitary gland is involved, this can affect normal growth and can sometimes lead to fertility problems. The effects of radiotherapy on the thyroid gland can reduce the amount of thyroid hormone in the body (hypothyroidism). The symptoms of hypothyroidism include extreme tiredness, weakness, weight gain, hair loss and muscle cramps.
If your child develops hormonal problems, it is usually possible for them to have hormone replacement therapy to help correct any symptoms. Your child’s doctor or specialist nurse can explain this.
Although these possible long-term effects sound worrying, it’s important to remember that not all of them will necessarily apply to your child.
Watch our radiotherapy video
Dr Vincent Khoo explains how radiotherapy is given and what you can expect.
Your child will have regular check-ups in the children’s (paediatric) or adolescents’ cancer clinic. The doctors will monitor them regularly for signs of any problems or long-term side effects.
As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. Knowing that they need radiotherapy treatment, which may cause side effects, can also be very difficult. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and part of the process that many parents go through at such a difficult time.
We can't address all of the feelings you may have on this page. However, our section on living with cancer talks about the emotional impact of caring for a child with cancer and suggests sources of help and support.
Children’s Cancer and Leukaemia Group (CCLG)
coordinates research and care for children and their parents. There are 21 CCLG specialist centres for the treatment of childhood cancer and leukaemia, covering all areas of the UK and Ireland. A map of the centres
is on the website.
offers practical support, nationally, to children and young people with cancer and leukaemia, and to their families.
This section has been compiled using information from a number of reliable sources, including:
National Institute for Health and Clinical Excellence (NICE). Improving Outcomes with Children and Young People with Cancer – The Manual. August 2005.
Pinkerton, et al. Evidence-based paediatric oncology. 2nd edition. 2007. Blackwell Publishing.
Pizzo P, et al. Principles and Practice of Paediatric Oncology. 6th edition. 2011. Lippincott Williams & Wilkins.
With thanks to Dawn-Marie Davies, Paediatric Specialist Radiographer, and Dr Tina Foord, Consultant Clinical Oncologist.