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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
Find out how we produce our information|
This information is about the use of radiotherapy to treat children with head and neck| cancers. We have separate information for children having radiotherapy to their 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 the Macmillan/CCLG booklet A parent's guide to children's cancer|, which contains more information about cancers in children, their diagnosis and treatment, and the support services available.
Watch the 'One of a Kind' video|
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 the cancer cells in one area of the body while doing as little harm as possible to normal cells. The treatment 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 10–15 minutes. Your child’s doctor will discuss the treatment and possible side effects with you. The length of time that the treatment is given for will depend on the type of tumour your child has, but may last for 2–6 weeks.
In order for radiotherapy to be as effective as possible, it must be carefully planned.
Before planning starts, your child will be assessed to make sure they are able to cope with treatment and the way it is given. The assessment will either be made when your child first meets the doctor who plans the radiotherapy (clinical oncologist), or on their first visit to the radiotherapy department. For treatment, 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.
A hospital play specialist, paediatric specialist radiographer, nursery nurse or specialist nurse may spend some time with your child to help them prepare for radiotherapy. Through fun and play, they will help explain the treatment to your child. This can help reduce any fear or worries they may have. Many parents are surprised at how cooperative their child can be during their treatment, once they are given plenty of time to prepare with the hospital play specialist.
If your child can’t lie still for long enough or would find it difficult to be in the treatment room alone, they can still have radiotherapy but will need to have a daily general anaesthetic. Most children under the age of three will need an anaesthetic; most children aged four or over will not.
If at all possible, the radiotherapy will be given without an anaesthetic. For this reason, several visits to the radiotherapy department may be needed for preparation with the hospital play specialist, or nursery nurse, before radiotherapy planning begins. You may be given games and exercises to play with your child at home to help them overcome any fear or anxieties they may have and to familiarise them with what radiotherapy involves|.
Treatment planning may take a few visits. On your child’s first visit to the radiotherapy department, they may have a CT scan or lie under a machine called a simulator. The CT scanner, or simulator, takes x-rays of the area to be treated. Treatment is planned by a cancer specialist (clinical oncologist). Marks may be drawn on your child’s skin to help the people giving the treatment (radiographers) make sure that 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.
A plastic mould of your child's head may be made to help them keep still during treatment. If this is necessary, the doctor or specialist nurse will explain this process to you.
The radiotherapy staff| are very experienced in treating children, and can offer you help and support.
At the beginning of each radiotherapy session, the radiographer will position your child carefully on the couch and make sure they are comfortable. Your child will be alone in the room during treatment, but they will be able to talk to the radiographer, who will be watching from the next room, over a communication system. You can stay with the radiographer, 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.
Radiotherapy is not painful, but your child has to lie completely still for a few minutes while the treatment is being given. If your child is having their treatment under a general anaesthetic, they can't eat or drink for at least four hours before being given their anaesthetic. Because of this, they 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. You can stay with your child until they are asleep.
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.
The immediate side effects of radiotherapy are usually very mild:
Your child may feel very tired| while they are having the treatment and for a few weeks afterwards. Their energy levels may take a few months to get back to normal once treatment has ended.
Your child may lose their appetite|. It may be useful for them to have frequent small snacks throughout the day, rather than large meals.
Radiotherapy to the head and neck often involves treating quite small areas, and only the treated area will be affected by local side-effects; your child will not be affected by all the side effects listed below. For example, your child will only get a sore mouth if they are having radiotherapy to the tissues in and around their mouth.
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 strength of their reaction depends on their skin type and the area being treated. Some children have no skin problems at all. The radiographers will look for these reactions, but let them know if your child feels any soreness.
It's important not to use soaps or talc on the treated area of skin. Hospital staff may suggest that you gently apply unperfumed moisturisers, such as E45 cream or aqueous cream. Always check before applying anything to your child’s skin.
These restrictions apply only to the affected area; the rest of your child’s skin can be treated normally. Their skin may peel after the redness has faded, but it should heal quickly. Skin reactions usually settle 2−4 weeks after the radiotherapy has finished, but the treated area may remain slightly darker than the surrounding skin.
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 wide-brimmed hat when out in the sun. Even after this time, the skin will be delicate, so extra care should be taken. Your child should use a sunscreen of at least factor 30. It's also important to remember that their skin can burn, even through clothing, if they are in intense sunlight for a long time.
It's fine for your child to swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. But if they're swimming outdoors, they should not stay in the water too long and should use a waterproof sunblock.
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. These 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.
If eating and drinking become too painful, a thin tube may be passed through your child’s nose and down into their stomach (a nasogastric or NG tube). Special liquid foods can be given through the NG tube. Another way of giving liquid foods is through a central line, which is inserted into a vein in your child’s chest, or by passing a tube (a PEG tube) through the wall of your child’s abdomen and into the stomach. This will be done while they are under general anaesthetic. Staff will explain in detail 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, but 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. It usually begins to fall out after 2−3 weeks. Often, the hair starts to grow back within 2−3 months of treatment ending. Sometimes it grows back a slightly different colour and texture, and possibly not quite as thick as before.
Losing hair can be very distressing for children|, but there are many ways of dealing with it. There are wigs|, hats, and head-coverings for children.
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. However, these symptoms are to be expected, and are known as ‘somnolence syndrome’. They gradually get better over about 2–3 weeks.
Radiotherapy given to the head or neck can sometimes affect the endocrine system. This is a network of glands that make hormones that 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 development 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). Symptoms of hypothyroidism include fatigue, weakness, weight gain, hair loss and muscle cramps.
If your child develops hormonal problems, it will usually be possible for them to have hormone replacement therapy (HRT) to help correct any symptoms. Your child’s doctor or specialist nurse can explain this.
Radiotherapy can cause some other long-term side effects|. These can start gradually, months or sometimes years after treatment. With time, the effect of radiotherapy to any growing tissues may become more noticeable. In particular, radiotherapy can sometimes affect growth and development, and may cause the muscles in the neck to develop unevenly or the face to become asymmetrical.
This sounds very worrying, but support is available from specialist staff who can help you and your family cope with any long-term side effects that occur. It's important to remember that not all children will develop long-term side effects.
Your child will have regular check-ups in the children’s (paediatric) or adolescent 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 that 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 here all of the feelings you may have. However, the booklet A parent's guide to children's cancer talks about the emotional impact of caring for a child with cancer| and suggests sources of help and support.
Our booklet Peppermint Ward| is a storybook for younger children with cancer. It looks at the issues that they and their family may face, and helps them explore their feelings.
You may also find our booklet Relationships, sex and fertility: for young people affected by cancer| useful.
This information has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.