Side effects of chemotherapy in children

There are three types of cells in the blood – red blood cells, white blood cells and platelets. Each has different functions. Chemotherapy can temporarily lower the number of all of these blood cells.
If their number gets very low, red blood cells or platelets can be replaced through a transfusion. But, it is not possible to give transfusions of white blood cells.

White blood cells play a vital role in fighting infection, which means that your child may become more susceptible to infections.

It is therefore important that your child has good personal hygiene whilst undergoing chemotherapy. This includes keeping clean and washing their hands after using the toilet.

Doctors will monitor your child’s health and will give them antibiotics to help fight infection if necessary. It is important that you inform your child’s doctor if your child has a high temperature or suddenly feels unwell.

Childhood illnesses, such as chickenpox or measles, can be particularly dangerous when your child has lowered immunity. They should not have contact with anyone who has these conditions. And, if they have been in recent contact with someone who has developed either chickenpox or measles, you should inform their medical team.

If your child is immune to these illnesses through previous contact/ having had the illness, they are unlikely to develop infection with conventional doses of chemotherapy. However, you should still tell your child’s medical team so they can assess the risk.

If your child is currently having chemotherapy, or has finished chemotherapy in the last six months, they should not have the following vaccines. This is because their immune system will be lowered, and they may not be able to fight the bacteria or viruses:

• Measles
• Mumps
• Rubella (German measles)
• MMR (measles, mumps and rubella)
• BCG (protecting against tuberculosis)
• Yellow fever
• Oral typhoid.

It is generally safe for your child to have ‘inactivated’ vaccines, which do not contain living bacteria or viral microbes. However, children on chemotherapy are often not given these as they are likely to be less effective while their immune system is lowered. You should always check with your child’s consultant before they have a vaccination.

The exception to this is the injectable flu vaccine – it is important for children on chemotherapy to be given a flu vaccine. Everyone else in your household should also have the vaccine, as your child is at extra risk from flu. The nasal spray flu vaccine is not suitable as it uses weakened flu viruses rather than inactivated ones.

Anaemia is a relatively common side-effect for children who are having chemotherapy. Symptoms of anaemia include extreme tiredness and shortness of breath.

This is because chemotherapy can temporarily lower the number of red blood cells, which carry oxygen around the body (in a substance called haemoglobin).

Your child’s haemoglobin (Hb) levels will be monitored by blood tests, so that action can be taken if they fall too low.

Iron levels may also be monitored by blood tests. This is because iron is needed to produce the haemoglobin that carries the oxygen around the body.

Children are not generally iron deficient when on chemotherapy. However, giving your child foods that are rich in iron may help to ensure that your child’s haemoglobin levels do not drop too low by maintaining their iron levels. This may include red meat, leafy vegetables, such as broccoli and watercress, nuts, dried fruit and beans.

Of those children who experience anaemia, some will have Hb levels that fall too low. These may need to have a blood transfusion to increase their number of red blood cells.

Your child’s doctor will advise you as to the best way to help your child if they become anaemic.

Not all chemotherapy causes hair loss. It depends on which drug, or combination of drugs, that your child has.

Some drugs result in no hair loss at all, or only a very small amount. Some cause only hair thinning, rather than loss. But, other drugs can cause more substantial hair loss.

Any hair loss will usually start within a few weeks of treatment beginning.

Once treatment has finished, hair should begin to grow back over the next few months. It may be different to how it was previously. For example, it may be curly when it was straight before.

Your child may be receiving radiotherapy as well as chemotherapy. If this is the case, they may have more permanent hair loss, as this can be caused by the radiotherapy.

Any hair loss will lead to an increased risk of sunburns and even heat strokes. So, make sure that your child’s head is covered during sun exposure.

As hair loss can be very visible, it can be upsetting for both the child and their friends and family. You may find it helpful to arrange a wig before your child loses any hair.

If your child is under 16 years old, or is under 19 years and in full time education, they are entitled to a free synthetic wig on the NHS. Speak to your child’s health team for more information.
For support on how to talk to your child about their possible hair loss, you can access the lovely resource from the Children’s Cancer and Leukaemia Group, called Anna loses her hair

Your child’s skin may become more sensitive with chemotherapy drugs, for example, to the sun and to chlorine, or they may develop rashes or changes in skin colour.

With any skin effects, it is important to ensure that your child is protected from the sun and to follow any advice given by your child’s health team.

Sometimes, chemotherapy side-effects can include causes changes to taste and appetite in children. It can also cause diarrhoea or constipation. If your child has a sore mouth (oral mucositis), they may not feel like eating.

Find out more about helping your child to eat.