What is chemotherapy-related mouth mucositis in children?

Chemotherapy is the use of strong medicines to treat cancer. These 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 ulcers or sores. 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, weight loss, and other problems.

What causes chemotherapy-related mouth mucositis in a child?

Chemotherapy kills cells that grow fast, like cancer cells. Mucous membrane cells also grow fast, so some types of chemotherapy may harm them. Most children getting chemo have some degree of mucositis.

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 chemotherapy treatment are factors. A child may also be at higher risk for mouth mucositis because of: 

• Poor dental and mouth care

• Loss of body fluid (dehydration)

• Being underweight

• Poor diet

• Other long-term (chronic) health problems

• Smoking, using chewing tobacco, or drinking alcohol

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

Mouth mucositis may start 3 to 10 days after starting chemotherapy. It tends to be worst at about 7 to 14 days and may last for weeks. Symptoms can be different in each child but may include:

• Red, shiny, swollen mouth, tongue, or gums

• Bleeding in the mouth

• Sores or soft white patches in the mouth, on the tongue, or on the gums

• Pain in the mouth or throat (may be worse when swallowing or eating)

• Trouble eating, talking, or swallowing

• Thick saliva or mucus

• Mouth dryness

• Imprints of the teeth on the tongue (called scalloping)

• A covering or coating all over the mouth

Be sure to tell your child's oncologist about any symptoms of mouth mucositis.

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

The healthcare provider will ask about your child's mouth symptoms, such as when they started and how they're affecting your child. Your child’s mouth, gums, and tongue will be examined. The healthcare provider may note how severe the problem is with a grading system. For instance, the mucositis may be graded from 0 to 4. No mucositis is a 0. Not being able to swallow or eat and drink is a 4. This can help guide treatment and track whether the symptoms get better or worse over time.

If needed, your child may be tested for other conditions. Some mouth conditions can cause many of the same symptoms. These include thrush (oral candidiasis) or viral infections.

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

Mouth mucositis can be treated in many ways. Some treatments are simple and can 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 the mouth.

• If your child is old enough, try ice chips, hard candy, throat drops (lozenges), or chewing gum.

• Do not give your child spicy, hot, acidic, or rough foods that may cause pain.

• 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 or sponge. Use a mild toothpaste with fluoride.

• Use lip balm to keep your child’s lips moist.

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

• Cleaning sores with salt water or peroxide solutions

• Using over-the-counter or prescription products that can help keep the mucosa from feeling dry

• Using pain relievers that are applied to the mouth or taken by mouth (oral)

• Having your child stay in the hospital for a while if your child has an infection or can’t eat or drink

If your child has severe pain, they may need medicine or fluids through an IV.

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

Possible complications of mouth mucositis include:

• Loss of fluid (dehydration) 

• Weight loss

• Inability to eat, drink, or take medicines

• 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 may help limit mucositis. Talk with your child's oncologist about these medicines. You can also help lessen the chance and the severity of mucositis by making sure your child:

• Gets a dental checkup before starting treatment

• Has dental problems fixed before starting chemotherapy

• Gets excellent mouth care every day, including brushing with a soft toothbrush and mild toothpaste at least twice a day and after eating

• Drinks extra liquids

• Has healthy protein in their 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. Report changes to your child's healthcare team.

• Make sure your child takes good care of their 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 about 30 minutes before your child eats. This can make it easier for your child to chew and swallow. 

When should I call my child’s healthcare provider?

Call your child's healthcare provider if any of the following occur:

• 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°F (38°C) or higher, or as directed by your child's healthcare provider

• White patches anywhere in the mouth

• Trouble eating, drinking, or taking medicines because of mouth sores

Be sure you know what problems you need to tell your child's oncologist about right away. Also be sure you know what number to call if you have questions or concerns after office hours or on holidays or weekends.

Key points about chemotherapy-related mouth mucositis in children

• Mouth mucositis is inflammation of the lining of the mouth (mucous membranes). 

• Chemotherapy often causes mucositis in children. 

• 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 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.