Childhood Cancer

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Childhood Brain and Spinal Cord Tumors

Mouth and throat sores

The mouth, throat, and intestines are lined with cells that divide rapidly and can be severely damaged by chemotherapy drugs. This damage is more common for children on very intensive protocols and for those having stem cell transplants. The sores that result in the mouth, throat, and intestines are extremely painful and can prevent eating and drinking. Check your child’s mouth periodically for sores, and if any are present ask the neuro-oncologist for advice. Following are some suggestions from parents:

  • To prevent infection, the mouth needs to be kept as clean and free of bacteria as possible. After eating, have your child gently brush teeth, gums, and tongue with a soft, clean toothbrush.
  • If your child is old enough, the doctor may recommend a rinse to decrease the amount of bacteria in your child’s mouth, which helps prevent mouth sores.

When David was told to use Peridex®, I asked the doctor if we could substitute 0.63 percent stannous fluoride rinse. He said yes. As a dentist, I knew Peridex® kills bacteria and lasts up to 8 hours, but it tastes terrible and stains teeth. Children do not like using it. The 0.63 percent stannous fluoride has the same bacteria-killing properties and also lasts up to 8 hours, but has a better taste and does not stain as badly. The fluoride also helps prevent cavities and makes the teeth less sensitive. It comes in a variety of flavors like mint, tropical, and cinnamon. It is a prescription drug that a lot of dentists dispense.

Mix 1/8 ounce of concentrate with warm water, making 1 ounce. A measuring cup comes with the bottle. I have David swish with half the mixture for 1 minute. (Time it, because it’s longer than you think!) This can only be used by kids who are old enough not to accidentally swallow it. Six-year-old David has no problem taking this once a day before he goes to bed. If and when he starts developing mouth sores, he will take it morning and evening. It’s important not to eat or drink for 30 minutes after rinsing. That is why David rinses before bedtime, after he has taken his meds and brushed his teeth.

  • Serve bland food, baby food, or meals put through the blender.
  • Use a straw with drinks or blender-processed foods.

Preston got bad mouth sores every time he was on high-dose metho-trexate. He could not swallow, but we were supposed to be forcing fluids to flush the drugs out. The only thing that felt good on his throat was guava nectar. It was very expensive and hard to find, and he would drink several quarts a day through a straw. Unfortunately, my daughter and husband both developed a liking for it, too. At one point, we cornered the market on guava nectar at three grocery stores in our neighborhood.

  • There are several prescription products available to treat mouth sores. One common product is called “magic mouthwash,” which contains an antibiotic, an antihistimine, an antifungal, and an antacid. Some formulations add dexamethasone. More information about this product is available at www.mayoclinic.com/health/magic-mouthwash/AN02024. If your child has painful mouth sores, ask the neuro-oncologist for a prescription. Because large amounts of lidocaine can numb the back of the throat and cause difficulty swallowing, this medication should be used at a dose recommended by the neuro-oncologist.
  • Glutamine, a nutritional supplement available at most drug and health food stores, may help prevent or minimize mouth sores in some children. If your child is receiving chemotherapy with a high probability of causing mouth sores, you may want to try glutamine as a preventive measure. The powder can be mixed in juice and should be started 1 or 2 days before your child receives a cycle of chemotherapy. Be sure to get your neuro-oncologist’s approval before giving glutamine.

Roger just began his second round of chemo. He is on lomustine, procarbazine, and some intravenous chemo. He seemed to be tolerating it fairly well until he started breaking out in terrible sores all through his mouth and under his tongue, very painful to him. He couldn’t even eat. I decided to get him to gargle and swish 100% pure aloe vera juice all through his mouth. He held the aloe vera in his mouth for 5 minutes before swallowing it that night before he went to bed and then 3 or 4 times a day for the next few days until he felt better. Strangely enough, the sores were almost all gone by morning. Roger woke up the next morning and said, “Wow that stuff works fast!”

Low blood cell countsNausea and vomiting

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