Childhood Cancer

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Childhood Brain and Spinal Cord Tumors

Immobilization devices

Different institutions use a variety of devices to immobilize children or teens to ensure that the radiation beam is directed with precision. Custom fitting the devices on a child who has already undergone numerous procedures requires skill and patience. This is especially true for children being fitted for a mask in preparation for radiation to the head or spine. Great care should be taken to ensure that making the mask is not traumatic. This can often be accomplished by using play therapy to demonstrate the procedure.

Masks are made from a lightweight, porous, mesh material. First, the technologist should explain and demonstrate the entire mask-making process to the child. The child then lies down on a table. The technologist places a sheet of the mask material in warm water to soften it. This warm mesh sheet is placed over the child’s face and quickly molded to his features. The child can breathe the entire time through the mesh material, but must hold still for several minutes as the mask hardens. The mask is lifted off the child’s face, and the technologist cuts holes in it for the eyes, nostrils, and mouth.

The cancer center staff had scheduled 2 hours to make a mask for my 3-year-old daughter. I asked them to very quietly explain every step in the process. I told her that I would be holding her hand, and I promised that it would not hurt, but it would feel warm. I asked her to choose a story for me to recite as they molded the warm material to her face to make the time go faster. She picked “Curious George Goes to the Hospital.” She held perfectly still; I recited the story; the staff were gentle and quick; and the entire procedure took less than 20 minutes.

For children having radiation to the spine, immobilization devices can be as simple as Velcro straps to hold the body in place. Some children will have special foam or plaster molds made to allow greater accuracy when directing the radiation.

My 4-year-old son needed 6 weeks of radiation scheduled to begin just weeks after his stem cell transplant. His immune system was still so low, although he was starting to recover from the month-long ordeal. The technicians thought he would lay face down quietly in a tub of warm plaster so that they could make his mold. I don’t think so! He was scared, and kicked and screamed, so we went home. We came back the next day, they sedated him with propofol, and then it took just a few minutes to make the mold and prepare him for radiation.

Immobilization devices can be fitted on well-prepared, calm children or sedated children. The following are parent suggestions for preparing a child for the fitting of an immobilization device:

  • Give the child a tour of the room where the fitting will take place.
  • Explain each step of the process in clear language.
  • Be honest in describing any discomfort the child may experience.
  • For small children, fit the device onto a mannequin or stuffed animal to demonstrate the process.
  • For older children or teenagers, show a video or read a booklet describing the procedure.

Seventeen-month-old Rachel was fitted with two immobilization devices. They made a mask to hold her head in position, as well as a body mold from her neck to her thighs.

Spending ample time on preparation generally means less time will be needed to fit a device. If the fitting goes well, it establishes trust and good feelings that will help make the actual radiation treatments proceed smoothly.

Radiation therapistSedation

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