Radiation to the whole brain is called cranial radiation. Because children who receive cranial radiation need to hold perfectly still during treatment, a mesh mask of the child’s face is made and used to keep the head still the head during treatments.

Making the mask

Great care should be taken to ensure the mask-making procedure doesn’t traumatize your child. It is helpful to use play therapy with young children to demonstrate the procedure beforehand. More time spent on preparation will mean less time spent on fitting the device. Also, if the fitting goes well, it creates trust and good feelings that will help the radiation treatments proceed smoothly.

The mask is made without sedation for well-prepared, calm children or it is done while young or active children are sedated. The following are parent suggestions for preparing a child for making the mask:

• Give the child a tour of the room where the fitting will take place
• Explain each step of the process in age-appropriate language
• Be honest in describing any sensations the child may experience
• For small children, put a mask on a mannequin or stuffed animal to demonstrate the process
• For older children or teenagers, show a video or read a booklet describing the procedure

Masks are made from a lightweight, porous, mesh material that your child can breathe through. First, the technologist should explain and demonstrate the entire mask-making process to your child. Some technologists make a mask of a child’s hand to show how it looks and feels. Then, the child lies down on a table, and the technologist puts a sheet of the mask material in warm water to soften it. This warm mesh sheet is then placed over the child’s face and quickly molded to her features. The child can breathe through the mesh material the entire time but must hold still for several minutes as the mask hardens. At some institutions, the mask is lifted off the child’s face, and the technologist cuts holes in the mask for the eyes, nostrils, and mouth. At others, the mask is left in place while a CT scan is done and holes are not cut into the mask. You and your child should understand your institution’s practices before the mask making starts so you will be prepared.

The cancer center staff had scheduled two hours for mask-making for my 3-year-old daughter. I asked them to explain very quietly every step in the process. I told her 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.

Very young children, or those who have difficulty holding still, are sedated while the mask is being made.

Shawn (2 years old) needed to be sedated for his 10 doses of cranial radiation. They also made his mask while he was anesthetized.

Radiation treatment

To receive cranial radiation, children are given appointments to visit the radiation clinic for a specific number of days, most often at the same time each day. Cranial radiation is usually given five days a week for two weeks (weekends off). If your child will be sedated, the sessions are usually scheduled early in the morning, because he will not be able to eat or drink before coming in for treatments.

When you arrive each day, you’ll check in at the front desk. The technologist or nurse then comes out to take your child into the treatment room. Often, parents accompany young children into the room. If your child requires anesthesia, it may be given in the treatment room or in a nearby anesthesia induction room.

I wanted my 4 year old to be able to receive the radiation without anesthesia. I asked the center staff what I could do to make her comfortable. They said, “Anything, as long as you leave the room during the treatment.” So I explained to my daughter that we had to find ways for her to hold very still for a short time. I said, “It’s such a short time, that if I played your Snow White tape, the treatment would be over before Snow White met the dwarves.” Katy agreed that was a short time, and asked that I bring the tape for her to listen to. She also wanted a sticker (a different one every day) stuck on the machine for her to look at. I brought her pink blanket to wrap her in because the table was hard and the room cold. Each day, she chose a different comfort animal or doll to hold during treatment. So we’d arrive every day with tapes, blanket, stickers, and animals. She felt safe, and all treatments went extremely well.

During the cranial radiation treatment, your child will lie on her back, the mask will be placed over his face, and the mask will be clamped to the table to keep your child’s head perfectly still. Measurements are taken to verify that the child’s body is perfectly positioned. Frequently, the technologist will shine a light on the area to be irradiated to ensure the machine is properly aligned. The technologist and parents leave the room, closing the door behind them.

At some institutions, parents are allowed to stay and watch the television monitor and talk to their child via the speaker system. If this is the case, the parent should be careful not to distract the technologist as he administers the radiation. At other institutions, parents are asked to wait in the waiting room. It’s important that parents understand the department’s policies; they should ask the radiation therapist if anything is unclear.

Matthew had his own calendar outside the radiation treatment room. For every treatment he received, he picked a sticker to place on his calendar. It was a wonderful way to show him how far he had come and how much farther he had to go before he would be finished. Matthew loved rummaging through the sticker box for the perfect addition to his calendar. When the last treatment had been given, he was allowed to remove the calendar from the wall and bring it home as a keepsake. We still have Matthew’s calendar.

The treatment takes only a few minutes and can be stopped at any time if the child has any difficulty. When the treatment is done, the technologist turns off the machine, removes the immobilization device, and parents and child can go home. If your child received anesthesia, he will need to recover from the anesthesia before he can go home. There is no pain at all when receiving radiation treatment, but some children report seeing flashing lights or noticing a burning smell. Both of these are normal experiences, but it is important to let the radiation oncologist know if your child mentions either of them.

There was something about the radiation or the anesthesia that frightened 3-year-old Shawn terribly. He would scream in the car all the way to the hospital. It was a scream as if he was in pain. He had nightmares while he was undergoing radiation and every night after it was over. We decided a month after radiation ended to bring a box of candy to the staff who had been so nice. Shawn asked, “Do I have to go in that room?” When I explained that it was over and he didn’t need to go in the room anymore, he asked if he could go in to look at it once more. He stood for a long time and just looked and looked at the equipment. Somehow he made his peace with it, because he never had any more nightmares.

Because radiation therapy is usually given at short, daily appointments, families that do not live within an hour or so of their treatment center often have to stay near the hospital. Your social worker can help you arrange to stay at a Ronald McDonald House or similar facility, at a hotel, or at a short-stay apartment near the hospital.