All infants, most preschoolers, and some school-aged children require sedation or a short-acting anesthesia (most commonly propofol is given intravenously) to ensure they remain perfectly still during radiation therapy. Parents will receive written instructions about pediatric anesthesia, including instructions about when to stop eating and drinking before sedation or anesthesia. Children can eat and drink after treatment, as soon as they are alert enough to swallow.

Joseph (age 5) had a good experience with the anesthesiologists who came to sedate him before each of his daily radiation treatments. They were kind and gentle, and explained each step of what would happen. They kept good records so once we figured out the medications and dosages that would allow him to go down and come back up quickly and cheerfully, they made sure to do that each day. It could have been a scary experience, but they smiled at him, encouraged him, and told him he was a champ. He was always happy to see them even when he felt pretty crummy.

Anesthesia is given via gas or through the child’s catheter or intravenous line (IV). Sometimes the parent can hold or comfort the child while anesthesia is given, but the parent must leave the room during radiation treatment. The entire procedure generally takes from 30 to 90 minutes. Nausea and vomiting are occasional side effects of anesthesia, but they are usually well controlled by anti-nausea drugs such as ondansetron (Zofran®).

Shawn was almost 3 years old when he needed his cranial radiation. He is an extremely active child, and we agreed with the medical team that he would have to be sedated. His appointment was always at 1 p.m., and we were told that he could have apple juice or Jell-O® at 6 a.m. but nothing to eat or drink after that. Every single morning he would drink the juice and then throw up. At the radiation room, I would hold him while he was anesthetized, then wait in the waiting room. They would bring him out to me in 30 to 45 minutes.

During a course of radiation therapy, the dose, drugs, and methods used to sedate or anesthetize the child may need to change because some children develop a tolerance to certain drugs. Good communication between parents and members of the treatment team should prevent unnecessary anxiety about increased dosages or the use of a different drug. In some cases, less anesthesia is needed if the child is gently coached about ways to hold still.

Each time my young son came in for radiation, part of the routine was to place the hard plastic mesh mask over his face while he was awake, just for an instant, to get him used to the idea of trying to wear it for treatments without sedation. No pressure was ever put on him about it; it was just mentioned as a possibility of something he could try, something that would let him keep eating and drinking all through the day instead of having to fast for a few hours before each sedation, which was very hard for such a small boy.

They left the mask on him for a tiny bit longer each time, until he was tolerating it for several seconds, and then close to a minute. His fifth birthday was at the exact middle of treatment, and he decided that since he was such a big boy now, he would try to do it without sedation. I know he was trying to please and impress all these kind people. He worked it out quietly with a favorite technician, asked the “sleepy medicine doctor” to wait outside the treatment room, let them screw the mask down to the table, and did the whole thing awake. I’ve never been more proud in my life. Everyone cheered and hugged him. He finished the rest of the treatments without sedation, sometimes eating and drinking on his way in the door just to show off that he could!