Digestive System
Side Effects

Mouth Sores:

The cells that line the inside of the mouth reproduce rapidly to repair the damage done by the teeth, rough food, and other normal wear and tear.  Chemotherapy can temporarily prevent the repair, and the mouth lining can break down.  Mouth sores are the result.  These sores can also develop in the throat.  Let your treatment team know if your child develops red or white areas or open sores inside the mouth.  Even with good mouth care some children will develop mouth sores.  If your child develops them, there are a few tips that may help him or her to be more comfortable:

Good mouth care is essential to help prevent mouth sores.

• Teeth should be brushed with a soft brush after each meal.  Infants’ and toddlers’ teeth should be cleaned with a soft cloth wrapped around your finger.
• DO NOT buy commercial mouthwashes that have alcohol because that will sting and burn the mouth.
• Your doctor may prescribe medications such as Peridex or Nystatin to assist with oral care.
• If mouth sores or bleeding prevents brushing, the mouth should be rinsed before and after every meal.  Your doctor may order a mouthwash, or you can use a mix of ¼ teaspoon salt, ¼ teaspoon baking soda, and 1 cup of water.
• If mouth sores become painful, the doctor may order medicine to numb the sore areas.  This medicine is most effective when swished around in the mouth right before a meal, because the numbing effect wears off quickly.  However, if your child gargles with this medicine to ease throat pain, he or she would wait at least 30 minutes before eating or drinking, because it can numb the gag reflex at the back of the throat and cause chocking.
• Your child needs to be able to eat and drink.  It is particularly important that your child be able to drink fluids.  If your child refuses to drink fluids or is unable to swallow saliva, please contact your treatment team.
• Feed your child soft, non-spicy foods (mashed potatoes and gravy, ice cream, popsicles, pudding, milkshakes, Jell-O, custards, and scrambled eggs).  Cut foods into tiny pieces or puree them in the blender if needed.
• Stay away from foods with sharp or rough edges (chips, toast, or tacos).
• Acidic foods (tomatoes, orange juice, or pickles) will irritate the tender area.
• A straw is helpful for directing fluids away from the mouth sores
• Food served cold or at room temperature feels better to a sore mouth than do warm foods.

 

Diarrhea:

Some chemotherapy can cause diarrhea.  If your child has a problem with this, your doctor will need to know about the color, size, and number of diarrhea stools per day.

Here are some ideas for easing bowel irritation:

• Keep your child quiet after meals with quiet play or a nap.  This will decrease bowel action.
• Feed your child small amounts of food frequently, instead of large meals all at once.
• Stay away from spicy-hot foods, or fatty foods, and milk products when your child has diarrhea.
• Stay away from high in fiber, such as fresh fruits and vegetables, and uncooked broccoli, corn, and cauliflower.
• Feed your child a soft, bland diet that is high in potassium.  Foods high in potassium that do no cause diarrhea are bananas, potatoes, and apricot or peach nectar.
• For the first 6 to 12 hours after diarrhea has started, it may be helpful to feed your child only clear liquids, such as tea, caffeine-free soft drinks, or Gatorade.  Then slowly begin bland, low-fiber solid food such as mashed potatoes, baked potatoes, bananas, rice, applesauce, and toast.

Call the treatment team if your child becomes tired or loses interest, has more than 4 diarrhea stools in 24 hours, goes more than 8 hours without urinating, or if the diarrhea does not improve within 24 hours.

 

Constipation:

Constipation can be caused by drinking less fluid, eating less fiber, decrease in exercise, or getting chemotherapy such as Vincristine.

These changes can correct the problem:

• Give your child a warm drink, such as hot coca or hot apple juice, around the time of day that he or she usually has a bowel movement.
• Increase the amount of fiber in your child’s diet by feeding fresh fruits and vegetables, dries fruits, whole grain cereals and breads, and oatmeal cookies.  Add bran to casseroles, cookies, and bread before baking.
• Encourage your child to drink more fluids, especially fruit juices.
• Encourage your child to get more exercise through play.

If none of these changes help, let your doctor know.  Sometimes a stool softener will be ordered to prevent constipation,  DO NOT give your child a laxative unless the doctor orders it.  Never give your child enemas or suppositories.  Always consult your child’s doctor.

 

Nausea and Vomiting:

Nausea and vomiting are caused by irritation of the stomach lining or by direct stimulation of the nausea and vomiting centers of the brain.  These centers are separate from each other, so your child may feel nauseous without vomiting, or may vomit without feeling nauseated.  This is why your child may continue to eat even though he or she cannot keep anything down.

Commonly, medicine-induced nausea and vomiting begins within 1 to 2 hours after taking a medicine and can last minutes or hours.  Episodes of server nausea and vomiting lasting longer than 12 hours should be reported to your doctor.  Some chemotherapy medicines do not cause nausea or vomiting, others are only mildly annoying, and some can cause intense nausea and vomiting.  Reactions are different for each patient, and your child may not act in the same way as another child receiving the same medicine.

Sometimes older children and adolescents develop what is called anticipatory nausea and vomiting.  The child becomes nauseated and may even vomit at the thought of chemotherapy.  The child may begin to get sick the night before chemotherapy or whenever you get close to the hospital.  Remember, your child cannot control this reaction and needs your support and understanding.  If your child develops this type of anticipatory nausea, discuss it with the treatment team, because they may be able to help.

There are a number of medicines used to treat nausea and vomiting caused by chemotherapy.  Your child’s doctor will work with you to discover which medicine or medicines are the most effective for your child.  Zofran is one drug that is most frequently used to prevent nausea and vomiting.  Zofran can be given by mouth or through the IV.  Zofran does not make you sleepy and has very few side effects.  The most common side effect is a headache.

Most of your child’s problems with nausea and vomiting will occur in the hospital or clinic, but if there continues to be a problem at home, here are some ideas to increase comfort:

• Serve meals in a well-ventilated room that is as free as possible from cooking and other smells.  Feed your child small, frequent meals.
• Stay away from fried foods, spicy or very rich foods, and foods with strong odors.
• Rinse your child’s mouth well after each episode of vomiting because stomach acid left in contact with the teeth and mucous membranes will cause tooth decay and irritate an already tender mouth.
• Feed only sips of cool, clear liquids such as Jell-O, or grape, apple, and cranberry juice, until tolerated, then move forward to full liquids, such as sherbet, vanilla ice cream, or vanilla pudding, and then slowly add solid foods.

If your child has received a chemotherapy treatment that is likely to cause prolonged vomiting, your child’s doctor may order anti-nausea medicine around the clock for at lease 12hours after your child receives chemotherapy.  Always contact your child treatment team with any concerns.

 

*Information provided by Florida Hospital Cancer Institute

Last update Nov. 1, 2008