Managing Mucositis

What is mucositis?

Mucositis is the swelling, irritation, and ulceration of the mucosal cells that line the digestive tract. Mucositis can occur anywhere along the digestive tract from the mouth to the anus. It can be a very troublesome and painful side effect of chemotherapy. Anticipating mucositis may help to manage some of the symptoms.

What causes mucositis?

The cells that line the digestive tract are rapidly producing. In other words, the life span of these cells is very short compared to other cells in the body. Chemotherapy agents do not differentiate between healthy cells and cancer cells. Because the digestive tract cells reproduce rapidly, the chemotherapy agents can destroy them quickly, breaking down the protective lining, leaving them prone to inflammation, irritation, and swelling. Mucositis can be even further complicated by nausea and vomiting that often occurs with treatment.

What are the symptoms of mucositis?

The following are the most common symptoms of mucositis. However, each child may experience symptoms differently. Symptoms may include:

• redness and swelling of the gums, with symptoms possibly progressing to ulcerations in the mouth and throat
• diarrhea
• abdominal cramping and tenderness
• rectal ulcerations or redness

The symptoms of mucositis may resemble other medical conditions. Always consult your child's physician for a diagnosis.

What can be done to manage the symptoms of mucositis?

Mucositis may occur a week or longer after completion of therapy. Unfortunately, symptoms may not be preventable. There are things, however, you can do for your child to manage the pain including the following:

For oral mucositis:

• Keep your child's mouth moist by encouraging him/her to drink plenty of fluids.
• Inspect your child's mouth daily with a flashlight to see if any ulcerations have developed or worsened.
• Oral hygiene should be done as often as four times a day: after each meal and before bedtime.
• Teeth should be brushed gently with a soft toothbrush.
• Mouthwashes that contain alcohol should be avoided. Your child's physician may prescribe a special mouthwash for your child.
• Avoid food with extreme temperatures, both hot and cold.
• Older children should not drink alcohol or smoke tobacco products.
• If the sores become very painful, your child's physician may be able to prescribe a numbing solution for the mouth or other analgesics (pain relievers).

For diarrhea or rectal irritation:

• If your child has severe diarrhea, maintain adequate fluid intake to prevent dehydration.
• Keep the rectal area clean and dry.
• Change diapers frequently.
• Clean your child's skin with a mild soap.
• Your child's physician may recommend several barrier ointments or creams.

For nausea and vomiting:
Complications from nausea and vomiting have decreased during the last decade due to the development of several medications that greatly reduce these unpleasant side effects of chemotherapy. The following may help reduce or prevent nausea and vomiting associated with chemotherapy:

• Avoid spicy or greasy foods when nauseated.
• Your child may prefer a dark, quiet, cool environment when nauseated.
• Medications, called antiemetics, may be prescribed to offset the nausea.
• If your child has severe nausea and vomiting, maintain adequate fluid intake to prevent dehydration.

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