Side-effects of radiotherapy for children

It is very likely that your child will feel tired during their treatment and, as the weeks of radiotherapy go on, this tiredness could increase.

This may be because their body is using its resources to repair any damage to healthy cells caused by the radiotherapy or because of all the journeys to and from the hospital.

Unfortunately, the feeling of tiredness does not stop immediately once the treatment stops and could continue for a number of weeks.

Encourage your child to rest or nap when they need to and try to plan rest breaks into their days even if they are not feeling tired. A gentle walk from time to time can also be helpful.

Children who have received radiotherapy targeted at a large area of their brain can get something called ‘somnolence syndrome’.

This is a form of extreme tiredness and can occur several weeks after finishing radiotherapy, just as you think your child is getting over the treatment. Your child may sleep a lot for 1–2 weeks, but they will recover.

During, or a few weeks after, radiotherapy, some children develop changes to their skin in the area being treated i.e. on their scalp.

These can be a bit like sun burn (redness, blotchy and itching) in children with pale skin, and darkening of the skin in those who have darker skin.

As your child’s skin will be more sensitive after radiotherapy, you should take care to protect them from strong winds and the sun and always ensure they wear a sunhat with neck protection when they are outside.

Usually, the sensitivity will fade in the month or so after treatment.

This is because radiotherapy increases the risk of developing skin cancer. Your child’s health team will be able to give you further guidance if your child develops skin sensitivity.

Your child should continue to use a high-factor sunscreen on areas of skin that have received radiotherapy in the long-term.

As a result of fatigue, feeling sick or actually vomiting after radiotherapy, your child may temporarily lose their appetite. 

If this happens, meal supplement drinks may be a good alternative, but always speak to your child’s health team first, as some drinks could affect their treatment. They may also have other tips for helping your child to eat.

‘Cognitive skills’ include thinking, memory, learning, concentration, decision-making and planning. They also include ‘processing skills’ – recognising and making sense of information from your senses, particularly sight and hearing.

If your child has had radiotherapy to a large area of their brain, they should have a neurological assessment to identify specific learning or processing difficulties.

These types of difficulties can vary greatly from child to child. They can depend, to some extent, on how old your child was when they were treated and the intensity of their treatment.

Cognitive difficulties are often subtle and can take longer to diagnose and support.

Emotional difficulties can be wide-ranging. Your child may:

• show heightened emotions
• have difficulty controlling anger
• be impulsive
• take excessive risks without fully understanding the danger.

Emotional difficulties can arise from anxiety, for example if your child is worrying that the tumour may return. They can also arise from anger (at having had to go through treatment when other children they know have not).

They can also arise due to physical changes to the area of the brain which controls emotions and inhibitions.

If you’re worried that your child is showing concerning behaviour, you may wish to find psychological support. This could also be done as a preventative measure involving all family members. This could help your family cope with such emotions, if and when they arise.

If your child has radiotherapy directed at the pituitary gland at the base of the brain, it is possible that they may grow more slowly or start growing later than their friends. This is because the pituitary gland controls the hormones that are linked to growth and development and radiotherapy to the gland can mean that not enough of the growth hormone is made. However, an artificial version of the growth hormone can be given to your child to counteract this effect as your child gets older.

Puberty may also be disrupted by the effect of radiotherapy on the pituitary gland and the hormones it controls. As a result, your child may start puberty earlier or later than usual. Girls, in particular, who have had radiotherapy to the head, are more likely to begin puberty earlier. Medicines can be given to halt puberty if your child starts earlier than usual, or to bring on puberty if it has been delayed.

Growth can also be affected if radiotherapy is given to the spine. This is because radiotherapy can affect growing bones, such as the vertebrae in the spine. To prevent curvature of the spine, such as a hunch or stoop, any vertebra needing radiotherapy will receive radiation to the whole vertebra to stop it growing unevenly.