Different chemotherapy drugs cause different side effects. Cancer treatments cause different reactions in different children and reactions can vary from treatment to treatment. Almost all side effects are only short-term and will gradually disappear once the treatment has stopped.

The main areas of your body that may be affected by chemotherapy are those where normal cells rapidly divide and grow, such as the lining of your mouth, the digestive system, your skin, hair and bone marrow. Although the side effects of chemotherapy can be unpleasant, they must be weighed against the benefits of the treatment.

The more common side effects are:

1. Hair Loss
Hair loss occurs with most chemotherapy drugs. Hair loss can begin 10 to 21 days after drugs are begun, with total loss in 1 to 2 months. Hair on your head is often lost first, but hair over the entire body can be lost. Regrowth may begin while you are still on chemotherapy, although it will be slow. Full regrowth happens when chemotherapy is finished.

2. Nausea & Vomiting
Nausea and vomiting can range from slight to severe. Your child's doctors will prescribe anti-emetics (to stop the nausea and vomiting) when he/she is on chemotherapy. Your child may be on more than one type of anti-emetics during chemotherapy. If your child vomits too many times, he/she can get dehydrated.

These suggestions may help your child when he/she is nauseated:

• Do not give his/her favourite foods
• Do not eat fatty, fried, very spicy or very sweet foods
• Eat cooked foods that are at room temperature. The smells from hot foods may make your child's nausea worse
• Keep your child's mouth clean; brush at least twice a day
• Do not force your child to eat

3. Infection
Infection is an important problem of cancer treatment. Your child may be at risk for infection due to the cancer itself affecting his/her body's own defences (leukaemia/lymphoma) or from the side effects of treatment (chemo/RT) affecting the production of white blood cells (WBC).

The body has many ways to protect us from infections. Skin, acid in the stomach and coughing are some ways that the body protects itself. WBC destroy germs after they enter the body.

Neutrophils are the special WBCs that fight infection. When the number of neutrophils (ANC) are <1.0 x 109/l, you are said to be 'neutropenic' and very prone to infections. If you are neutropenic for only a few days, the risk of infection is small. If the neutropenia lasts for a week or longer, the risk of infection is very high. Even mild infections can cause life-threatening illness.

Infection cannot be completely prevented. However, there are many things you can do to decrease the risk of infection in your child.

• Avoid large crowds or anyone with signs of infection.
• Avoid contact with people with contagious diseases such as flu, measles or chicken pox
• Keep your child clean by bathing daily and washing hands after using the bathroom.
• Keep your child's mouth very clean by brushing his/her teeth
• Avoid uncooked vegetables. Fruits need to be washed thoroughly and peeled. Avoid grapes as far as possible as they are difficult to wash and peel
• Avoid constipation and straining to have a bowel movement
• Remove fresh flowers and live plants from the rooms as they may harbour fungus

4. Mucositis (Sore Mouth)
Cancer and cancer treatment can sometimes cause mucositis (a sore mouth). This may cause your child to have a reduced oral intake and be dehydrated. There are things you can do to help your child's mouth heal and to make it feel better.

• Examine your child's mouth at least once daily. Look for any ulcers, sores, red areas, or white patches. Report changes and any mouth pain to your doctor or nurse.
• Keep your child's mouth clean and moist. Clean your child's teeth even though it is sore. If it hurts to use a soft brush, use an oral swab.
• Ensure your child rinses his/her mouth frequently with salt water or Sodium Bicarbonate solution (can be obtained from the ward).
• Before meals and as needed for comfort, apply an anaesthetic (a numbing agent), such as 'Lignocaine', to sore areas of your child's mouth. This will numb his/her mouth and make eating easier.
• Eat frequently and in small amounts.

There are other side effects that are specific to the chemotherapy your child is on. This will be explained to you during your treatment.