Gastrointestinal issues in children and teens

Many cancer treatments can cause nausea, vomiting, diarrhea, and constipation. The severity of these side effects varies among children and the type of treatment they receive. Sometimes these side effects improve as they adjust to treatment and most side effects go away after treatment ends.

Nausea and vomiting

Nausea, also called feeling “queasy” or “sick to your stomach,” is that unpleasant feeling you have when you are going to throw up. Vomiting is throwing up what is inside your stomach through the mouth. Nausea and vomiting can happen together, or one can occur without the other. The severity of nausea and vomiting varies among children. Sometimes these side effects improve as they adjust to treatment and most side effects go away after treatment ends.

Talk to your child's healthcare team about any side effects they experience. Their healthcare team may be able to prescribe medication to help with nausea. Give medications as prescribed. Do not give your child over-the-counter medications or supplements without speaking to healthcare team first. 

 The following tips may help prevent or control nausea and vomiting:

• Eat 5-6 small meals throughout the day
• Eat dry, bland foods, such as crackers or toast
• Avoid foods that may trigger nausea such as fried foods, spicy foods or foods with strong smells
• Try products that contain the spice ginger. Some people find that ginger helps relieve nausea.
• Drink small amounts of fluids throughout the day, especially between meals. Try water, giner ale and sports drinks to stay hydrated.
• Stay sitting up after eating for 30 minutes
• Wear comfortable, loose-fitting clothing
• Keep odors to a minimum
• Ask your child's healthcare team about complementary therapies that may help, such as acupuncture or meditation. 

Note: Anyone who cleans up vomit should wear disposable gloves to protect from exposure to cancer drugs. 

Severe side effects

Call your healthcare team immediately if your child is experiencing any of the following:

• Fever of 100.4°F or higher
• Nausea and/or vomiting accompanied by abdominal pain or a severe headache
• Vomiting blood (which may look like coffee grounds)
• Inability to keep down medication. If your child vomits soon after taking a medication, call their doctor or pharmacist for instructions.
• Vomiting for more than two days
• Signs or symptoms of dehydration (dark urine, small amounts of urine, excessive thirst, dry mouth, rapid pulse, headaches, dizziness and confusion)

Diarrhea and constipation

Diarrhea and constipation are common side effects of cancer treatment. The severity of diarrhea or constipation varies among patients and depends on the type of treatment they receive. Sometimes side effects improve as they adjust to treatment. Most side effects go away when treatment ends.

Tell your child's healthcare team if they are experiencing new or worsening diarrhea or constipation. Do not give over-the-counter medications without talking to their doctor.

Follow these tips to manage diarrhea:

• Drink clear liquids to stay hydrated
• Avoid acidic drinks, such as orange juice
• Eat foods that are easier to digest, such as white toast, crackers, pretzels, soft fruits and vegetables without seeds or skins, and broth-based soups
• Include foods with soluble fiber, such as white rice, oatmeal, skinless potatoes, applesauce and bananas
• Avoid foods that can make diarrhea worse, such as spicy foods, high-fiber foods, high-fat foods, and raw fruits and vegetables
• Avoid milk and milk products if these seem to make diarrhea worse
• Avoid drinks and foods with sugar alcohols (xylitol, sorbitol, etc.), such as products labeled "sugar free"
• Take care of the skin around the anus by gently washing and drying the area after bowel movements. On clean, dry skin, apply a water-repellent ointment. 

Follow these tips to manage constipation:

• Gradually increase fiber intake with whole fruits, vegetables, beans, legumes, and whole grains
• Drink plenty of liquids
• Try drinking warm liquids in the morning or prune juice
• Exercise and play; ask your child's healthcare team for an exercise program
• Ask their healthcare team if they may need a fiber supplement, stool softener, or laxative. Do not give your child medications or supplements without first talking to their healthcare team.

Severe side effects 

Call a doctor right away if your child has any of the following symptoms:

• Loose bowel movements for more than two days
• Blood in the stool
• Moderate to severe abdominal pain or cramping
• Fever of 100.4°F or higher
• Inability to control bowel movements
• Symptoms of dehydration (dark urine, infrequent urination, dizziness, dry mouth or dry skin, or irregular heartbeat/pulse)

Tracking side effects 

Certain foods, medications or activities may trigger or make your nausea and vomiting worse. Tracking your daily health
and habits in a journal or app on your phone may help you and your doctor discover what triggers your nausea and vomiting.