# Preventing chemotherapy sickness (nausea and vomiting) in children

Source: https://onco.cc/protocols/paediatric-chemotherapy-nausea-vomiting-prevention/  
OnCo record `paediatric-chemotherapy-nausea-vomiting-prevention` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

How likely a child's chemotherapy is to cause sickness decides which anti-sickness medicines they get, given before the chemotherapy, not after the child is sick. The strongest chemotherapy gets three medicines together. If a child is still sick, the team steps up the medicines straight away and for the next cycle, because sickness that is not controlled makes the next cycle worse.

## Summary

Children's Oncology Group endorses four POGO guidelines (GRADE) and the ASCO 2020 antiemetics update. First classify the acute emetogenicity of the chemotherapy using the POGO 2019 paediatric classification (high, moderate, low, minimal; for example cisplatin 12 mg/m2 per dose or more is highly emetogenic). Acute prophylaxis: highly emetogenic, a 5-HT3 antagonist plus dexamethasone plus aprepitant or fosaprepitant (strong, high), with palonosetron-based alternatives where dexamethasone or the NK1 antagonist cannot be given, and olanzapine to be considered (conditional, moderate); moderately emetogenic, a 5-HT3 antagonist plus dexamethasone (strong, moderate); low, a 5-HT3 antagonist (strong, low); minimal, no routine prophylaxis (strong, very low). Delayed phase after highly emetogenic chemotherapy: oral aprepitant if started acutely (strong, high), dexamethasone after ondansetron or granisetron (strong, moderate), continue olanzapine, and no 5-HT3 antagonists (strong, low). Breakthrough nausea: escalate to the prophylaxis for the next emetogenic level (strong, low) or, on highly emetogenic regimens, consider switching to palonosetron and adding dexamethasone, an NK1 antagonist or olanzapine; next cycle, use what worked. Anticipatory nausea: control acute and delayed nausea from the start (strong, moderate); consider hypnosis, systematic desensitisation or relaxation and lorazepam; not ginger routinely; never clonidine.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: paediatric CINV; pediatric chemotherapy-induced nausea and vomiting; antiemetics in children; POGO CINV guidelines; breakthrough nausea children; anticipatory nausea children
- Tags: protocol; paediatric; nausea-and-vomiting

## Connected records

- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Antiemetics for chemotherapy-induced nausea and vomiting](https://onco.cc/technologies/antiemetic-therapy/)
- drugs: [Aprepitant (and fosaprepitant)](https://onco.cc/drugs/aprepitant/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Granisetron](https://onco.cc/drugs/granisetron/), [Ondansetron](https://onco.cc/drugs/ondansetron/), [Palonosetron](https://onco.cc/drugs/palonosetron/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- ideas: [Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary](https://onco.cc/ideas/idea-moon-olanzapine-antiemetic-everywhere/)

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