# Preventing mouth sores (oral mucositis) in children having cancer treatment or a stem cell transplant

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

## TL;DR

Some chemotherapy and transplants cause painful sores in the mouth and throat. Older children who can manage it suck ice during short infusions of certain drugs, and children having a stem cell transplant or radiotherapy to the head and neck have gentle red-light treatment inside the mouth. Good daily mouth care and a dental check before treatment help too.

## Summary

The Pediatric Oncology Group of Ontario 2021 update (seven systematic reviews, 107 studies, GRADE), endorsed by the Children's Oncology Group, covers patients aged 0 to 18. Cryotherapy: use for older, cooperative children receiving short infusions of melphalan or 5-fluorouracil (strong, high), consider for short infusions of other mucotoxic chemotherapy (conditional, moderate); the panel thought it not feasible for infusions longer than 1 hour or in young children. Intraoral photobiomodulation in the red spectrum (620 to 750 nm): use for children having autologous or allogeneic transplant and for head and neck carcinoma radiotherapy (strong, high), consider for radiotherapy to other head and neck cancers such as rhabdomyosarcoma (conditional, moderate). Do not give palifermin routinely (strong, high), because its benefit was modest (risk ratio for severe mucositis 0.81) against short-term harms, possible long-term effects on cancer outcomes, cost and availability; do not give G-CSF to prevent mucositis (strong, high). The adult MASCC/ISOO 2020 guideline adds multiagent basic oral care protocols during chemotherapy, radiotherapy and transplant (level III), dental assessment before treatment (expert opinion), and differs on palifermin, which it recommends for autologous transplant with high-dose chemotherapy and total body irradiation.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: paediatric oral mucositis prevention; pediatric mucositis prophylaxis; cryotherapy ice chips children; photobiomodulation children transplant; mouth care during chemotherapy children
- Tags: protocol; paediatric; mucositis

## Connected records

- protocols: [Oral care and oral mucositis prevention during cancer treatment](https://onco.cc/protocols/oral-mucositis-prevention-and-oral-care/)
- cancers: [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [Oral cryotherapy (ice chips) to prevent mucositis](https://onco.cc/technologies/oral-cryotherapy-mucositis/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/)
- drugs: [Filgrastim (G-CSF)](https://onco.cc/drugs/filgrastim/), [Palifermin](https://onco.cc/drugs/palifermin/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Mucositis and stomatitis](https://onco.cc/terms/mucositis/)
- ideas: [Ice chips in the chair for every bolus fluorouracil and high-dose melphalan infusion](https://onco.cc/ideas/idea-upgrade-oral-cryotherapy-with-bolus-chemotherapy/)

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