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Less nausea in children with cancer

Nausea is described by children with cancer as one of the most unpleasant side effects of treatment. 40 % of the children suffer from nausea. Nursing research indicate that signaling and counseling for children who feel nauseous is important. In addition, medication and nutrition tips can help.
Rosanne Been, a pediatric oncology nurse and clinical epidemiologist, is doing research on nausea in children at the Máxima Center. Using data collected over the past five years in the KLIK-system (monitoring Quality of Life), she studies how often nausea occurs in children with cancer, what the risk factors are and what the impact of nausea is on their quality of life. She says: ‘Three months after the diagnosis, about 40% of the children suffer from nausea. Fortunately, this percentage decreases somewhat during the first year of treatment. Certain types of chemotherapy have the side effect of making children feel nauseous to a greater or lesser extent. In addition, some children suffer from nausea because of the type of cancer; this is the case, for example, with certain brain tumors.’


During chemotherapy, children receive medication that suppresses nausea. Rosanne: 'Older children can tell if they are feeling nauseous. With young children it is sometimes harder to say. Parents often learn the signs of nausea in their child during the disease process and can then quickly raise the alarm. Doctors ensure that anti-nausea medication is prescribed, which is appropriate for the child's situation.'

Nutrition tips

In addition to drug treatment, there are other ways to reduce nausea, Rosanne says. 'Some children with cancer are given tube feedings that they don't tolerate well if they feel nauseous. A dietitian can help them think about other tube feedings or give more tips on eating and drinking to reduce nausea. For example, an ice lolly can sometimes help. Children are also advised to eat and drink small amounts at regular intervals, because an empty stomach can make nausea worse. Read more tips (in Dutch) from the Máxima Center against nausea here.

Worry and treatment anxiety

Nausea also occurs in about 20% of the children when they think about medical treatments. 'Worry about the disease, treatment anxiety and pain can be risk factors for nausea. Nurses and medical pedagogical care providers get to know the children well during the treatment process and can often talk to them about the anxiety and fear they experience. In doing so, they help the children reduce their fear of medical procedures. This in turn can help to reduce nausea. With our team, we try to make sure that the nausea decreases as soon as possible,' said Rosanne Been.

Measuring nausea

At the Máxima Center, various (nursing) research is carried out to measure the degree of nausea. Els Haverkate, one of the pediatric nurses/nurse researchers, says: 'Managing nausea is a challenge. Many children suffer from it, don't feel well and we want to prevent this as much as possible. In order to better recognize nausea and thus treat it, there are two measurement tools, the Pediatric Nausea Assessment Tool (PeNAT) and the Baxter Retching Faces (BARF) scale. I asked 34 children aged 4 - 18 years about their experience with the measurement tools using a questionnaire. It turns out that the children like both instruments to indicate how nauseous they feel. Of course, we have to take into account different age groups in communication. The BARF instrument works with faces (smileys) and that works well to determine the degree of nausea. We are now doing follow-up research in a larger group of children. Ultimately we hope to use a measuring instrument for nausea at the Máxima Center, just like the one for pain. This will enable us to recognize nausea even better and treat it. Because this makes the care for children with cancer much better.'