Medical Oncologist
Children
Nausea and vomiting in children on chemotherapy
The same classes of anti-sickness medicine as in adults, at doses worked out from the child's weight, given preventively around each cycle rather than when sickness appears. Paediatric teams are generally more aggressive about controlling it, because children dehydrate faster and cannot describe how they feel. Everything here defers to your own paediatric team.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
How is sickness managed in children on chemotherapy?
With the same classes of anti-sickness medicine used in adults, at doses worked out from the child's weight, and given preventively around each cycle rather than only when sickness appears. Paediatric teams are generally more aggressive about controlling it than adult teams, because children become dehydrated faster.
Everything on this page defers to your own paediatric team. Do not adapt adult advice, do not give a medicine intended for an adult, and do not use anything left over from a previous illness.
Why the threshold for going in is lower
A small child has less reserve. Vomiting that an adult could ride out for a day leads to dehydration in a child within hours, and the signs are harder to read because they cannot describe how they feel. This is why paediatric teams ask to be contacted sooner rather than later.
Ask for the thresholds in writing: how many episodes, how long without fluids, and when to come straight in.
!
Go to hospital the same day
A fever · vomiting where nothing has stayed down for several hours · far fewer wet nappies than usual, or no urine passed · unusually sleepy, floppy or hard to rouse · no tears when crying, or a dry mouth and tongue · vomit containing blood or green-coloured · a swollen or hard stomach · severe stomach pain. Go to the nearest emergency department and say clearly that the child is on chemotherapy. Do not give paracetamol to bring a temperature down before being seen.
Not sure whether this applies to you?
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What helps a child through the sick days
Alongside the medicines, not instead of them. Most of this is about smell, small amounts and distraction.
Give the medicines on schedule
At the times you were given, for the full number of days, including days the child seems well. This is the single most important thing and the one most often let slip once a child perks up.
Ask about
- What to do if a dose is vomited back
- Whether a liquid or dissolving form exists
Keep cooking smells away
The commonest trigger, and often stronger for children than adults. Cook in another room with a window open, and serve food cool rather than steaming.
Small amounts, very often
A few spoons every hour rather than meals. An empty stomach makes sickness worse. Cool, bland and familiar works better than anything tempting or new.
Do not serve a favourite food on treatment day. A single bad association can last years.Fluids above everything
Small sips constantly, ice chips, ice lollies made from safe water, or rehydration solution if the team agrees. Whatever cup, straw or spoon they will accept.
Distraction
A film, a game, a story, someone sitting with them. Sickness is worse when a child is lying still thinking about it, and paediatric units have play specialists who do this professionally.
Keep a simple record
How many times sick, what stayed down, wet nappies or trips to the toilet, temperature. One line a day. It is what the team will ask for and what allows the plan to be tuned.
The part parents miss
Sickness that starts before you reach the hospital
Children are, if anything, more prone than adults to developing a learned sickness response. After a bad cycle or two, a child can begin vomiting in the car, at the sight of the building, or on the morning of treatment. This is a genuine physical reaction rather than fear or reluctance.
Why it matters
It is the one pattern of chemotherapy sickness that reliably gets worse with each cycle if nothing is done, and it responds far better when caught early. Parents often do not report it because it looks like the child simply does not want to go.
What is done about it
Getting the sickness after treatment properly controlled comes first, so the association stops being reinforced. Beyond that, paediatric teams use medicines given before coming in, play specialists, distraction techniques, and sometimes psychology support. They deal with this regularly.
How it shows in a child
Refusing to get in the car, crying at the sight of the building, complaining of a stomach ache on treatment mornings, or being sick in the waiting room before anything has been given. Parents often read these as behaviour rather than as a symptom, which is why it goes unreported for several cycles.
What helps at home
Keep favourite foods away from treatment days. Bring something absorbing for the journey and the wait. Keep the routine on treatment day as predictable as possible. And tell the team the moment it starts rather than after several cycles.
Do not give a child a sedative or anti-anxiety medicine from any other source. Ask the paediatric team.Being straight with you
What this page cannot tell you
It cannot tell you which medicines your child should have, at what dose, or how often. Paediatric doses are calculated from weight and sometimes body surface area, and they change as a child grows through a long course. Nothing here should be used to start, stop or change anything.
It also cannot give you the thresholds for your child. How many episodes, how long without fluids, and when to come in depend on age, weight and treatment, and they are tighter for a small child than for an adult. Ask your paediatric team for their numbers and keep them on the fridge.
What to do next
Ask for the anti-sickness plan and the escalation thresholds in writing before the next cycle. Set alarms for every dose. Keep the daily record. Keep favourite foods off treatment days. And if sickness is starting before you arrive at the hospital, say so now rather than later.
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Questions we are asked
Common questions about sickness in children
He vomited the tablet straight back. Do we give another?
Ask your paediatric team for their instruction and write it down, because the answer differs between medicines and doses. Do not simply repeat it. If nothing is staying down, contact them — anti-sickness medicine can be given by injection or into a drip instead.
Can we give the same medicine we use for travel sickness?
Not without asking. Medicines from home can interact with chemotherapy, mask a fever, or be the wrong dose for a child whose weight has changed. The paediatric team will prescribe what is appropriate, and there is almost always a suitable option.
How do we tell if she is getting dehydrated?
Watch wet nappies or trips to the toilet, whether there are tears when crying, whether the mouth and tongue look dry, and how alert she is. Unusual sleepiness or floppiness is a late and urgent sign. Children dehydrate faster than adults, so act sooner.
He is refusing all food. How long can that go on?
Focus on fluids and contact the team rather than setting your own limit, because in children the margin is smaller. Not drinking is the urgent problem. There is usually a treatable obstacle — a sore mouth, an infection, or sickness that is not properly controlled.
Does sickness get worse with each cycle in children?
Often it improves as the plan is tuned, as with adults. The exception is sickness that starts before arriving at hospital, which does build if untreated. Reporting how each cycle went is what allows the anti-sickness plan to be strengthened.
She only wants sweets and packaged snacks. Is that alright?
During the difficult days, food eaten beats food that is ideal, so allow it within reason and add something with protein alongside. The exception is food safety during the low-count days — no street food, nothing left standing, nothing pre-cut. Ask the team what they restrict.
Should we tell him it might make him sick?
Ask the play specialist or nurse how to pitch it for his age. Children generally cope better with honest, simple preparation than with surprises, but the wording matters and over-explaining can create anticipation. The team does this constantly.
Can he go back to school between cycles?
That depends on blood counts and on what is going around at school, and it is a question for the paediatric team rather than a general rule. Many children return during the good days between cycles. Ask specifically about the low-count window, when infection risk is highest.
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Sources
- National Cancer Institute — Nausea and Vomiting Related to Cancer Treatment (PDQ)
- Cancer Research UK — Children's cancer treatment side effects
- Macmillan Cancer Support — Feeling sick and being sick
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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