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Lumbar punctures and intrathecal chemotherapy for your child | CION Cancer Clinics
Intrathecal chemotherapy is medicine given into the fluid around the spine during a lumbar puncture. Nearly every child with ALL has it, because most medicines in the blood cannot reach leukaemia cells hiding around the brain and spinal cord. Most young children sleep through it and go home the same day. This page explains what happens, how your child may feel afterwards, and which signs need urgent care. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is intrathecal chemotherapy, and why does my child need it?
- What happens during a lumbar puncture?
- How might my child feel afterwards?
- What do the words on the report mean?
- What do families fear, and what is true?
- How can you prepare your child, and what can this page not tell you?
- Common questions about lumbar punctures and intrathecal chemotherapy
The short answer
What is intrathecal chemotherapy, and why does my child need it?
Intrathecal chemotherapy is medicine given through a thin needle into the fluid around the spine during a lumbar puncture. Almost every child with acute lymphoblastic leukaemia (ALL) has it, because it protects the brain and spinal cord from leukaemia cells.
Why the spine and not a drip?
The brain and spinal cord sit behind a natural barrier that keeps most medicines in the blood out. Leukaemia cells can hide in the fluid there, called cerebrospinal fluid or CSF. Putting chemotherapy straight into that fluid reaches cells a drip in the arm or a port would miss. This is why it is given even when no leukaemia has been found in the fluid.
Two jobs at once
Each lumbar puncture usually does two things. A few drops of fluid are collected and checked for leukaemia cells. Then the medicine goes in through the same needle. The first sample, taken near diagnosis, helps the team decide how much treatment the brain area needs.
Which medicines are used?
Methotrexate is the most common. Some plans combine it with cytarabine and hydrocortisone, sometimes called triple intrathecal therapy. Children with acute myeloid leukaemia (AML) and some lymphomas may also have it. The medicine, the number of lumbar punctures and their timing all come from your child's treatment protocol.
This page gives no doses. Your child's haematologist sets every part of the plan.On the day
What happens during a lumbar puncture?
Blood counts and fasting
A blood test checks platelets, the cells that help blood clot, so the needle is safe. If your child will be put to sleep, you will be told when to stop food and milk. Follow those timings exactly.
Sleep medicine or numbing
Most young children have sedation or a short general anaesthetic, so they sleep through it. Older children and teenagers may choose numbing cream and a local injection instead. You can usually stay until your child is asleep.
The needle and the medicine
Your child lies curled on one side or sits bent forward. The doctor cleans the lower back, places a fine needle between two bones well below the spinal cord, collects fluid and gives the medicine slowly.
Rest and going home
A small dressing covers the spot. Your child rests and is watched as they wake. Many teams ask children to lie flat for a while. Most go home the same day.
Not sure whether this applies to you?
Ask an oncologistAfterwards
How might my child feel afterwards?
Many children feel fine by the evening. Some have one or more of these for a short time. Tell the nurse what you notice.
Headache
A headache that is worse when sitting or standing and eases when lying down can happen after fluid is taken. It usually settles with rest and drinks.
Tends to help
- Lying flat for a while
- Plenty of fluids, if allowed
- Quiet play at home
Sore back
The needle spot may ache or feel bruised. Ask the team which pain relief is safe with your child's blood counts before giving anything.
Sleepiness and feeling sick
Sedation can leave a child drowsy, clumsy or grumpy for the rest of the day. Some feel sick or vomit once. Offer small sips first, then light food.
Rarer effects of the medicine
Very occasionally the medicine itself irritates the nerves, causing stiffness, confusion, a fit or weakness. These are uncommon, and the team watches for them.
Any of these needs urgent attention. See the box below.
!
Signs that cannot wait
Go to the nearest emergency department or call 108, and tell them your child has leukaemia and had a lumbar puncture, if your child has a fever, a fit, new weakness or numbness in the legs, loss of bladder or bowel control, a stiff neck, confusion, a severe headache that does not ease lying down, or bleeding or clear fluid leaking from the back.
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On the report
What do the words on the report mean?
- LP (lumbar puncture)
- The procedure itself: a needle into the lower back to reach the fluid around the spinal cord.
- Intrathecal (IT)
- Given into that fluid. "IT methotrexate" means methotrexate given during a lumbar puncture.
- CSF (cerebrospinal fluid)
- The clear fluid that bathes the brain and spinal cord. It is the sample sent to the lab.
- CNS status
- CNS means central nervous system, the brain and spinal cord. The label shows whether leukaemia cells were seen in the fluid. It helps set how many lumbar punctures are planned.
- Traumatic tap
- Some blood mixed into the fluid sample during the needle. It is common and can make the result harder to read.
- Cytospin
- The lab method used to look for leukaemia cells in the fluid under a microscope.
Commonly believed
What do families fear, and what is true?
"A needle in the spine can paralyse my child."
The needle goes in below where the spinal cord ends, into a space that holds only fluid and loose nerve roots. Lasting nerve damage from the needle is very rare. The team checks platelets first to lower the chance of bleeding.
"No leukaemia was found in the fluid, so we can skip it."
Intrathecal treatment is given to stop leukaemia coming back in the brain, not only to treat cells already seen. Leaving it out may raise the chance of the leukaemia returning there. Any change to the plan must come from your haematologist.
"Repeated lumbar punctures will damage his brain."
Children have many lumbar punctures over treatment, and most have no lasting problem from them. Some chemotherapy can affect learning or memory in some children, which is why teams follow survivors over time and offer school support if needed.
"Being put to sleep so often is dangerous."
Short sedation for procedures is given by trained staff who watch breathing and heart rate throughout. Repeated sessions are routine in children's cancer care. Tell the team about any past reaction or recent cough or cold.
Being straight with you
How can you prepare your child, and what can this page not tell you?
Honest, simple words work better than surprises. Tell a young child the doctor will help them sleep and put medicine in their back to keep the poorly cells away. Let older children ask questions and choose small things, like which toy comes along or who holds their hand.
Before the day
Keep a note of the fasting time and the treatment calendar. Mention any cough, fever or new medicine when you arrive. Bring a comfort item, something to do while waiting, and a change of clothes in case of vomiting.
Who this approach may not suit on a given day
A lumbar puncture may be delayed if platelets are too low, if your child has an infection near the lower back, or if they are unwell with a fever. This is a safety decision, not a setback, and the team will reschedule.
What this page cannot tell you
It cannot tell you how many lumbar punctures your child will need, which medicines they will receive or what the fluid results mean for your child's outlook. Your child's haematologist knows the protocol and the results. CION's haematology team reviews each child's plan, discusses it at a tumour board and coordinates care with qualified paediatric centres.
Questions parents ask
Common questions about lumbar punctures and intrathecal chemotherapy
Does a lumbar puncture hurt my child?
Most young children are asleep under sedation and do not feel it. Children who stay awake usually feel a sting from the numbing injection, then pressure. The back may ache afterwards. Ask the team which pain relief is safe, and tell them if your child is frightened, because options can change.
How many lumbar punctures will my child have?
It depends on the type of leukaemia, the risk group, whether cells were found in the fluid and the protocol used. They are usually more frequent early in treatment and spaced out later. Ask for a written calendar so you can plan school and travel around them.
Why does my child have to lie flat afterwards?
Lying flat for a while may help the medicine spread through the fluid and may lower the chance of a headache. Teams differ on how long they ask for. Follow your own team's instruction, and use the time for a story, a film or a nap.
Can the lumbar puncture be done if platelets are low?
Sometimes a platelet transfusion is given first, or the procedure is moved to another day. The safe level depends on your child and the team's policy, and reference ranges differ between laboratories. The team decides on the day. Never try to push the date on your own.
Can I stay with my child during the procedure?
Many centres let a parent stay until the child is asleep and come back as they wake. For awake procedures, a parent often sits at the head to hold a hand. Ask beforehand what your centre allows, so you can tell your child what to expect.
What does it mean if leukaemia cells are found in the fluid?
It means the leukaemia has reached the fluid around the brain and spine. Treatment is then usually more intensive in that area, with more intrathecal doses and sometimes other steps. It changes the plan, and your haematologist will explain what it means for your child.
Can my child eat and play normally the next day?
Most children are back to usual food and gentle play by the next day. Keep the dressing clean and dry as your team advises. Avoid rough games and heavy lifting until the back feels normal. If a headache comes back when your child sits up, tell the team.
Can CION arrange intrathecal chemotherapy for my child?
CION's haematology team can review your child's reports and plan, discuss it at a tumour board and help you reach a centre with a paediatric haematology unit. Ask whichever centre treats your child who does the procedure, what sedation is used and who to call afterwards.
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Sources
- National Cancer Institute — Childhood Acute Lymphoblastic Leukemia Treatment (PDQ) - Patient Version
- American Cancer Society — Leukemia in Children
- NHS — Lumbar puncture
- Leukemia & Lymphoma Society — Acute Lymphoblastic Leukemia (ALL)
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.
Keep reading
Related pages
ALL Treatment Phases in ChildrenWhere lumbar punctures fall across treatmentRisk Groups in Childhood ALLHow fluid results feed into the risk groupSteroids and Behaviour Changes in ChildrenAnother common part of treatment families ask aboutLate Effects After Childhood Blood CancerWhat follow-up looks like after treatment endsPaediatric Blood CancersEvery guide for parents of a child with a blood cancer
Talk to us
Have your child's treatment plan and questions about lumbar punctures?
Send us the reports. The CION haematology team will go through the plan with you and help you reach the right paediatric centre. One helpline serves every CION centre.