Hematologist
CION Cancer Clinics
Steroids and your child's behaviour during leukaemia treatment | CION Cancer Clinics
Yes, steroids commonly change a child's behaviour during leukaemia treatment. Anger, tears, constant hunger and poor sleep are expected with prednisolone and dexamethasone, and usually ease after each course ends. They are a main medicine against the leukaemia, so never skip or stop a dose on your own. This page explains what you may see, what helps at home, and which changes need a same-day call. 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
The short answer
Why is my child so different on steroids?
Steroid medicines used in leukaemia treatment act on the brain as well as on the leukaemia cells. Mood swings, anger, tears, huge hunger and poor sleep are common, expected and usually settle once the steroid course ends.
Which medicines are we talking about?
The two steroids most children with acute lymphoblastic leukaemia (ALL) receive are prednisolone and dexamethasone. They are a real part of the treatment, not a side medicine. They kill leukaemia cells directly, which is why they are given in the first month of treatment and then in short bursts, often called pulses, through the later phases.
Why the behaviour changes happen
Steroids copy a stress hormone the body makes on its own. In large amounts they raise appetite, disturb the sleep clock and make feelings stronger and faster. A child who was calm may become irritable. A child who was cheerful may cry over small things. None of this means your child has become a different person, or that your parenting has changed.
Who sees it most
Not every child reacts the same way. Some barely change. Toddlers and teenagers often find it hardest, and dexamethasone tends to affect mood more than prednisolone in many children. Your team chooses the medicine for the leukaemia, not for the behaviour.
Never stop, skip or reduce a steroid dose because of behaviour. Talk to the treating team first. They set the plan.What parents notice
What changes might you see at home?
Most families see some of these, rarely all of them. They tend to build up during a course and fade in the days after it ends.
Mood and temper
Sudden anger, shouting, hitting out, crying without a clear reason, or clinging to one parent. Small refusals can turn into long tantrums.
Often worse
- In the evening
- When hungry or tired
- After a hospital visit
Hunger and food cravings
Many children want to eat all the time, including at night. Cravings for salty or spicy food are common. Refusing food can trigger real distress, not simple naughtiness.
Sleep
Trouble falling asleep, waking at night, or being wide awake early in the morning. Poor sleep then makes the mood changes worse the next day.
Body changes
A rounder face, weight gain around the tummy, and sometimes aching legs. Children who notice this may feel shy or upset about how they look.
These body changes slowly settle after steroids finish.Not sure whether this applies to you?
Ask an oncologistOver a course
How does the pattern usually go?
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The first days of a course
Appetite often rises first. Some children seem more energetic or restless. Sleep may start to slip. This is a good time to set simple routines before the harder days arrive.
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The middle and end of a course
Mood changes are usually strongest here. Tempers can be short and tears quick. Keep days predictable, lower expectations for school work, and plan quiet time.
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The days after the last dose
Many children feel flat, tired or low for a short time as the body adjusts. Some have aching legs or tummy discomfort. Tell your team if your child seems unusually weak or unwell.
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Between courses
Most children return close to their usual selves. Appetite calms and sleep improves. If behaviour stays very different long after a course, mention it at the next visit.
!
When a change is not just the steroids
Call your treating team the same day, or go to the nearest emergency department or call 108, if your child has a fever, is confused or very drowsy, sees or hears things that are not there, talks about harming themselves, has severe tummy pain or vomiting, or is very thirsty and passing urine far more than usual. Do not give any extra medicine at home before speaking to the team.
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At home
What tends to help, and what tends to backfire?
Tends to help
Tends to backfire
Healthy snacks ready in small portions: fruit, roasted chana, curd, idli
Arguing over every request for food
Fixed bedtime, lights low, screens off early
Late nights because the child is awake anyway
Naming it calmly: "this is the medicine talking"
Harsh punishment for anger the child cannot control
Keeping gentle, clear rules about hitting and safety
Dropping every rule until treatment ends
Taking turns between adults for the hardest hours
One parent carrying every difficult evening alone
Commonly believed
What do families worry about, and what is true?
"The steroids have changed my child forever."
For most children the behaviour changes are temporary and linked to the days they take the medicine. Your child's usual nature usually returns between courses and after treatment ends. If it does not, the team can look for other causes and arrange support.
"We should skip a few doses to calm her down."
Steroids are one of the main medicines fighting the leukaemia. Missing doses may weaken treatment. Stopping suddenly can also be unsafe. Any change must come from the treating team, who may have ideas that help without touching the plan.
"Giving him all the food he asks for will make him fat for life."
The weight gain during steroid courses usually comes down afterwards. The aim is not to starve a hungry child. Offer filling, simple food in small amounts, and ask to see a dietitian if weight is rising fast.
"If we are strict enough, the tantrums will stop."
Steroid anger is driven by the medicine, so punishment rarely works and often adds fear. Calm, steady limits work better. Keep safety rules, and give comfort once the storm has passed.
Being straight with you
What about school, siblings and you?
Tell the school, in simple words, that a medicine may make your child irritable, hungry or tired for a few days at a time. Ask for extra snacks, a quiet place to rest and patience with outbursts. Many families keep children home during the hardest days of a course.
Brothers and sisters
Siblings may be hit, shouted at or left out, and may feel it is unfair that rules have changed. Explain that the medicine causes the anger. Give them some time of their own with a parent, even a short walk.
Looking after yourself
Living with steroid behaviour is exhausting, and feeling angry or sad yourself is normal. Share the load with family where you can, and tell the team if you are struggling. Counselling support is part of care.
What this page cannot tell you
This page cannot tell you which steroid your child will get, for how long, or how your child will react. It cannot judge whether a particular change is the medicine or something else. Your child's haematologist and nurses know the plan and can examine your child, so bring your questions and a note of what you have seen.
Questions parents ask
Common questions about steroids and behaviour in children
How long do steroid mood changes last?
They usually last while the course is being taken and ease over the days after it ends. Some children feel low or tired for a short while as the body adjusts. If your child still seems very different long after a course, tell the team so they can check for other causes.
Can the doctor change the steroid if the behaviour is very bad?
Sometimes the team can adjust timing or give extra support, but the steroid is chosen to treat the leukaemia. Only the treating haematologist can decide whether any change is safe. Describe exactly what is happening at home, with examples, so they can weigh it properly.
What time of day should the steroid be given?
Follow the written instructions from your team. Many teams suggest giving steroids earlier in the day and with food, as late doses can make sleep worse. Do not change the timing on your own; ask at the next visit whether a different time would suit your child.
My child wants to eat all night. What should I do?
Keep simple, filling snacks ready and offer them in small portions. Brush teeth after late snacks. Avoid long fights over food. If your child has diabetes, or is very thirsty and passing a lot of urine, tell the team, because steroids can raise blood sugar.
Is it normal for my child to hit me or say hurtful things?
It is common, and it is very hard. Your child is not choosing to hurt you. Keep everyone safe, stay calm and set short, clear limits. Offer comfort afterwards. If aggression puts anyone at risk, or your child talks about harming themselves, contact the team the same day.
Will steroids affect my child's schoolwork?
Concentration, sleep and mood can all dip during a course, so schoolwork often slips for a few days. It usually picks up again between courses. Ask teachers for flexibility on tests and homework, and share the treatment calendar so they know which weeks may be harder.
Can my child go out and play during a steroid course?
Gentle activity usually helps mood and sleep. Whether crowds, parks or school are safe depends on blood counts and infection risk at that time, which the team will guide you on. Steroids can also make legs ache, so shorter, calmer play may suit better.
Who can help us cope at CION?
The CION haematology team, nurses and counsellors can talk through what you are seeing and suggest practical steps. They cannot promise the behaviour will stop quickly, but support often makes the hardest days easier. Bring your child's treatment plan and a short diary of changes to the visit.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Childhood Acute Lymphoblastic Leukemia Treatment (PDQ) - Patient Version
- American Cancer Society — Leukemia in Children
- NHS — Steroids
- 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 the steroid courses fall across treatmentThe Long Maintenance Phase: Two Years at HomeLiving with steroid pulses during maintenanceSchool During Childhood Leukaemia TreatmentWorking with teachers through the harder weeksSiblings During a Child's Leukaemia TreatmentHelping brothers and sisters copePaediatric Blood CancersEvery guide for parents of a child with a blood cancer
Talk to us
Finding the steroid weeks hard at home?
Tell us what your child is going through. The CION haematology team will talk it through with you and help you plan for the next course. One helpline serves every CION centre.