How chemotherapy is given to children — IV, intrathecal & oral

Intrathecal chemotherapy means the medicine is injected directly into the cerebrospinal fluid — the clear fluid that surrounds the brain and spinal cord. It is done during a lumbar puncture (spinal tap), where a fine needle is placed between the vertebrae in the lower back. Most medicines given into the bloodstream cannot cross the blood-brain barrier in meaningful amounts, which means cancer cells sheltering in the central nervous system would otherwise be beyond reach. Intrathecal chemo delivers medicine directly into that protected space. It is used most commonly in children with certain types of leukaemia and some lymphomas where there is a risk of cancer spreading to, or already present in, the central nervous system. The procedure is done under sedation or general anaesthesia in children so that it is comfortable and still.

Intravenous (IV) chemotherapy is given through a drip directly into your child's bloodstream. Because children often need many blood tests and IV medicines over months of treatment, the team usually places a semi-permanent access device — a central line, a PICC line (peripherally inserted central catheter), or a subcutaneous port — early in the treatment journey. These devices spare your child repeated needle insertions for every cycle. On chemotherapy days, the medicine is prepared by a specialist pharmacy and infused slowly, usually over 30 minutes to several hours depending on the drug. A nurse stays close throughout to monitor for any reactions. The dose is calculated specifically for your child's size and age, and is checked before every session.

Yes — some chemotherapy medicines are given by mouth (orally) as tablets, capsules, or liquid formulations. Oral chemo for kids is used in certain maintenance phases of treatment, particularly for childhood leukaemia. It can be taken at home, which means fewer visits to the hospital. However, oral chemotherapy is still a powerful medicine that must be handled and given exactly as prescribed. The team will teach you when to give it, how to handle tablets safely (some should not be crushed or split), what to do if your child vomits a dose, and what side effects to watch for. Regular blood tests are still needed to monitor your child's response even during home-based oral treatment.

Most children who need several months of chemotherapy are given a central venous access device — either an external central line (tunnelled under the skin on the chest) or an implanted port (a small disc placed under the skin that is accessed with a special needle only when needed). The procedure to place either device is done under general anaesthesia and takes about 30 to 60 minutes. Once in place, the device allows the team to give chemotherapy, draw blood, and administer other medicines without repeated needle punctures in arms or hands. Ports are often preferred because there is nothing visible on the skin between uses, which means swimming and bathing are easier. The team at CION will discuss which device is best suited to your child's treatment plan and lifestyle.

IV chemotherapy itself is usually not painful to receive — through a central line or port, there is no needle inserted for each session. Intrathecal chemotherapy is done under sedation or a short general anaesthetic so that children are fully asleep and feel nothing during the procedure. Some chemotherapy medicines cause a burning or stinging sensation if they leak out of a vein during infusion without a central line, which is one reason access devices are used. The side effects that come on in the days following a cycle — nausea, mouth sores, fatigue — can be uncomfortable, but the team actively manages these with anti-nausea medicines, mouth care, and supportive care. Please tell the nurse or doctor about anything your child says is painful so it can be addressed promptly.

The length of a chemotherapy session depends entirely on which medicines are being given and the protocol your child is following. Some infusions take 30 to 60 minutes. Others — particularly for solid tumours — may run for several hours and require the child to be admitted to hospital overnight. Intrathecal chemotherapy sessions (including anaesthesia, the procedure, and a short recovery period) usually take a few hours from arrival to discharge. The team will tell you exactly what to expect for your child's specific cycle before each appointment. Bringing a favourite book, toy, or tablet loaded with games or videos can help children pass the time comfortably in the day-care chair.