Growth, Puberty and School — During Childhood Cancer Treatment

Many children do show catch-up growth once chemotherapy and steroids stop. Whether this happens fully depends on the type of treatment, the child's age at diagnosis, and whether the pituitary gland was affected by radiation. Your team can track this with regular height measurements and, if needed, a bone age X-ray — which shows how much growing potential remains. If catch-up growth does not happen on its own, growth hormone treatment is sometimes recommended following assessment by a paediatric endocrinologist.

Both are possible, depending on the treatment. Radiation near the brain can disrupt the hormones that trigger puberty — sometimes causing it to start earlier than expected, and sometimes delaying it. Chemotherapy alone is less likely to affect puberty timing, but this varies with the specific drugs used. If you notice signs of puberty that seem out of step with your child's age — breast development, pubic hair, or a growth spurt that arrives too early or too late — tell the team at your next visit rather than waiting.

Some treatments — particularly certain chemotherapy drugs and radiation to the pelvis or lower spine — carry a risk of affecting fertility in later life. The risk depends on which drugs are used and at what doses. Before treatment starts, your oncologist should discuss this with you. For older children and adolescents, fertility preservation options may be available, and this conversation should happen before treatment begins, not after. If it has not been raised, ask directly at your next appointment.

Growth monitoring during treatment usually means height and weight recorded at every visit. If radiation was given near the brain or spine, your team will arrange hormone blood tests at intervals throughout treatment and after it ends. Bone age X-rays may be done periodically to assess remaining growth potential. If a problem is found, a referral to a paediatric endocrinologist will be arranged. It is reasonable to ask at each visit whether these checks are on schedule.

Growth hormone deficiency means the pituitary gland is not producing enough of the hormone that drives height gain. In children treated for cancer, it is most common after cranial radiation and can appear years after treatment ends — often when the child fails to accelerate in height the way puberty would normally cause. If blood tests confirm the deficiency, growth hormone injections are sometimes prescribed, given daily at home. These are regulated by CDSCO in India and are prescribed by a paediatric endocrinologist following assessment.

There is no single answer — it depends on the cancer type, the treatment plan, and how your child responds. Periods of low immunity, typically in the days after each chemotherapy cycle, usually mean staying home to reduce infection risk. During recovery weeks, many children can attend for at least part of the day. Longer admissions — such as those needed for bone marrow transplant — require extended absence. A social worker or patient navigator at the treatment centre can help you plan your child's education around the treatment calendar.

Some children do end up shorter than their predicted height, particularly those who received high-dose radiation to the spine during critical growing years. This is more likely in children treated at a very young age, when more growth remains ahead. It is not reversible in the way a temporary slowdown from steroids is. If this is a possibility for your child's treatment plan, ask your oncologist to discuss it directly. Understanding the risk early means you can plan for the monitoring that will catch problems as soon as they appear.

A long-term follow-up programme is a structured plan for monitoring children after cancer treatment ends. It tracks growth, hormone levels, heart health, learning, and other late effects that can emerge months or years later. Guidelines from the Children's Oncology Group and ESMO recommend this kind of follow-up for all children treated for cancer. At CION, the treating team will discuss what ongoing monitoring your child needs at the end of active treatment. Ask specifically which specialist reviews are recommended, how often your child should be seen, and who coordinates the follow-up.