Pediatric Radiation Therapy: What Parents and Patients Need to Know

Part 1 of a MedReport series on pediatric radiation therapy, covering what it is, how it  works, and what families can expect, by Robyn Warnell, BSN, RN. 

Introduction 

A cancer diagnosis is difficult for any family to process. When radiation therapy is part of  the treatment plan, it can result in a wave of questions and concerns. What exactly is  radiation therapy? Will it hurt? What should families expect? These are reasonable and  important questions. Understanding radiation therapy can help patients and families  navigate this treatment more confidently. 

Radiation therapy is a commonly used cancer treatment in both children and adults. It  plays a central role in the care plans of many children diagnosed with cancer (2).  Doctors use radiation therapy as a primary treatment or in combination with  chemotherapy, immunotherapy, or surgery (2, 3). Treatments depend on the clinical  team’s choices for each patient.

How Radiation Therapy Works 

Radiation therapy uses energy beams to damage the DNA inside cancer cells. These  high-energy beams are similar to X-rays. Once radiation damages a cancer cell’s DNA  beyond repair, the cell loses its ability to divide and eventually dies. Healthy cells might  also be affected by the treatment. Normal cells can repair radiation damage over time.  Cancer cells cannot (2, 3). 

Radiation therapy involves carefully planned daily doses, called fractions, over several  weeks. This takes advantage of the difference in the cells’ healing abilities. Typical  pediatric radiation courses are four to five days per week for four to seven weeks (4).  This gives healthy cells recovery time between sessions while the dose builds up and  takes its toll on cancer cells. Cellular damage from radiation does not stop the moment  treatment ends. Cancer cells continue to die off for weeks to months after the final  session (2, 3). 

It’s important to know that the treatment itself is painless. Children do not feel the  energy beams during a session. There is no heat, no tingling, and no sensation of any  kind during radiation delivery (4). 

Why Doctors Recommend Radiation for Children 

Radiation therapy is a proven treatment for various childhood cancers. Radiation treats  cancers such as Hodgkin lymphoma, Wilms’ tumor, neuroblastoma, soft tissue  sarcoma, and tumors of the brain and spinal cord in pediatric patients (2). Many factors  determine whether radiation is recommended and how it fits into the overall treatment  plan. These include the type of cancer, where it is in the body, how far it has  progressed, and the child’s age and general health status (3). 

The team that makes treatment decisions may include a pediatric oncologist, radiation  oncologist, surgeon, and other specialists. In some cases, radiation is the primary  treatment. Doctors use radiation therapy to make a tumor smaller before surgery,  eliminate residual cancer cells, or treat metastases (3). 

One common misconception is that a cancer that needs radiation must be very serious.  In fact, radiation is part of treatment plans for many childhood cancers with high cure  rates. Including radiation in a treatment plan is a clinical decision about what is most  effective for that specific cancer. It does not necessarily indicate severity (2).

Figure 1. An Elekta Versa HD linear accelerator (LINAC) in a radiation therapy treatment room at Gold  Coast University Hospital, Australia. The treatment table is positioned in front of the machine’s rotating  gantry. Note the calming ceiling display, a feature many pediatric centers use to help reduce patient  anxiety (5). 

Types of Radiation Therapy Used in Children 

Radiation is not a single, one-size-fits-all treatment. Doctors use a range of clinical  considerations to select the approach for each child. The three main forms used in  pediatric oncology are as follows. 

External Beam Radiation Therapy (EBRT). EBRT is the most often prescribed form of  radiation therapy for children. A machine called a linear accelerator generates high energy beams. These beams target the cancer from multiple directions, which enables  accurate delivery of radiation to the tumor. The machine rotates around the patient and  produces sounds that can seem strange as it works. But it never directly contacts the  body. Types of EBRT include 3D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), and  stereotactic radiosurgery (SRS) (2). 

Proton Therapy. Proton beam therapy is an emerging type of radiation treatment. It  focuses radiation directly on the tumor while delivering less radiation to the surrounding  tissue. Proton therapy may be preferable for younger children, for tumors near sensitive  organs or structures, and for situations requiring a higher total radiation dose. Not all  treatment centers have the equipment required for proton therapy. Insurance coverage  is not always guaranteed (6). 

Brachytherapy (Internal Radiation). In some cases, the most effective approach is to  deliver radiation from inside the body. During brachytherapy, a surgeon places a small  radioactive seed or pellet directly at the cancer site. The patient may swallow a capsule  containing the material. This method is used less commonly in children. Brachytherapy  

may be appropriate for certain cancers, such as retinoblastoma or some types of  sarcomas. This treatment typically requires a hospital stay. There are guidelines for  contact with others while the radiation source remains active (7). 

Before Treatment Begins 

Radiation therapy begins with planning and preparation. The first step is a consultation  with a radiation oncologist. The oncologist reviews the child’s medical history. They will  discuss treatment goals, risks, and benefits. The radiation oncologist will also review  potential radiation side effects. 

Next comes the planning session, also called a simulation. The radiation therapy team  maps the treatment area in precise detail. They will also determine the body position the  child must maintain during each session. For tumors of the head and neck, a custom  mesh mask is fitted to the child’s face and head to prevent any movement during  treatment. A molded cradle or cushioned support is used for tumors elsewhere in the 

body. Consistency in positioning across sessions is crucial for accurate radiation  delivery (4). 

The simulation session typically takes longer than a treatment session. Younger  children or those who have difficulty staying still may require sedation or anesthesia.  Anesthesia is both safe and effective for maintaining the precise immobility required by radiation treatment (9). Families should plan for the simulation to take longer than a  regular appointment. It’s a good idea to bring comfort items, such as a familiar blanket,  stuffed animal, or headphones, to help reduce anxiety during preparation (4). 

Figure 2. A thermoplastic mesh immobilization mask made for a child undergoing radiotherapy, decorated  with Batman imagery. Custom decorations like this are a child-friendly adaptation that care teams use to  reduce anxiety and help children feel more at ease during treatment (8). 

What a Typical Treatment Session Looks Like 

Daily radiation appointments are generally straightforward once the routine treatments  begin. The radiation therapist positions the child on the treatment table using the mask 

or mold made during simulation. Once the child is in the correct position, all staff leave  the treatment room before the machine activates. The team monitors the child via video  and maintains voice contact via a two-way speaker system throughout the session (4). 

The actual radiation delivery typically takes less than 10 minutes. The total appointment,  including check-in, positioning, and treatment, may take 30 to 45 minutes. If sedation is  needed, the appointment will take longer (9). Children who do not require sedation can  often listen to music or audiobooks or watch a show during treatment. After the session,  most children can return to their normal activities (4). 

Many families are surprised to find that the daily routine becomes familiar very quickly.  Children often develop a rapport with their radiation therapists and nurses, who see  them nearly every day throughout the treatment course. 

Common Myths About Pediatric Radiation Therapy 

My child will be radioactive after treatment. This is not accurate for the most  common form of radiation therapy. Children receiving EBRT are not radioactive after  their sessions. As long as they feel well, they can be around siblings, classmates, and  others without restriction. Children receiving brachytherapy will have specific guidelines  while the radiation source is active (4). 

The child will feel the radiation working. Radiation is invisible and imperceptible  during delivery. Children feel nothing during treatment. Side effects develop gradually  over time due to cumulative exposure, not during the sessions themselves (4). 

Radiation always causes other cancers. There is a small, long-term risk of secondary  cancer associated with radiation therapy. The oncology team carefully weighs this risk  against the benefits of treatment. Treatment plans will minimize exposure to healthy  tissue while using the lowest effective dose (10). 

Side Effects 

Radiation therapy side effects in children develop gradually and differ based on the  body area treated. Nearly all children will experience some degree of fatigue. Localized  skin changes, such as redness, dryness, or peeling, may also occur in the treatment  area. Side effects typically begin around weeks two to three of treatment (11). Additional  side effects, such as nausea, hair loss in the treatment area, or changes in appetite, are  more specific to certain treatment locations (11). 

Side effects often peak one to two weeks after the final treatment session rather than  during the treatment course itself. The care team monitors children closely throughout  treatment and at follow-up appointments. They can recommend supportive care  strategies to help manage symptoms (11).

Long-Term Monitoring 

Long-term monitoring is an important part of care for children who have received  radiation therapy. Late effects may include changes in growth, hormonal function, or  cognitive development. The radiation dose, age at treatment, and treatment area will  influence the occurrence of late effects. These effects can appear months to years after  treatment ends (12). Pediatric oncology teams use the Children’s Oncology Group  survivorship guidelines as a framework for screening and detecting these changes early  (13). 

Looking Ahead 

This article provides a foundation for understanding pediatric radiation therapy. The next  article in this series examines what children experience during and after treatment. It  discusses the physical and emotional side effects families should be aware of.  Subsequent articles will cover the week-by-week treatment timeline and practical  strategies for supporting a child and family throughout the radiation journey. 

References 

1. National Cancer Institute. A young girl, possibly a childhood leukemia patient, talking  with her doctor [photograph]. Unsplash; 2021 Sep 9 [cited 2026 Apr 12]. Available from:  https://unsplash.com/photos/man-in-white-dress-shirt-beside-woman-in-pink-and-white polka-dot-shirt-ajH95zTZH8k. Free to use under the Unsplash License. Cover image. 

2. Upadhyay R, Paulino AC. Risk-stratified radiotherapy in pediatric cancer. Cancers  (Basel). 2024;16(20):3530. doi: 10.3390/cancers16203530 

3. Shen CJ, Terezakis SA. The evolving role of radiotherapy for pediatric cancers with  advancements in molecular tumor characterization and targeted therapies. Front Oncol.  2021;11:679701. doi: 10.3389/fonc.2021.679701 

4. Lam A, Leung E, Holt T, Brown C, Hollis A, Tan HQ, et al. Simulation and treatment  procedures in paediatric radiation oncology: a practical guide. J Med Radiat Sci.  2022;69(3):351-362. doi: 10.1002/jmrs.582 

5. Olszewski C. Elekta Versa HD linear accelerator at the Gold Coast University  Hospital [photograph]. Gold Coast, Australia: Wikimedia Commons; 2018 Mar 9 [cited  2026 Apr 11]. Available from:  

https://commons.wikimedia.org/wiki/File:Elekta_Versa_HD_linear_accelearator_at_the_ Gold_Coast_University_Hospital_02.jpg. Licensed under CC BY-SA 4.0. 

6. Together by St. Jude. Proton beam radiation therapy. https://together.stjude.org/en us/treatment-tests-procedures/treatments/radiation-therapy/proton-beam-radiation.html 

7. Together by St. Jude. Brachytherapy. https://together.stjude.org/en-us/treatment tests-procedures/treatments/radiation-therapy/brachytherapy.html

8. CuriosityScribe. Thermoplastic mesh mask made for a child used to hold their head in  a fixed position during radiotherapy treatment, decorated with the imagery of Batman  [photograph]. London, England: Wikimedia Commons; 2022 May 5 [cited 2026 Apr 11].  Available from: 

https://commons.wikimedia.org/wiki/File:Batman_Radiotherapy_Mask.jpg. Licensed  under CC BY-SA 4.0. 

9. Ferrante M, De Luca E, Lama S, Romano F, Mirizzi G, Garzillo C, et al. Standardized  anesthetic protocol in pediatric radiotherapy: a retrospective analysis of clinical efficacy  and outcomes. Clin Transl Radiat Oncol. 2025;52:100931. doi:  

10.1016/j.ctro.2025.100931 

10. Roganovic J. Late effects of the treatment of childhood cancer. World J Clin Cases.  2025;16(3):101151. doi: 10.12998/wjcc.v13.i7.98000 

11. Lucas JT, Holmes JA. Acute and long-term side effects of radiation therapy in  pediatric cancer treatment. In: Lakhoo K, Abdelhafeez AH, Abib S, editors. Pediatric  Surgical Oncology. Cham: Springer; 2023. 

12. Palmer JD, Tsang DS, Tinkle CL, Olch AJ, Kremer LCM, Ronckers CM, et al. Late  effects of radiation therapy in pediatric patients and survivorship. Pediatr Blood Cancer.  2021;68 Suppl 2:e28349. doi: 10.1002/pbc.28349 

13. Children’s Oncology Group. Long-term follow-up guidelines for survivors of  childhood, adolescent, and young adult cancers. https://survivorshipguidelines.org 

About the Author 

Robyn Warnell, BSN, RN, is a registered nurse with over 20 years of clinical  experience, including more than six years in oncology. She also has a personal  connection to radiation therapy, which deepens her commitment to making this topic  clear and approachable. Robyn currently works as a nurse navigator and writes to help  patients and families navigate complex medical experiences.

Assessed and Endorsed by the MedReport Medical Review Board