Childhood Cancer Scans and Scanxiety

"Scanxiety" is the informal word for the worry that builds before an imaging test and stays until results come back. It is not a diagnosis. It is a very common experience, and in pediatric cancer it lands on two people at once: the child, who dreads the machine, and the parent, who dreads the report.

NCI notes that almost half of people with cancer report some anxiety, and about a quarter report a great deal. It also names the moments when it spikes. Diagnosis. Starting treatment. Finishing treatment. Remission. Any hint of recurrence. Scan days sit right on top of those moments, which is why a family that has been coping well can fall apart the week of a scan.

Naming it helps. So does splitting it in half. The child's problem is the machine. Your problem is the result. They need different plans.

Ask which test is booked, because the demand on the child differs a lot.

CT. St. Jude describes the scan itself as lasting only a few seconds, with the whole appointment often 10 to 20 minutes. The child hears a clunk as the scanner starts and a whir as the camera moves. Contrast, if used, is a clear liquid swallowed or given by IV. CT uses a small amount of radiation. St. Jude says the added cancer risk is small, that children are more sensitive because they are still growing, and that teams adjust the dose for a child's age and size. Asking whether the dose is child-sized is a fair question.

MRI. A typical MRI takes 60 to 90 minutes, depending on the body part. It is loud, so children get earplugs or noise-reducing headphones. Metal must come off first, and patients pass a metal detector more sensitive than the airport kind. A parent usually waits in the next room with the technologist, and the child can talk through a two-way intercom.

PET. The child gets an injection of a tracer, a form of glucose carrying a small amount of radioactive material. Then comes the part nobody warns families about: roughly 45 minutes of quiet waiting while the tracer spreads, followed by 30 to 45 minutes of scanning. For at least four hours before, St. Jude says the child may have only water or sugar-free flavored water, since sugar interferes with the test. Hard exercise beforehand is out, and blood sugar is checked before the injection.

That waiting period is the hidden difficulty of a PET day. Plan for a hungry, bored child who is not allowed to run around.

Some children cannot hold still long enough for clear images. St. Jude says the team weighs the child's age, the type of scan, how long it takes, and the child's medical needs.

With anesthesia, expect fasting instructions from your team, which you should follow exactly. Anything in the stomach during anesthesia risks food or liquid entering the lungs. A parent can usually stay until the child is asleep. An anesthesia provider watches throughout, and afterward nurses monitor heart rate, blood pressure, breathing, and alertness until the child wakes.

Awake scanning is worth pushing for when it is realistic. St. Jude reports that teams try to limit general anesthesia in children, and notes research suggesting that repeated anesthesia, or a single session longer than three hours, may affect brain development in young children. A child in an every-three-months scan schedule is looking at many of these over the years.

Child life specialists at St. Jude work with children as young as 4, though most start practicing somewhere around 6 or 7. Readiness is individual. Ask the team whether an awake attempt is reasonable, and what happens if it fails partway.

You cannot talk a seven-year-old into holding still for forty minutes. You can train it.

St. Jude's child life team uses methods that work at home:

• The statue game. Lie completely still, starting at two or three minutes, and stretch it out over days toward 45 minutes or more.
• Breath holds. Start with slow breathing and short pauses, working up to about 15 seconds, since some scans need brief breath holding.
• A fort with noise. Drape a sheet over a table so the child lies in a small space, and run a vacuum nearby to mimic the sound.
• The real soundtrack. Play recordings of MRI machine noise so the sound is familiar, not startling.

Ask the hospital about a mock scanner, which is a practice machine children can climb into. Ask whether the center offers goggles for movies, music during the scan, or cushions and belts to help the body stay put. St. Jude also gives a small logistical tip that runs the other way: a tired child is more likely to fall asleep during the scan, so for an early appointment let them stay up a little later the night before, and for a late one wake them early or skip the nap.

Tell the truth in the smallest true version.

For a preschooler: "The camera takes pictures of the inside of your body. It doesn't hurt. It's noisy, and you have to be a statue."

For a school-age child: "The scan shows the doctors what is happening inside. It can't hurt you. The hard part is holding still, so we're going to practice."

For a teenager: give the actual schedule, the actual duration, and the actual reason. Then let them choose the parts they can control, including the music, who comes along, and whether a parent is in the room.

Two things to avoid. Do not promise "it won't take long" if it is a 90-minute MRI. And do not say results will come today unless the team said so.

Ask before you leave: who calls, and by when? A specific answer, such as "the oncologist calls within three business days," gives you something to hold on to.

Also decide in advance how you will handle the patient portal. Many results post to the portal before anyone explains them, and reading a radiology report cold, on a Friday night, is how a good weekend gets destroyed. It is fine to decide as a family to wait for the call, or to have one adult read first.

Fill the gap with something structured. Plan the wait days on purpose, and tell the child what happens next either way.

Anxiety has crossed a line when it stops working as ordinary worry. NCI describes anxiety that needs treatment as anxiety that damages daily functioning, keeps going despite coping efforts, or blocks medical care, such as a needle fear that stops a test from happening.

NCI lists counseling, cognitive behavioral therapy, relaxation training, meditation, and guided imagery as approaches that generally come first, with anti-anxiety medicines or antidepressants added when needed. Ask the oncology team for the psychologist or social worker. In pediatric centers, this is a normal referral, not an escalation.

If a child or teen talks about wanting to die, hurting themselves, or life not being worth living, treat it as urgent. Call or text 988, the Suicide and Crisis Lifeline, right then. If they have a plan, the means to act, or you think they are in immediate danger, call 911 or go to an emergency department — do not wait for a clinic callback.

Call the care team the same day if the child stops eating or sleeping in the days before a scan, refuses to leave the car at the hospital, or begins vomiting from anxiety.

For the tests themselves, see What to Expect During an MRI and What to Expect During a CT Scan. For the waiting, see Waiting for Results: How to Cope and Imaging Tests for Cancer. Also useful: Infection Precautions for Children During Cancer Treatment and Feeding and Appetite Changes in Childhood Cancer.

• Adjustment to Cancer: Anxiety and Distress (PDQ), National Cancer Institute
• Children with Cancer: A Guide for Parents, National Cancer Institute
• Magnetic Resonance Imaging (MRI), Together by St. Jude
• Computed Tomography (CT) Scan, Together by St. Jude
• PET (Positron Emission Tomography) Scan, Together by St. Jude
• Diagnostic Imaging Scans with Anesthesia, Together by St. Jude
• Diagnostic Imaging Scans Without Anesthesia, Together by St. Jude
• Playing Statue Can Have Big Rewards: Tips for MRIs without Anesthesia, Together by St. Jude
• 988 Suicide & Crisis Lifeline, Substance Abuse and Mental Health Services Administration