Childhood Cancer Scans and Scanxiety

This page is for parents of children with cancer who face regular scans. It explains what each scan asks of a child, how to practice at home, and how to handle the wait for results.

"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. 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. Learning that cancer has returned. 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.

CT. NCI says a CT scan can take from a few minutes to half an hour, depending on the body area. Contrast, if used, may be given by mouth or through an IV. CT uses radiation. NCI notes that children are more sensitive to it because their cells divide quickly and they have more years ahead in which a cancer could develop. It describes about 1 to 2 extra cancers per 10,000 child CT scans in research. It also says doctors should justify each scan and consider options without radiation when they can. Asking whether the dose is set for a child is a fair question.

MRI. NIBIB (part of NIH) explains that the patient must stay very still, or the pictures blur. The machine is loud, and hearing protection may be needed. Metal and implants must be reported beforehand because of the strong magnet. Ask your team how long your child's MRI will take, since it depends on the body part.

PET. Ask the team for the exact steps. Preparation, such as fasting rules and waiting time after the injection, varies by center and by scan, so follow the written instructions you are given.

NIBIB notes that many young children need anesthesia to stay still for an MRI, and that anesthesia carries added health risk. The choice depends on your child's age, the scan and your child's needs, so ask the team to explain why they recommend one or the other.

If your child will have anesthesia, follow the fasting instructions exactly. If a scan can be done awake, ask whether an awake attempt is reasonable, and what happens if it does not work. Ask too how many sedated scans your child is likely to need over time.

You cannot talk a young child into holding still. Preparation helps, and your hospital can guide it.

• Ask whether the center has a child life specialist, a practice scanner, or other ways to prepare.
• Ask whether music, a movie or a parent nearby is allowed during the scan.
• Let your child practice lying still at home in short stretches, and praise the effort.
• Play recordings of loud machine sounds so the noise is less of a shock.

Practice helps the body. The right words help the mind. 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. Taking the pictures doesn't hurt. 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" unless you know. 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 does any of these (it also lists reduced quality of life):

• Damages daily functioning.
• Keeps going despite coping efforts.
• 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. Anti-anxiety medicines or antidepressants are 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 does any of these:

• Stops eating or sleeping in the days before a scan.
• Refuses to leave the car at the hospital.
• 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
• Computed Tomography (CT) Scans and Cancer, National Cancer Institute
• Magnetic Resonance Imaging (MRI), NIBIB, National Institutes of Health
• 988 Suicide & Crisis Lifeline, SAMHSA