The Effect of Honey in Oral Care Intervention Against Chemotherapy-Induced Mucositis in Pediatric Cancer Patients: A Pilot Study

Before implementing the intervention, nurses and doctors will educate parents and children for approximately 60 minutes about oral care with honey. In this session, parents will learn how to perform basic oral care (toothbrushing, mouthwashing, and lip care). The nurse will also teach about the benefits of honey and how to use it in oral care, such as how to apply honey to the mouth, make a honey mouth rinse, and use honey as a lip care agent in children's oral care. The nurse demonstrates how to apply honey directly to the patient's oral cavity and lips and make honey mouthwash. Nurses and doctors also advise parents to provide oral care to their children at least three (3) times per day using honey for five (5) days. The honey administration protocol used in this study was based on that used in the Montalebnejad study. The intervention group will receive oral care through honey thrice daily (30 minutes after breakfast, lunch, and before sleep) for five days. Each oral care session lasts between 15-20 minutes (includes toothbrushing, mouthwashing, and lip care). For each oral care intervention, 35 mL of honey was applied topically in the oral cavity, and 15 mL was used as a mouthwash and lip care. The first application of honey in oral care to the patient will be done by the nurse. The nurse will apply honey to the oral cavity, and then give the patient honey mouthwash, and smear honey on the lips. The patient's parents will pay attention to the actions taken by the nurse. The next oral care application of honey was done by parents. The nurse provides parents with a daily activity book to monitor their compliance with the intervention. The book includes a daily oral care activity sheet, which must be completed every time parents provide oral care for their child. Apart from that, parental compliance is monitored by nurses directly observing parents' actions in providing oral care interventions to children for five (5) days while the child is in the hospital. In this study, Indonesian natural and standardized flower honey will administered to the intervention group, in addition to routine and standard care performed at the clinic after each chemotherapy session. The honey contains a flower honey from Indonesian forests that meets Indonesian national standards. The honey contained 17-20% (maximum water content of 22%), 60% sugar reduction, 10% sucrose, 40 ml NaOH/kg acidity, and the diastase enzyme activity of 8 DNs (minimum 3 DNs). These Indonesian honey samples contained minerals (Ca, Na, P, Fe, Mg, and Mn), vitamins (B1, B2, B5, B6, and C), and enzymes.