Nutritional requirements for a child with cancer

The importance of good nutrition

Good nutrition is very important for children being treated for cancer. Children with cancer often have poor appetites due to one, or more, of the following:

• The hospital environment.
• Side effects of chemotherapy or radiation.
• Depression.
• Changes in the cells of the mouth which may alter the way food tastes.
• Side effects from medications.
• Inadequate absorption of calories, vomiting and diarrhea.

Poor nutrition contributes to poor growth. If a child with cancer maintains adequate nutrition, then the child may be more likely to:

• Better tolerate chemotherapy or radiation and with fewer side effects.
• Heal.
• Grow and develop.
• Maximize quality of life.

Special diets for children with cancer

Children with cancer often have increased calorie and protein needs. Protein is needed for growth and to help the body repair itself. Getting enough calories can help the body grow, heal and prevent weight loss. If your child is having trouble eating enough calories and protein, your child's physician or dietician may suggest serving high-calorie and high-protein foods (i.e., eggs, milk, peanut butter and cheese).

Sometimes, even when high-calorie and high-protein foods are offered, children with cancer have trouble eating enough. Tube feedings may be necessary to help provide your child with adequate nutrition or to prevent malnutrition. This involves placing a small tube (called a nasogastric, or NG tube) through the nose, down the esophagus and into the stomach. A high-calorie formula or supplement can be given to your child through this tube to help promote appropriate growth and development.

Children undergoing treatment for cancer sometimes need total parenteral nutrition (TPN) to help meet their nutritional needs. TPN is a special mixture of glucose, protein, fat, vitamins and minerals that are given through an IV into the veins. Many people call this "intravenous feedings." TPN provides the nutrients your child needs when the child cannot eat or absorb the nutrients from foods. The TPN solution is usually infused continuously over several hours of the day.

Managing treatment side effects and maintaining proper nutrition:

Your child's cancer treatment (chemotherapy, radiation and surgery) may cause side effects that make it difficult to eat enough food. The following are some of the side effects and ideas on how to manage them:

Poor appetite

• Try smaller, more frequent meals and snacks.
• Try changing the time, place, and surrounding of meals.
• Let your child help with shopping and preparing meals.
• Offer high-calorie, high-protein meals and snacks.
• Avoid forcing your child to eat - this may make your child's appetite worse.
• Make meal time a happy time.

Mouth sores

• Use soft foods that are easy to chew.
• Avoid foods that may cause irritation to the mouth, including the following:
  • Citrus fruits or juices (i.e., orange, tangerine, grapefruit).
  • Spicy or salty foods.
  • Rough, course, or dry foods (i.e., raw vegetables, crackers, toast).
• Cut foods into small pieces.
• Serve foods cold or at room temperature - hot foods may irritate the mouth and throat.
• Use a blender to make foods softer and easier to chew.
• Add sauces or gravies to food to make them easier to swallow.

Taste changes

• Offer salty or seasoned foods.
• Use flavorful seasoning on foods.
• Marinate meats in fruit juice, teriyaki sauce, or Italian dressing.
• Try serving foods at different temperatures.
• Offer foods that look and smell good.
• Keep your child's mouth clean by rinsing and brushing.

Dry mouth

• Try sweet or sour foods and drinks such as lemonade.
• Offer hard candy, popsicles or chewing gum.
• Offer softer foods that may be easier to swallow.
• Keep your child's lips moist with lip balm.
• Offer small, frequent sips of water.
• Offer foods that have more liquid in them.

Nausea and vomiting

• Try easy-to-digest food such as clear liquids, gelatin, toast, rice, dry cereals, and crackers.
• Avoid foods that are fried, greasy, very sweet, spicy, hot or strong-flavored.
• Offer small, frequent meals.
• Offer sips of water, juices, sports drinks, or other beverages throughout the day.

Diarrhea

• Try to avoid high-fiber foods including the following:
  • Nuts and seeds.
  • Whole grains.
  • Dried beans and peas.
  • Raw fruits and vegetables.
• Try to limit greasy, fatty or fried foods.
• Limit gassy foods, including the following:
  • Beans.
  • Cauliflower.
  • Broccoli.
  • Cabbage.
  • Onions.
• Offer small, frequent meals and liquids throughout the day.
• Limit milk and milk products if lactose intolerance is a problem.
• Drink plenty of liquids throughout the day.

Constipation

• Include high-fiber foods, including the following:
  • Whole grain breads and cereals.
  • Raw fruits and vegetables.
  • Raisins and prunes.
• Drink plenty of fluids; hot drinks are sometimes helpful.
• Keep the skin on vegetables when cooking them.
• Add bran or wheat germ to foods such as casseroles, cereals or homemade breads.

Tooth decay

• Use a soft tooth brush and take your child to the dentist regularly.
• Encourage rinsing the mouth with warm water when gums and mouth are sore.
• Encourage brushing teeth after eating meals and sweets.
• Limit foods that stick to the teeth such as caramels, taffy, gummy candy, or chewy candy bars.

The treatment of cancer can be difficult for anyone of any age. Supportive care (treatment of disease side effects or symptoms) from the various members of the healthcare team, including dietitians and child life therapists, can make the nutritional aspects of treatment less difficult. Suggestions for creating a child-centered environment, making tasty high-calorie snacks, and possible alternatives to oral nutrition are a part of the supportive care included in the treatment of cancer.

Every child is different and every child tolerates treatment differently. Your child's physician and healthcare team will discuss the best method of promoting a healthy nutritional status during your child's treatment.