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 treatment

• Depression

• Pain when eating

• Changes in the way food tastes

• Side effects from medicines

• Nausea, vomiting, and diarrhea

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

• Better tolerate treatment with fewer side effects

• Heal faster

• Grow and develop

• Maximize their quality of life

Special diets for children with cancer

Children with cancer often need more calories and protein. 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 healthcare provider or dietitian may suggest serving high-calorie and high-protein foods, such as eggs, milk, peanut butter, and cheese.

Sometimes, even when high-calorie and high-protein foods are offered, children with cancer have trouble eating enough. Rarely, tube feedings may be needed to help give your child enough nutrition or to prevent malnutrition. This involves placing a small tube (called a nasogastric, or NG tube) through the nose, down the food pipe (esophagus), and into the stomach. A high-calorie formula or supplement can be given to your child through this tube. It can 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 is given through an IV (intravenous) into the veins. Many people call this intravenous feeding. TPN gives the nutrients your child needs when your child can't eat or absorb the nutrients from foods. The TPN solution is usually given over several hours each day. While IV nutrition may seem easy, long-term use can cause side effects and nothing is better than taking in food and calories through the stomach when possible.

Sometimes after chemotherapy, blood counts may be low. During these times, your child's healthcare team may suggest not eating certain foods like uncooked vegetables and undercooked meats. Make sure to discuss special diet restrictions with your child's healthcare team.

Managing treatment side effects and maintaining correct nutrition

Your child's cancer treatment may cause side effects that make it hard to eat enough food. These are some of the common side effects and ideas for managing them. Be sure to tell your child's healthcare team about any side effects your child has. They may offer suggestions or prescribe medicine to help manage side effects. Know what side effects you need to call your child's healthcare team for right away.

Poor appetite

• Try smaller, more frequent meals and snacks.

• Try changing the time, place, and surroundings for meals.

• Ask your child what foods sound good to eat.

• Offer high-calorie, high-protein meals and snacks.

• Don't force your child to eat. This may make your child's appetite worse.

• Make mealtime a happy time.

Mouth sores

• Offer soft foods that are easy to chew.

• Don't let your child eat foods that irritate the mouth, including:

  • Citrus fruits or juices (such as orange, tangerine, grapefruit)

  • Spicy or salty foods

  • Rough, coarse, or dry foods (such as raw vegetables, crackers, pretzels, chips, 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.

• Ask your child's healthcare provider if they recommend a mouth rinse to help with pain.

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 (but not if mouth sores are a problem).

• Offer hard candy, ice pops, ice chips, or chewing gum if age appropriate.

• 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.

• Stay away from 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.

• Ask your child's healthcare provider if they recommend medicine to help with nausea or vomiting.

Diarrhea

• Try to stay away from high-fiber foods, including:

  • 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:

  • 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.

• Offer plenty of liquids throughout the day.

• Ask your child's healthcare provider if they recommend medicine for diarrhea.

Constipation

• Offer high-fiber foods, including:

  • 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. This adds fiber.

• Add bran or wheat germ to foods, such as casseroles, cereals, or homemade breads.

• Ask your child's healthcare provider if they recommend medicine for constipation.

Tooth decay

• Use a soft toothbrush to brush at least twice a day.

• Take your child to the dentist regularly.

• Encourage rinsing the mouth with warm water when gums and mouth are sore.

• Encourage gently 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 hard for anyone of any age. Supportive care (treatment of disease side effects or symptoms) from your child's healthcare team can make the nutritional part 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 healthcare provider and healthcare team will discuss the best method of promoting healthy nutrition during your child's treatment.