Nutrition and Cancer
Decrease in appetite | Increase in appetite | Other nutritional changes | Communication | Nutritional support | Enteral tube feeding | Total parenteral nutrition
Good nutrition is important for the child with cancer. It helps children grow, repair tissues damaged by therapy, experience fewer side-effects of therapy and feel better. Nutritional needs of children vary with age, sex, body size and general state of health, as well as the type of cancer and treatment. The primary goals of nutrition are to prevent nutritional deficiencies and weight loss, to promote normal growth and development, and to maintain quality of life.
A registered dietitian can provide useful information for managing treatment complications which affect appetite and eating ability. If your child is unable to take in adequate nutrition, the dietitian can provide suggestions. Even after completion of treatment, it is important to evaluate whether nutrition is still adequate to support growth and development. When your child is hospitalized, a registered dietetic technician can assist you in planning meals and arranging for snacks and food options as needed. If it becomes necessary for you to write down what your child eats and drinks while hospitalized, the dietetic technician will explain the procedure to you and help if needed. Together with the medical staff; the dietitian and dietetic technician will help your child maintain adequate nutrition. Sometimes your child may be reluctant to eat or his body may reject some foods because of the cancer and its treatment. A child is more likely to be affected by loss of appetite than an adult, because children tend to be picky eaters. When your child is having trouble eating, a dietitian can suggest foods which may help decrease the discomfort. For example, if your child has a dry mouth, offering liquids and moist foods such as pudding pops, yogurt, ice cream, popsicles and milkshakes may provide relief and nutrition.
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Decrease In Appetite
Most children will experience a lack of appetite at some time during treatment. It can be related to the treatment or to emotions or both. When decreased appetite continues for a period of time, it may lead to weight loss and fatigue.
Helpful Hints
Make mealtimes calm and relaxed. Maintain a positive attitude in yourself and encourage one in your child. If your child will not eat, avoid arguing or nagging or punishing by withholding affection or activities the child enjoys. Do not force your child to eat. Offer a variety of foods to increase your child's willingness to eat. Smaller, frequent meals are often more acceptable. Allow your child to eat whenever he is hungry. Try not to miss chances to offer snacks when you are waiting in clinic or for tests. Appeal to your child's sense of smell. Smelling favorite foods cooking may help stimulate his appetite.
Calories
Calories are a measure of food energy and can be found in most foods in different amounts. They are necessary for the body to function properly and for a child's normal growth and development. It is important to get enough calories each day to prevent weight loss.
Protein
Protein is important to consume because it helps the body strengthen and repair itself. The best sources of protein include milk, eggs, cheese, chicken, turkey, beef, fish and peanut butter.
Proteins are also found in plant foods such as grains, dried peas and dried beans. When a diet does not include enough calories, protein may be used for energy instead of building new body tissues.
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Milk
- Offer malts, milkshakes, eggnog, Instant Breakfast" powder, flavored milk
- Serve ice cream or frozen yogurt between cake slices, cookies, or graham crackers
- Offer pudding, cheese cake, cream pies
- Use whole milk in cooking whenever possible, such as in soups, hot cereals and gravies
Protein
- Add cut or diced meats, fish, poultry, or eggs to salads, sauces, casseroles, soups, noodles and vegetable dishes
- Offer simple fried foods, such as fried chicken or cheese sticks
- Use gravy or sauce with meat or chicken
- Use extra cheese on pizza and sandwiches or melt cheese over toast, vegetables, or snacks
- Add grated cheese to vegetables, casseroles, cream sauces, salads and mashed potatoes
- Serve high calorie meats such as sausage, lunchmeat, salami and hot dogs
- Use peanut butter as a spread or dip for raw vegetables and fruits
Fruit
- Add cut-up fruits to cereal, pudding, yogurt, ice cream, and milkshakes
- Make Jell-O" using fruit juice instead of water and add fruit pieces
- Add sugar, honey, or whipped cream to fruit
- Make muffins with fruit, such as bananas and blueberries
Vegetables
- Add grated vegetables to soups, sauces, casseroles, breads, or desserts (like carrot cake or zucchini bread).
- Serve with a cream or cheese sauce, such as scalloped potatoes and cream-style corn.
- Add extra margarine or butter (avoid low-calorie and fat-free margarines).
- Serve raw vegetables with ranch dressing or onion dip. Please check with your child's physician before serving raw vegetables.
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Grains
- Make hot cereals with milk instead of water; serve with cream or "half and half", and margarine/ butter, or fruit
- Spread peanut butter or cream cheese on crackers or bread
- Add jelly and margarine or butter to bread and muffins
- Serve French toast, waffles, and pancakes with ice cream, fruit, or extra butter and syrup
- Use rice or egg noodles in casseroles and soups
- Dip meats in breadcrumbs or flour before frying
- Use breakfast bars and buttered popcorn as snack food
Commercial and Nutritional Formulas
If your child cannot eat enough calories and protein to maintain growth during treatment, the dietitian may suggest a nutritional beverage such as Boost or Ensure to enhance nutrition. Some products are for drinking and others are designed to be added to food. Your dietitian will be able to arrange a trial to determine what is best-suited for your child.
Infant Formulas
Infant formulas contain 20 calories per fluid ounce. If your infant needs extra calories and nutrition, the formula can be prepared differently. Your dietitian will give you written instructions on formula preparation to increase the calories in each ounce.
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Increase In Appetite
Sometimes children temporarily gain extra weight during treatment because of steroids used to treat cancer. The extra weight comes from fluid and fat being stored when extra calories are consumed. Below are some ideas about how to limit weight gain.
- Try to divert attention away from hunger by keeping your child occupied with other activities such as reading, coloring, or doing puzzles.
- Encourage physical activity, according to physician's guidance.
- When hunger strikes between meals, drink water or calorie-free beverages. Wait 20-30 minutes and see if the hunger disappears.
- Choose low calorie fruits and vegetables more frequently. Have them cut-up and ready for snacking.
- Limit high-calorie foods and desserts to one normal serving per day.
- Limit salty foods to one normal serving per day. Salt causes the body to retain water.
Other Nutritional Changes
Taste Changes
During treatment, your child may comment that certain foods don't taste the same. Altered taste is a temporary side effect of chemotherapy, radiation, or cancer. Some children complain that meats taste bitter or metallic and sweet foods are too sweet. Many patients prefer spicy, tangy foods such as pizza, chili and spaghetti. If your child has altered or absent taste, you may have to experiment with different foods to learn which foods he prefers. Below are some suggestions for managing mouth blindness.
- Prepare foods that look and smell good
- Tart foods such as oranges or lemonade may have more taste
- Spicy flavorings and seasonings such as marinades like soy sauce, Italian dressing, or sweetened fruit juice may be added to foods to enhance flavor
- Salty foods like pizza, hotdogs, and sausage may be preferred
- If beef is not well accepted, substitute chicken, fish, cheese, eggs or turkey
- Barbequed/charcoal grilled foods may be more flavorful
- Foods may be better accepted cold or at room temperature
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Nausea and Vomiting
Nausea and vomiting are common side-effects of many cancer treatments and can affect your child's treatment. Using an antiemetic (nausea) medication prescribed by your physician can help to reduce nausea and vomiting. Offering smaller, more frequent mini-meals or snacks helps to keep nutrition stable. Encourage fluids such as broth, tea, non-citrus fruit juices and soft drinks, even if your child is not able to eat. Solid foods your child maybe able to eat without vomiting include Jell-O" gelatin, toast, pretzels and saltine crackers; bland foods such as mashed potatoes, rice; and foods that are easy to digest like chicken or green beans. Fatty or greasy foods may not be tolerated.
Your child may comment about strong food odors. It may be helpful to avoid cooking or serving foods that have strong odors such as cabbage, onions, fish or garlic. Cold foods are less odorous and have may be more tolerable. After vomiting, allow him to brush his teeth and rinse his mouth before eating again.
For some children just the thought about coming to the hospital can cause a nauseous feeling.
Teenagers may experience more nausea and vomiting as they progress through treatment. If a child is nervous and anxious, nausea and vomiting are more likely to happen. Be sure to continue your child's medication on a regular basis.
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Dry Mouth
A dry mouth may be caused by drugs or radiation which decreases saliva production. When this happens, food may taste different and become more difficult to chew and swallow. Some of the suggestions below may be helpful in dealing with this problem.
- Encourage a sip of beverage with each bite of food.
- Encourage high-calorie nutritional liquids and moist foods.
- Thin foods with liquids by adding cream, milk, juice, gravy, broth, sauces, syrup, mayonnaise, melted butter, oil, salad dressing, or yogurt. Mixing in a food processor or blender helps thin solids.
- Try dunking foods such as cookies in milk.
- Choose sugar-free gum or suck sugar-free hard candies, popsicles, or ice chips.
- Try lemonade or warm tea with lemon.
- Occasionally teenagers have used artificial saliva products to moisten their mouth. Ask your physician or nurse for more information.
Sore Mouth or Throat
When your child refuses to eat or drink or has trouble swallowing; you may discover that he has mouth sores. You may be able to see red, raw areas, bleeding from the gums or lips. Sometimes there will be visible sores. Mouth sores are a common side-effect of some of the cancer treatment drugs. They can change your child's usual eating habits and may lead to an infection. Below are some helpful hints in managing mouth sores.
- Serve soft and tender foods such as puddings, scrambled eggs, cottage cheese, casseroles, or mashed potatoes
- Cut food into bite-sized pieces and moisten with liquid such as gravy, broth, or sauce
- Encourage frequent sipping of beverages that feel soothing to your child
- Clean your child's mouth after meals and before going to bed using soft materials such as toothettes or Q-tip" swabs
- Regular mouth care is essential to prevent dental caries, mouth disease or gum sores
- Your child's mouth may feel better if rinsed with a soothing mouthwash. Following are some recipes to try.
- Mix one teaspoon of salt to four cups of lukewarm water.
- Dilute regular mouthwash with an equal parts of water, e.g. mix 2 cups mouthwash with 2 cups of water.
- Mix one part hydrogen peroxide with four parts water. For example one tablespoon hydrogen peroxide with four tablespoons water.
- If mouth sores are painful, give only the pain reliever that has been recommended by your physician.
- Nystatin" and Peridex" are mouth sore products. Specific instructions will be given to you by your physician.
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Heartburn
Heartburn is a sensation of burning or pressure felt in the upper stomach. It is caused by stomach acid fluids that back-up in the upper esophagus. Some methods of managing heartburn include:
- Offer small, frequent meals.
- Try eliminating chocolate, caffeine, fatty foods, and pepper.
- Encourage sitting up instead of lying down after eating.
- If the problem continues, your physician may prescribe a medication to ease the discomfort.
Diarrhea
Several chemotherapy drugs and radiation can cause irritation to the intestines, which can lead to changes in your child's normal bowel patterns. Diarrhea means more frequent, loose or watery stools. To keep diarrhea to a minimum you might consider the following suggestions.
- Encourage low fiber foods such as cooked fruit and vegetables, chicken, beef, eggs, bananas, smooth peanut butter, saltines and white bread.
- Offer several mini-meals throughout the day.
- Avoid caffeine containing beverages like Coke, Mountain Dew, and tea.
- Avoid greasy, fatty foods, raw vegetables, nuts, onions, garlic, broccoli, corn, and cauliflower.
Constipation
Constipation can be a common side effect of some cancer treatment and pain management medications. Hard stools, pain when attempting to have a bowel movement, a change in bowel movement patterns, or increased gas are signs of constipation. To keep the bowels moving regularly consider the ideas below.
- Maintain normal activities and exercises.
- Encourage extra liquids such as water, apple or prune juice.
- Encourage high fiber foods such as fruits, raw vegetables, popcorn, raisins, grapes, nuts, dried prunes, bran muffins and granola bars.
- Encourage using the bathroom at the same time each day or after meals to establish a daily routine.
- A stool softener may be prescribed while receiving chemotherapy. Use the medicine as instructed by your child's physician. If your child gets diarrhea, discontinue its use until the stool is formed again. Do not use enemas or suppositories without your oncology physician's consent.
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Communication
Call your child's nurse or physician when your child:
- has any change in his normal bowel patterns, eating habits or appetite
- appears to have a hard swollen stomach
- has diarrhea that lasts for one day or more
- does not have a bowel movement in a day or two with prescribed medications for constipation
- mouth pain so severe that he can neither sleep nor eat
- a fever
- excessive bleeding from mouth sores
- continues to vomit even after he has received anti-nausea medication
- becomes unable to eat or drink
- urinates less than two times a day
- has blood in his vomit (Consider the color of food your child has eaten in the last 24 hours, such as red Jell-O" or beets)
- drinks less fluid or vomits many times
- has bloody stools
- vomits green liquid
- experiences abdominal pain
Nutritional Support
Nutrition is important for everyone, but it is especially important for the child with cancer. Research studies have shown that a well-nourished child is able to tolerate cancer treatments better. The Division of Hematology/Oncology is staffed with dietitians who are certified in nutritional support and who will monitor your child's nutrition throughout treatment. A high calorie, high protein diet which may include a high-calorie commercial formula, is often the first line of defense against nutritional problems. However, despite the best efforts to provide nourishing foods, a child with cancer may fail to gain weight. Under such circumstances, supplemental nutrition by tube called enteral nutrition or intravenous called parenteral nutrition may become necessary.
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Enteral Tube Feeding
When a child has decreased appetite, difficulty swallowing or surgery that interferes with eating, it becomes difficult to eat enough to maintain adequate nutrition. A very thin, flexible tube is sometimes passed through the child's nose and into the stomach or intestine. A liquid nutritional formula, fluids and medications are given through the tube. Eating and drinking can still be accomplished with the tube in place. Another option is a tube placed through the skin directly into the stomach or intestine by a special surgical procedure. For either option, a pump is often used to control the amount of formula given through the tube over a 12 to 24 hour period. Some children receive the formula at night only and eat and drink as desired during the day. Others may be fed during waking hours at mealtime without a pump.
Total Parenteral Nutrition (TPN)
When a child has severe mouth sores or digestive problems, parenteral (intravenous) nutrition is an effective method to provide nutrition. TPN bypasses the normal digestion in the stomach and intestine. It is a special intravenous mixture which is given into the blood through a central line or port. The mixture contains all the nutrients needed for your child's healing, growth, and development. Patients receiving TPN are at increased risk for infection due to special types of IV lines and the solutions used. Thus, careful attention to detail and management of the line is especially important. This treatment may also be given at home by parents who have been properly trained.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Written 9/05
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