Nutritional Requirements for a Child with Cancer

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 and/or radiation
  • Depression
  • Changes in the cells of the mouth that 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, he or she may be more likely to:  

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

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 dietitian may suggest serving high-calorie and high-protein foods (e.g., eggs, milk, peanut butter, cheese).  They also may recommend that your child try oral supplements such as Carnation Instant Breakfast or Pediasure.

Sometimes, even when high-calorie and high-protein foods are offered, children with cancer have trouble eating enough. Often times, in these situations medications which stimulate the appetite may be used.  Tube feedings may be necessary to help provide your child with adequate nutrition or to prevent malnutrition. This involves placing a small tube through the nose, down the esophagus and into the stomach or small intestine.  Your child’s physician and dietitian will explain the different types of formulas that can be given through these tubes and will also discuss a plan for feeding your child using these tubes.   

Children undergoing treatment for cancer sometimes require IV nutrition which is called total parenteral nutrition (TPN).  If your child requires this, the dietitian and physician will explain how long your child will remain on TPN and will discuss why it is needed.

While your child is undergoing treatment a dietitian will be involved in his or her care during the hospital stay and when your child is seen at clinic appointments by the physician.  The dietitian will provide goals for how much your child needs to eat and drink.  They will also discuss your child’s growth and weight gain goals.  Sometimes during treatment, children can become very uninterested in eating, especially if they have experienced significant nausea, vomiting, or pain with eating.  This can also happen after children have been on TPN or IV fluids and have not eaten by mouth for an extended period of time.  In these situations, a speech language pathologist can work with your child to help him or her start eating again.  They can also provide strategies for eating at home.    

Your child's cancer treatment (chemotherapy, radiation and/or 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:

  • 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.
  • 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.
  • Offer milkshakes and smoothies.
  • 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.
  • Offer new foods or foods your child did not used to like.
  • 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.
  • 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.
  • 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.
  • 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.

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 speech language pathologists, 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 dietitian and healthcare team will discuss the best method of promoting a healthy nutritional status during your child's treatment. 

Last Updated 11/2014