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Nutritional Needs for Kids With Cancer

When your child is undergoing cancer treatment, there's a lot to think about. Sometimes it can be easy to forget about your child's nutritional needs. But maintaining adequate nutrition is necessary for kids with cancer to stay healthy and cope with the side effects of cancer or its treatments.

The best way for kids to keep up their strength and deal with side effects is by staying hydrated, taking only doctor-recommended supplements, and eating as well as possible, even though it may be difficult. For some kids undergoing treatment, that might mean getting enough to eat; for others, it could mean making sure not to eat too much.

Staying Hydrated

Kids undergoing cancer treatment often lose a lot of water from vomiting, diarrhea, or by just not drinking enough. This can lead to dehydration, but it can be handled by making sure your child gets plenty of fluids. Tap, filtered, or bottled water is best, but your child can also get necessary fluids from other sources like sports drinks, juices (100% juice is best), and clear broths.

Water helps with nearly every bodily function, aiding in digestion, metabolizing fat, flushing toxins from the body, and maintaining body temperature. In addition to preventing dehydration, getting enough fluids helps prevent constipation, a condition that is likely to make your child even less inclined to eat.

Eating Right

Every kid with cancer has specific nutritional needs, so it's important to talk to a nutritionist about what would be best for your child to eat. In general, kids with cancer have an increased need for protein, carbohydrates, and healthy fats.

The body uses protein to grow, repair tissues, build blood cells, and replenish the immune system. Getting enough protein can help your child heal faster from the effects of radiation and chemotherapy, while also helping to prevent infections. Foods like cheese, eggs, milk, yogurt, lean meats, poultry, fish, beans, peanut butter, nuts, lentils, and soy are all good sources of protein.

Carbohydrates are the body's fuel, providing energy for cells and helping to maintain organ function. Good sources of carbs include breads, pasta, potatoes, rice, cereals, fruits, corn, and beans. Whole-grain varieties of breads and pastas are usually best because they add fiber, which helps kids feel fuller longer and prevents constipation, another common side effect of cancer treatment.

Fats help the body store energy, insulate body tissues, and carry certain vitamins throughout the bloodstream. Fats also are dense in calories, which is important to a child who might be losing weight during treatment. Not all fats are created equal, though. Unsaturated fats that are found in fish, nuts, olive oil, and vegetables like avocados are much healthier than saturated fats and trans fats that are found in red meats and greasy, fried foods.

Dietary supplements are typically not recommended, as they can interfere with some cancer treatments. Don't give your child a dietary supplement unless your doctor recommends it. It's best that kids get their nutrients through food.

Helping Your Child Eat More

When kids aren't feeling their best, it can be difficult to get them to eat. Try these tips to help ensure your child gets enough nutrients:

  • Offer smaller, more frequent meals. Also serve meals on a smaller plate, since a large plate of food can seem like too much to someone with a decreased appetite.
  • Always have food on hand. Whether it's a breakfast bar, a liquid nutrition drink or shake, crackers, or fruit, keep snacks handy in case your child suddenly gets hungry.
  • Try blander foods. If your child seems sensitive to strong smells or tastes, stick to plain meals like breads, pastas, rice, and broth-type soups.
  • Experiment with food temperatures. Many kids undergoing treatment prefer foods that are served at room temperature rather than very hot or too cold.
  • Avoid acidic foods. If mouth sores are a problem, stay away from acidic foods like orange juice, lemonade, and tomatoes.
  • Make foods easier to swallow. If swallowing is difficult, try pureed foods, soups, shakes, or smoothies. A straw may help them go down easier.
  • Don't offer liquids with meals. Serve drinks in between meals, instead of with meals. This way, your child doesn't fill up on fluids and has an appetite to eat. (But if your child has mouth sores or dry mouth, offering fluids with meals actually helps the food go down.)
  • Make up for lost calories. Your child might not want to eat very much on days when he or she receives chemotherapy. So in between treatments, make up for the decreased intake with things like high-calorie bars and milkshakes. Ask your child's doctor for recommendations.

Helping Your Child Eat Less (or Better!)

Many kids undergoing cancer treatment tend to eat less and lose weight because their appetites are affected.

But some kids actually have increased appetites, especially if they're on steroid medications that can make them hungrier. This often leads to fluid retention and weight gain. While these issues will go away after treatment ends, in the meantime, it's important for kids to maintain a healthy weight.

Here's how to do that:

  • Set a mealtime schedule. Provide three moderate-sized meals a day, plus 2-3 snacks, and make sure your child sticks to that schedule. Encourage your child to wait for at least 20 minutes after eating something before asking for more. (In general, it takes kids this long to realize they're full.)
  • Limit salt intake. Help prevent fluid retention by limiting the amount of salt in your child's diet. Avoid fast foods, processed foods, frozen meals, and snacks like chips and pretzels. Use spices other than salt to season foods made at home.
  • Serve fruits and veggies first. Offer fruits and vegetables at the beginning of the meal, followed by whole-grain products (like breads and pastas). Foods like these that are high in fiber keep kids feeling fuller longer.
  • Provide healthy snacks. Keep only healthy foods in the house for snacking, and bring healthy snacks with you when you go out. Monitor your child's intake of soda and sweets, which are both loaded with empty calories.
  • Stay active. Help keep your child's mind off eating by distracting him or her with alternative activities such as sports, games, reading, or hobbies. To help burn excess calories, your child should try to stay active and get plenty of exercise if he or she feels up to it.

When the steroid or other treatment ends, your child's appetite should return to normal and may even decrease for a short time. This is normal and not typically a cause for alarm. Your child's doctor will probably be expecting the weight loss associated with this and will keep a close eye on it.

Eating to Reduce Side Effects

Cancer and its treatments can cause a number of side effects, including nausea, vomiting, dry mouth, mouth sores, constipation, and diarrhea. They also can cause kids to have heightened sensitivity to food smells or temperatures, difficulty swallowing, or changes in taste that might make them not like foods they once enjoyed. Fortunately, once treatment ends, these problems go away.

In the meantime, help with nausea and vomiting by making sure your child takes all medications correctly and eats the right things. Offer bland foods, especially on days when your child receives treatment. Avoid salty, sweet, fatty, and fried foods. Food smells also can play a part in making a child nauseated. Consider offering foods with little or no smell, and don't cook hot foods around your child.

To help control diarrhea, give your child foods like white bread, bananas, white rice, and applesauce that are easy to digest. Avoid dairy products; greasy, spicy, or fried foods; high-fiber foods; raw fruits and vegetables; and foods like cabbage and broccoli that can cause gas. Kids with diarrhea should drink more than usual to replace lost fluids.

To help control constipation, offer your child high-fiber foods, such as fruits, vegetables, nuts, and whole-grain breads and cereals. In addition to water, give your child fruit and vegetable juices, such as prune juice, and warm liquids like tea.

If your child's tastes change as a result of cancer or treatment, it may seem like an insignificant problem, but if it causes your child to lose interest in eating, it won't be. You'll need to address this situation for as long as it lasts, which can be weeks or even years.

Get your child to practice good oral hygiene by brushing his or her teeth regularly and rinsing out his or her mouth frequently. This can help make food taste better. So can things like plastic spoons if your child becomes sensitive to the taste of metal.

Encourage your child to try new foods (those with strong flavors can often mask the taste changes in your child's mouth) and keep a wide variety of foods handy to meet your child's changing tastes.

Practice Safe Food Handling and Preparation

Kids with cancer are at high risk for infection, so it's very important to know how to handle and prepare food safely. This means washing your hands well before handling food or after touching things like raw meat and poultry.

It also means things like keeping hot foods hot and cold foods cold. Prepared food should never be allowed to sit at room temperature for more than an hour, and leftovers should be eaten within a few days.

Raw fruits and veggies should always be washed well before they're eaten. This includes melons or any other thick-skinned fruit you might cut with a knife. Cooked foods should be cooked well before they're served. Other foods, like yogurt and some cheeses, should be avoided because they contain live bacteria. In some cases, doctors may even advise a child undergoing chemotherapy to avoid raw foods entirely.

Encourage Proper Eating Habits

When kids have trouble eating enough, it can be easy to give in and allow them to eat anything, healthy or not, just so they're getting some calories. While getting enough calories and protein is important, it's also important to incorporate healthy eating practices into your child's routine.

Eating healthy all the time will make your child less likely to binge on sweets or fried foods. And remember, some day the treatment will end, and your child's appetite will go back to normal. When it does, make sure your child knows the right foods to eat by teaching good eating habits now.

It can be tricky to keep your child eating well during treatment, but it's important to try. Kids who maintain adequate nutrition and hydration are better able to tolerate and stay on schedule for treatments, steer clear of infections, keep up their current weight, and stay strong enough to participate in activities they enjoy — all of which increase their chances for the best possible outcome.

Reviewed by: Michell Fullmer, RD, LDN
Date reviewed: August 2012