Nutrition

Good nutrition is important for children experiencing the stress of cancer and the side effects of treatment. Not only do children need adequate nutritional stores for fighting disease, but they have additional requirements for normal growth and development. Supplying and encouraging good nutrition is an important role that can empower parents when they realize the significance of a balanced diet.

A well nourished child will be able to:

withstand the effects of cancer and its treatments such as chemotherapy, radiation or surgery
fight off infections
avoid weight loss
repair cells and heal wounds by building new tissues
achieve normal growth and development.

Good Nutrition

The building blocks necessary for energy, growth and repair of skin, hair, muscles and organs are: protein, carbohydrate, fat, vitamins and minerals. Your child needs to eat a balanced diet according to Canada's Food Guide to obtain adequate amounts of these nutrients.

Canada's Food Guide

Food Group       | Nutrients      | Daily Servings | Group Members
_________________|________________|________________|________________________
Grain Products   | Carbohydrate,  |      5-12      | Bread, Cereal, Pasta, 
                 | Vitamins,      |                | Rice, Rolls
                 | Minerals, Fibre|                |
_________________|________________|________________|________________________
Vegetables       | Carbohydrate,  |      5-10      | Raw / cooked Fruits and
                 | Vitamins,      |                | Vegetables, Fruit
                 | Minerals, Fibre|                | and Vegetable Juices
_________________|________________|________________|________________________
Milk Products    | Protein, Fat,  | Children 4-9   | Whole Milk, Yogurt,
                 | Vitamins A & D,|  years: 2-3,   | Cheese, Ice Cream
                 | Calcium        | Youth 10-16    |
                 |                |  years: 3-4    |
_________________|________________|________________|________________________
Meat &           | Protein, Fat,  |      2-3       | Meat, Fish, Poultry,
 Alternatives    | Vitamins, Iron |                | Eggs, Cheese, Peanut
                 |                |                | Butter, Tofu,
                 |                |                | Baked Beans

How to Encourage Eating

Be adaptable

Food cravings and food "jags" are common to children with cancer
Be flexible and supportive.

Be creative

Make foods more appealing
Use cookie cutters to make different shapes of cheese, bread, etc.
Praise children when "eating well".

Let children participate

Encourage children to participate in planning and preparation of meals and snacks.

Take advantage of "trouble free" times

Take advantage of foods high in calories and protein when appetite is good to make up for nutritional losses during periods when eating was/is poor.

Making Every Bite Count

When your child's intake is poor, try calorie and protein rich foods:

High Carbohydrate Foods

Honey, molasses, jam, jelly, sugar: Drizzle on cereal or fresh fruit; spread on toast or crackers; use in desserts.

High Fat Items

Butter, margarine, cooking oil: Melt into soups, potatoes, rice, vegetables, hot cereals; spread on toast, muffins and rolls
Mayonnaise: On salads, sandwiches
Sour Cream: On cooked vegetables; dip for raw vegetables; in gravy
Peanut Butter: On fresh fruit, vegetables, crackers, toast; in milkshakes
Cream Cheese: Spread on bread, crackers, celery
Whipped Cream: Top on puddings, pies, jello, fruit, cereal, hot chocolate, milkshakes
Ice Cream: Dessert and beverages

Protein Boosters

Milk: Soup, eggs, sauces, gravies, cereal, puddings, instant rice
Skim Milk Powder: Fortify milk; add 250 ml. of skim milk powder to 1 L. whole milk
Cheese: Grate on sauces, soups, pie, pasta, vegetables
Cottage Cheese: Mix with fruit and honey
Eggs: Blend into sauces, soups
Meat: Diced in casseroles, soups
Peanut Butter: Spread on bread, waffles, crackers, celery

High Calorie Snacks

Dried fruits, nuts
Chocolate
Chocolate milk
Granola
Buttered popcorn
Hot chocolate
Bacon
Cheese and crackers
Milk shakes
Rice Krispie squares
Whole milk
Ice cream floats

Nutritional Supplements

If your child is unable to eat enough to maintain proper nutrition, your doctor or dietitian may recommend commercial supplements which are high in calories and protein.

These products are more expensive than homemade supplements so you may want to contact the dietitian before you try a commercial supplement for recipes.

Effects of Treatment on Nutrition

Cancer treatments may cause significant changes in your child's ability to eat. These treatments may cause some harm to your child's digestive system as they destroy cancer cells.

Side effects of treatment vary from patient to patient and depend on the site of therapy, type and duration of treatment. Most side effects go away once treatment is completed.

Understanding why changes in your child's eating habits occur will help you overcome these barriers to good nutrition.

Chemotherapy

Possible impact: Healthy cells may be damaged as the drugs destroy fast-growing cancer cells.

Side effects:

sore mouth, throat
loss of appetite
cramps, diarrhea
changed sense of taste
nausea, vomiting
constipation

Radiation Therapy

Possible impact: Normal cells in the area of the body receiving treatment may be damaged.

Side effects:

loss of appetite
pain in jaw
headache
feeling of fullness
diarrhea
dry mouth
changed sense of taste
difficulty swallowing
nausea, vomiting

Surgery

Possible impact: Body undergoes additional stresses in postoperative period.

Side effects:

chewing problems
changed sense of taste
difficulty swallowing
feeling of fullness
diarrhea

Overcoming Side Effects

The following are suggestions to help your child overcome common feeding problems. If they do not work, talk to your doctor, dietitian or nurse for alternative treatments.

Loss of Appetite ("I don't feel hungry")

Try smaller meals more often
Have nourishing snacks handy for nibbling
Serve favourite foods: chicken noodle soup, macaroni and cheese, mashed potatoes with butter, spaghetti
Add eye appeal... serve a variety of colourful foods
Use the previous ideas for increasing calories and protein without increasing the amount of food to be eaten
Light or moderate activity may stimulate an appetite

Mouth Sores

Avoid:

acidic foods: tomatoes, citrus fruits (oranges, grapefruits)
spicy foods: pepper, chili
hot foods
raw fruits and vegetables
dry coarse foods: chips, pretzels

Try bland soft foods: mashed potatoes, soft eggs, cooked cereals, cream soups, mashed bananas, watermelon, Popsicles, sherbet/sorbet, slushes/milkshakes, ice cream. It helps to use a wide straw to drink liquids or liquefied foods (this way the mouth is not injured further by chewing).

Health food stores recommend L-lysine (an amino acid) taken daily to avoid development, or to speed the healing of mouth sores.

Foods Taste Funny

Foods that once were loved by some children may no longer taste the way they should to them. Protein foods such as meats or sweets may be rejected by your child.

Serve foods chilled or at room temperature
Avoid extremely sweet foods such as candy, jams and honey
Try marinating meat, chicken or fish in sweetened juices, sweet 'n sour sauce. Mustard and ketchup are some favourite condiments.
If your child does not have mouth sores, try tart foods such as lemonade, cranberry juice, pickles and spices

Unsettled Stomach

Clear liquids are recommended: flat ginger ale or cola, chicken broth, Jello, Koolaid, Popsicles, flavoured ice cubes
When stomach begins to settle, offer dry toast, crackers, soft eggs, rice, mashed potatoes
To prevent vomiting:
save liquids for drinking one hour before or after meals
foods should be eaten slowly
avoid foods high in fat such as cream soups, whole milk, gravy, fried foods
try to keep your child from lying down after eating.

Diarrhea

Avoid fiber which may irritate the intestines: whole grains, bran, seeds, popcorn, raw fruits and vegetables
Avoid fatty or spicy foods, carbonated beverages
Try boiled rice, bananas, rice cereal, dry toast, mashed potatoes, other small portions of these foods at room temperature
Encourage fluids between meals to prevent dehydration.

Constipation

Drink plenty of liquids
Raw fruits and vegetables (with skins on)
Whole grain breads and cereals, sesame seed sticks, fig newtons, oatmeal cookies, granola, datenut bread
Add bran and wheat germ to casseroles, hot cereals, peanut butter sandwiches, puddings, etc.

Infants Have Special Needs

It may be difficult to assess feeding problems in children under one year of age. Obviously nutrition is just as important as in the older child. Observation of the child at feeding times and the amount taken is important. The weight of the child should be monitored carefully to make sure that a fairly normal weight is maintained. Amounts of feeds and schedules may need to be very flexible and each infant's needs will have to be assessed individually.

References

Acknowledgments to Moira Macleod, Dietetic Intern at Victoria Hospital, 1987 for development of "Nutrition, Cancer and Your Child" from which this information is adapted.
Brain Tumor Patient Resource Handbook - Adult Version 1992
Managing Your Child's Eating Problems During Cancer Treatment - U.S. Department of Health and Human Services 1991

Swallowing Difficulties

Rarely, a child may have difficulty swallowing related to malfunctioning of the swallowing mechanism. The "gag" may work too well, or not well enough. In the situation where the gag is overactive, food in the back of the throat may cause choking and vomiting. When it does not work well enough, attempts at swallowing may result in food going to the wrong place such as the windpipe, resulting in chronic feeding difficulties which can result in weight loss and persistent lung infections.

To bypass the malfunctioning swallowing mechanisms, a tube may be placed through the nose into the stomach (nasogastric feeding tube) and may be used on a temporary basis for feeding purposes. Using this tube for an extended period may result in chronic irritation of the nose and/or chronic sinus infections and is not recommended. If long term (lasting for months) feeding difficulties are anticipated, a gastric feeding tube may be placed directly into the stomach through the skin on the abdomen (a G-tube). One can feed an individual indefinitely through this tube if necessary. It can easily be removed at any time, leaving a small scar. Usually, over months, many swallowing difficulties will improve and the feeding tube can be removed. Attempts can be made to feed the child by mouth with the tube in place, and there can be a gradual return to normal eating.

Parents can be taught to feed the child with both the gastric and nasogastric tubes. Obviously, a child with such a difficulty will require a great deal of support and encouragement.

Some hospitals have a "swallowing team" who will coordinate and supervise the care of these children.