Good nutrition is important for the child, adolescent or young adult with cancer. It helps them grow, repair tissues damaged by therapy, have less side effects of therapy and feel better. Nutritional needs of children differ with age, sex, body size, and general state of health, as well as the type of cancer and treatment. 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 have fewer side effects
• Have improved wound healing
• Grow and develop
• Maximize quality of life

Special Diets for Children with Cancer

Children with cancer often have greater 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 doctor or dietitian may suggest they eat high-calorie and high-protein foods (e.g., eggs, milk, peanut butter, cheese, nuts and beans). They also may suggest that your child try oral supplements such as Carnation Instant Breakfast, Ensure, Boost or Pediasure.

Sometimes, even when high-calorie and high-protein foods are offered, children with cancer have trouble eating enough. When this happens, medications that increase your child’s appetite may be used.

Tube feedings may be needed to help provide your child enough 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 doctor and dietitian will teach you about the types of formulas that can be given through these tubes and will talk with you about a plan for feeding your child using these tubes.

Children that are having treatment for cancer sometimes need IV nutrition, called total parenteral nutrition (TPN). When needed, TPN can be a good way of giving complete nutrition that is managed by the dietitian, pharmacist and doctor. A dietitian will be involved your child’s care during the hospital stay and when they are seen at clinic appointments. The dietitian will make goals for how much your child needs to eat and drink. They will also talk with you about your child’s growth and weight gain goals. Sometimes during treatment, children can become very uninterested in eating, especially if they have had lots of nausea, vomiting, or pain with eating. If this happens, a speech language pathologist can work with your child to help them start eating again. They can also give you tips to help with eating at home.

Managing Treatment Side Effects and Nutrition

Your child's cancer treatment (chemotherapy, radiation and / or surgery) may cause side effects that make it hard to eat enough food. These 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 setting of meals.
• Let your child help with shopping and fixing meals.
• Offer high-calorie, high-protein meals and snacks.
• Do not force your child to eat – this may make your child's appetite worse.
• Make mealtime a happy time.

Mouth Sores

• Use soft foods that are easy to chew.
• Do not use foods that may cause irritation to the mouth. Some foods that can do this are:
• Citrus fruits or juices (i.e., orange, tangerine, grapefruit)
• Spicy or salty foods
• Rough, course, or dry foods (i.e., raw veggies, crackers, toast)
• Cut foods into small pieces.
• Serve foods cold or at room temp – hot foods may bother 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.

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 other temperatures.
• Offer a variety of foods, including new foods or foods your child did not use to like.
• Keep your child's mouth clean by rinsing and brushing.
• Offer new foods or foods your child did not used to like.
• Use plastic forks, knives, and spoons if your child has a taste like metal in their mouth.

Dry Mouth

• 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.

Nausea and Vomiting

• Try easy-to-digest food such as clear liquids, toast, rice, dry cereals, and crackers.
• Do not offer 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 drinks throughout the day.

Diarrhea

• 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.

Constipation

• Include high-fiber foods, such as:
• Whole grain breads and cereals
• Raw fruits and veggies
• Raisins, prune juice, or apple juice
• Drink plenty of fluids; hot drinks are sometimes helpful.
• Keep the skin on veggies when cooking them.
• Add bran or wheat germ to foods such as casseroles, cereals, or homemade breads.
• Continue normal activities and exercises.

General Instructions

The treatment of cancer can be hard for a person of any age. Supportive care (treatment of disease side effects or symptoms) will be recommended by members of the healthcare team, including dietitians and speech language pathologists. These treatments and recommendations can help your child meet his or her nutritional goals. Ideas such as making a child-centered environment, making tasty, high-calorie snacks and alternatives to oral nutrition are a part of the supportive care included in the treatment of cancer.

Each child is different and each child tolerates treatment differently. Your child's dietitian and healthcare team will talk to you about the best way to help your child meet his or her nutritional goals during treatment.

Even after the end of treatment, it is important to check whether your child’s nutrition is still adequate to support growth and development.