Management of pediatric treatment effects

Nutritional management of treatment side effects

Your child’s cancer treatment (chemotherapy, radiation, medications and surgery) may cause side effects such as nausea, vomiting or diarrhea, which can contribute to poor nutrition and poor growth. Other factors that may influence how well children eat or maintain their weight include:

• The hospital environment
• Depression
• Changes in the cells of the mouth, which may alter the way food tastes
• Inadequate absorption of calories due to vomiting and diarrhea
• Food odors (that can be avoided by using cold plates or serving food cool or at room temperature)

If a child with cancer maintains adequate nutrition, then 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

Nutritional side effects of cancer treatment and suggestions

As each child’s individual medical profile and diagnosis is different, so is his or her reaction to treatment. Side effects may be severe, mild or absent. Be sure to discuss with your child’s cancer care team any/all possible side effects of treatment before the treatment begins.

• Decreased appetite
  • Try smaller, more frequent meals and snacks.
  • Try changing the time, place and the 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 — doing so may make your child’s appetite worse.
  • Make mealtime a happy time.
  • Have mini-meals or snacks ready so that a fleeting appetite can be addressed immediately. 
• Mouth sores
  • 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 or grapefruit)
    • Spicy or salty foods
    • Rough, course or dry foods (i.e., raw vegetables, crackers or toast)
  • Use pear, peach and apricot nectars and pudding pops.
  • 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.
• Taste alterations
  Sweet foods are often the first to lose their appeal. Many commercial supplements are especially sweet, so your child may not want them. Continue to try alternatives until you find something your child will accept.
  • 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.
  • Give your child plastic utensils.
  • Offer foods that look and smell good.
  • Keep your child's mouth clean by rinsing and brushing.
• Dry mouth
  • Try sweet or sour foods, and drinks such as lemonade.
  • Offer hard candy, frozen treat 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.

Chewing gum can stimulate gastric secretions and help to increase appetite but it also can cause physical fatigue in a child with cancer and therefore be a possible choking risk.

• Nausea and vomiting
  • Try easy-to-digest food such as clear liquids, gelatin, toast, rice, dry cereals or 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.
• Diarrhea
  Try to avoid high-fiber foods including the following:
  • Nuts and seeds
  • Whole grains
  • Dried beans and peas
  • Raw fruits and vegetables

Try to limit gassy (i.e., beans, cauliflower, broccoli, cabbage, onions), fatty or fried foods. Offer small, frequent meals and drink liquids throughout the day. If lactose intolerance is a problem, limit milk and milk products.

• Constipation
  Incorporate 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.

• Tooth decay
  • Use a soft toothbrush and take your child to the dentist regularly.
  • Encourage rinsing the mouth with warm water when gums and mouth are sore.
  • Encourage brushing teeth after eating meals and sweets.
  • Limit foods that stick to the teeth such as caramels, taffy, gummy candy or chewy candy bars.

Helpful hints

Use creative meal presentations. Instead of pancakes and sausage, make a butterfly. Use the sausage link for the butterfly body, cut the pancake in half and place the rounded edges against the link.