Childhood Cancer : Diet, Infections

by National Cancer Institute

(Page 10 of 14)

Diet

Many side effects from cancer treatment may make it hard for your child to eat. Some physical side effects include loss of appetite, sore mouth, changed sense of taste, nausea, vomiting, diarrhea, constipation, and weight gain. The emotional side of cancer treatment may also affect your child's eating habits. When children are upset, worried, or afraid, they may have eating problems. Losing his or her appetite and feeling nauseated can be normal when your child is nervous or afraid. The treatment team, including the nutritionist/dietitian at the hospital where your child receives treatment, can help you plan the food to serve at home. Let the team know if you notice that your child is losing or gaining weight. Ask what has worked for other children. The good news is that even children who have trouble eating have days when eating is a pleasure. The following suggestions may help your child feel more like eating:

Serve appealing food.

Build meals around your child's favorite foods, but do not force favorite foods during nausea attacks. Forcing may cause a lasting dislike of the food.

Try always to give high-calorie foods (for example, macaroni and cheese with real butter and cheese, or milkshakes made with ice cream). Add instant breakfast powders to all milk and milk products.

Adopt a casual attitude about mealtimes.

Let your child eat whenever he or she is hungry or offer food often during the day. Have high-calorie, high-protein snacks handy. Taking just a few bites of the right foods or sips of the right liquids every hour or so can help increase your child's intake of proteins and calories. You can freeze portions of a favorite dish and serve them when your child wants them.

Oral medicines may affect your child's appetite. Some are best given in the morning, some at midday, and some on a full stomach. Ask the doctor when and how medicines should be given. Tell the doctor if your child has no appetite or has any other side effects.

Try changing the time, place, and surroundings of meals. A picnic, even if it is in the house, can make mealtime more fun. Watching a favorite TV show or inviting a special friend to join your child at meal or snack time also can help your child feel more like eating.

Create a pleasant setting.

Make mealtimes calm and relaxed. Do not hurry meals.

Praise good eating. Try using small rewards, such as a favorite dessert or a new toy, to encourage good eating. Siblings should be considered when setting up a reward system. It is important that siblings are not left out, but be careful not to encourage healthy siblings to overeat.

Avoid arguing, nagging, or punishing. Forcing a child to eat may make things worse.

If your child's eating becomes a serious problem, ask your child's doctor about medicines that can improve appetite.

Sometimes children gain extra weight during treatment because of the buildup of excess water in the body. Do not put your child on a diet. Instead, call the doctor. If the weight gain is due to extra water, the doctor may recommend using less salt, because salt causes the body to hold onto water. The doctor may also order medicines called diuretics to get rid of the excess water.

Children who have cancer need diets high in both calories and protein. High-calorie foods help prevent weight loss, and protein foods help the body stay strong and repair itself. To get your child to eat more protein and calories, try these tips.

Offer liquids during the day, but not at mealtimes. Liquids are filling and take away an appetite for solid foods. Give your child a straw to make drinking easier.

Some types of chemotherapy may change your child's sense of taste for a while. Well-seasoned foods, such as spaghetti, tacos, and pizza, may seem good at such times. Sometimes, adding extra salt or sugar, or using less, may make foods taste better.

Avoid empty-calorie foods, such as soft drinks, chips, and candy, that can make your child's appetite worse without providing good nutrition. Milkshakes, yogurt, fruit, juices, or "instant breakfasts" provide extra calories and protein.

You will also find many helpful suggestions in NCI's booklet Eating Hints for Cancer Patients 13, available from the CIS at 1-800- 4-CANCER (1-800-422-6237) or TTY at 1-800-332-8615. It is also available online.

Infections

Infections are common in children who have cancer, especially in children who are receiving chemotherapy. Chemotherapy lowers the white blood cell count, which increases the chances of infection. You should report any sign of infection, such as a fever, to your child's doctor right away.

Infections are usually caused by bacteria or viruses. To find the cause of your child's infection, the doctor may take samples (cultures) of the throat, blood, urine, or stool. If the infection is from bacteria, your child will receive antibiotics. Antibiotics will not work against viruses. Unless a virus has been identified, however, most children are treated with antibiotics until their blood counts improve, even if bacterial infection cultures are negative. Your child may receive other medicines to help ease the symptoms. If the infection is serious, or the white blood cell count is very low, your child may need to be treated at the hospital. Your child's doctor may also stop the cancer treatment for a short time until the infection is gone.

Some viral infections, such as chickenpox, can cause major problems for a child receiving chemotherapy. Call the doctor right away if your child is exposed to chickenpox or to anyone who has recently received the chickenpox vaccine. And ask your child's teachers to let you know if a schoolmate develops chickenpox. Some families ask teachers to ask schoolmates' families to call them at once if chickenpox develops in their families.

Once children have had chickenpox, they usually do not get it again, but some children on chemotherapy who have already had chickenpox may develop shingles. Shingles is a blister-like skin rash that looks like chickenpox. Instead of appearing all over the body, however, shingles is in just one area. Call the doctor right away if you think that your child may have shingles.

Regular or red measles (also known as rubeola or 9-day measles) may also be more serious for a child on chemotherapy. If your child comes into contact with this type of measles, you should call the doctor. The doctor may give your child medicine to prevent or control the infection.

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