Nutrition and Side Effects

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Cafeteria at St. Jude — Hospital stays can interfere with normal eating routines and make it hard to eat healthy.

During cancer or other serious illness, many children have trouble eating healthy and meeting nutrition goals. Problems with eating and nutrition can result in:

Weight loss
Delayed growth
Feeling tired or irritable
Getting sick more easily
Weakness and lack of energy for physical activity

Poor nutrition can be due to several factors. Children who have problems with their mouth, stomach, or intestines are at a higher risk of not getting enough nutrients because they have trouble eating or digesting food. Changes in routine or meal restrictions during hospital stays or medical treatments can interfere with normal eating. Children may also have decreased appetite due to pain, stress, worry, and lack of physical activity.

For many children, treatment side-effects or other symptoms make it hard to meet nutrition goals. There are strategies that can help families address specific side effects and nutrition problems.

Tips for nausea and vomiting
- Eat plain, bland foods, such as cereal, canned or fresh fruit, rice, noodles, toast, mashed or baked potato, soup, crackers, plain meat, or chicken.
- Eat 6 to 8 small meals a day.
- Avoid spicy, heavy, fried, sweet, fatty or foods with strong odors.
- Eat and drink slowly; take small bites and sips.
- Have solid food and liquids at different times. Drink beverages between meals instead of during meals.
- If food smells are a problem, prepare or open foods in another room. Choose cold or room-temperature foods. Use cups with lids.
- Learn the best times to eat around treatments.
- Allow some time for food to digest before being active.
- Create a calm environment for mealtimes.
- Eat dry foods, such as toast, crackers, or dry cereal after waking up and throughout the day.
- Suck on hard candies, such as lemon drops and fruit-flavored candy to help relieve nausea and bad taste in the mouth.
- To further relieve bad taste in the mouth, rinse the mouth before eating with 1 to 2 ounces of a homemade mouth rinse. To make the rinse, mix 1 teaspoon of baking soda, ¾ teaspoon of salt, and 1 quart of water.
- Be careful about eating favorite foods when feeling sick to avoid negative associations with those foods.
- Drink beverages chilled and with a straw.
Tips for diarrhea
- Drink plenty of liquids.
- Eat smaller meals.
- Choose mild foods that are easy on the stomach.
- Try the BRAT diet: bananas, rice, applesauce, and toast. Limit this diet to only for a few days, as it is too low in some nutrients.
- Eat slowly and chew food well.
- Choose high-fiber foods wisely:
  
  Soluble fiber found in oatmeal, oat-based cereals, applesauce, bananas, and the inside of apples, pears, and peaches can help firm loose stool.
  
  Insoluble fiber found in leafy greens, fruit/vegetable peels, skins and seeds could make diarrhea and cramping worse.
- Avoid carbonated drinks, beans, cabbage, cauliflower, and broccoli if experiencing stomach cramps.
- Foods to limit or avoid:
  
  Caffeine
  
  Milk and dairy products
  
  Juice and sugary drinks
  
  Foods that are spicy or high in fat or sugar
  
  Foods that are very hot or very cold
Tips for constipation
- Drink plenty of liquids and try warm beverages.
- Drink beverages with caffeine, including coffee, tea, and cola.
- Drink a hot beverage or eat hot cereal first thing in the morning.
- Eat more foods with fiber such as fruits, vegetables, and whole grains.
  
  Choose whole grain breads and cereals. Read food labels and look for choices with 100% whole wheat, rye, oats, or bran as the first or second ingredient.
  
  Eat brown or wild rice instead of white rice or potatoes.
  
  Bake with whole wheat flour. You can use it to replace some white or all-purpose flour in recipes.
  
  Eat baked beans more often.
  
  Add dried beans and peas to casseroles or soups.
  
  Choose fresh fruit and vegetables with the peels/skins on instead of as juices.
  
  Eat snacks of dried fruit, such as prunes, raisins, or craisins.
- Increase physical activity.
Tips for sore mouth and throat
- Eat soft foods such as pudding, Jell-O, mashed potatoes, mac and cheese, applesauce, bananas, and ice cream.
- Use a blender, or cut food into small pieces so it is easier to eat.
- Use a straw to make liquids easier to swallow.
- Offer cold foods like popsicles, ice cream, milkshakes, smoothies, or flavored ice.
- Let cereal soak in milk to soften it before eating.
- Include fruits and vegetables through soups, stews, smoothies, and pureed fruit pouches.
- Use a slow cooker to create moist, tender meals.
- Add gravies to meats.
- Avoid salty, spicy, sour, or very strongly seasoned foods, as these foods may burn the mouth and throat.
- Avoid hard or rough foods like toast and crackers.
- Have a good mouth care routine:
  
  Use a soft toothbrush after meals and snacks.
  
  Gently place the brush onto each tooth, and move it in a circle. Do not press too hard which could injure the gums.
  
  Use dental floss after brushing to clean well between the teeth. Be gentle so as not to injure the gums.
  
  Use foam brushed dipped in water if the mouth is too sore to be brushed.
  
  Use a mouth rinse if recommended by the care team.
  
  Keep lips moisturized.
  
  Be sure to see a dentist regularly to check for any cavities or dental concerns.
Tips for changes in taste
- Offer chicken or fish instead of beef or pork.
- Marinate fish, chicken, and other protein foods.
- Add flavor with strong-tasting seasonings.
- Try cold foods like egg salad, cheeses, and shakes.
- Offer strongly flavored, tart, or spicy foods, such as citrus, chocolate, lasagna, spaghetti, or barbequed meats (unless mouth or throat sores are present).
- Take small sips between bites to rinse away bad tastes.
- Add sauces to foods.
Tips for dry mouth
- Encourage plenty of fluids.
- Add extra butter, gravies, and sauces to foods.
- Rinse your child’s mouth often.
- Have your child suck on ice chips, popsicles, gum, and hard candies to help keep their mouth moist.
- If your child does not have mouth sores, offer sweet or tart foods.
Tips for poor appetite
- Eat small meals and snacks throughout the day.
- Sip on milkshakes, smoothies, and soups.
- Try new foods and seasonings.
- Eat foods with extra calories, such as ice cream, stuffed potatoes, or casseroles.
- Start with small portions and increase gradually.
- Use plastic utensils if food tastes like metal.
- Set reminders to eat. For example, set a phone alarm, or plan to eat at specific times even if not hungry.
- Eat favorite foods any time of the day. For example, eat breakfast foods for dinner if that’s what sounds good.
- Keep snacks close by.
- Take a walk before meals or do light exercise to increase appetite.
- Limit liquids during meals to allow more room for food.
- Present foods in an attractive way to make them more appealing. Try serving foods on colorful plates or plates that feature a favorite character.
Tips for feeling full too fast
- Offer small meals more often instead of large meals only a few times a day.
- Drink liquids between meals instead of with meals. Avoid high-calorie liquids during meals.
- Add extra butter, gravies, and sauces.
Tips for cramps, heartburn, and bloating
- Encourage your child to eat slowly.
- Offer small meals more often instead of larger ones only a few times a day.
- Avoid gas-forming foods, such as nuts, beans, broccoli, and onions.
- Avoid fried, greasy, and spicy foods.
- Try bland, low-fat foods.
- No matter what, some children may have trouble with appetite. Some general strategies to improve nutrition include:
- Encourage your child to eat six times a day. Try to plan three meals and three snacks.
- Power pack meals. Offer the high calorie version of food or add extra margarine, cheese, gravy, or sauce to foods to make each bite count.
- Maintain variety. Offer a variety of foods from all food groups, according to the Dietary Guidelines for Americans.

How parents can support nutrition goals

Help children plan eating around times when they are feeling better. Photo shows a childhood cancer patient eating a grilled cheese sandwich in the hospital cafeteria. — Help children plan eating around times when they are feeling better.

During a serious illness, eating habits can change unexpectedly. It can be easy for mealtimes to become stressful for families. These reminders can help families meet nutrition needs.

Encourage your child to eat and enjoy food when feeling well. Many children find that the desire to eat changes at different points during treatment. Parents can help children plan eating around times when they are feeling better.
Offer favorite foods and drinks. This is particularly important when a child is too sick to eat or drink much. Offer desired foods often to help encourage your child to eat.
Don’t be pushy. Gently remind your child when it's time to eat. Trying to force children to eat can cause children to resist more. Trying to “win” a battle over food can also cause more stress on families.
Be flexible. Offer choices, follow cravings, and don’t get stuck on having to follow a “normal” schedule.
Maintain routine. Like flexibility, routine is also important. Eating is a bonding time for most families. Continue family meal traditions even if the child wants to eat something different or nothing at all.

Nutritional supplements

Nutritional supplements or meal replacements may be needed if your child has trouble meeting nutrition needs with food. These are usually liquid meal replacements and are available in a variety of flavors. If your child loses weight, your care team may recommend nutrition products such as Pediasure^® or Ensure^®. In some cases, your care team may give medicine to help improve your child’s appetite.

Talk to your child’s care team when poor eating continues for more than two or three days. Be sure to ask before using any supplements or meal replacements. Some products may not be safe or could interfere with your child’s treatments. You care team may suggest help from a nutrition professional. Read more about Clinical Nutrition and nutrition support.

Good nutrition helps pediatric patients achieve normal growth, continue to take part in daily activities, and improve overall health.

For more information on nutrition and healthy weight for families, see We Can – Nutrition Tools and Resources.

Key Points

Good nutrition is important for your child’s normal growth and development, overall health, and ability to do daily activities.
Side-effects of treatments can make it hard for your child to eat healthy and meet nutrition goals.
Talk to your child’s care team when poor eating continues for more than a few days.
Your child’s care team can help you plan nutrition strategies to cope with specific side effects.