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Nutrition and Side Effects

During cancer, many children have trouble eating and meeting nutrition goals. Problems in 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

Cancer-related problems in eating and nutrition can be due to a number of factors. Children who have tumors of the 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 make it hard to meet nutrition goals.

lunch time in a pediatric cancer hospital cafeteria

Hospital stays or medical treatments may result in changes in routine that interfere with normal eating. Side effects from treatments add to eating and nutrition troubles. There are tips below that can help pediatric cancer patients and their families address some side effects and nutrition problems.

Help for Nutrition Challenges Due to Side Effects

Chemotherapy, radiation therapy, surgery, or other treatments may result in nausea, vomiting, diarrhea or constipation, and poor appetite. Treatments can cause painful sores to develop along the mouth and throat. The taste and smell of foods can also change, and even favorite foods may no longer be appealing. There are strategies that can help families address specific side effects and nutrition problems.

    • 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 6-8 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 meal times.
    • 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 (Recipe: 1 teaspoon of baking soda, ¾ teaspoon of salt, and 1 quart of water solution).
    • Be careful about eating favorite foods when feeling sick to avoid negative associations with those foods.
    • Drink beverages chilled and with a straw.
    • 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
    • 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.
    • Increase intake of 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.
    • 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.
    • Eat small meals and snacks throughout the day.
    • Sip on milkshakes, smoothies, and soups.
    • Try new foods and seasonings.
    • Eat foods with extra of 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 at 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.

    No matter what, some children may have trouble maintaining an appetite during cancer. Some general strategies to improve nutrition include:

    • Eat six times a day – three meals and three snacks.
    • Power pack meals – offer the high fat 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 pediatric cancer, eating habits can change unexpectedly. It can be easy for meal times to become stressful for families. These reminders can help families in meeting nutrition needs.

  • Encourage children to eat well when feeling well. Many patients find that the desire to eat changes at different points during a cycle of treatment. Parents can help children plan eating around times when they are feeling better.
  • Lean on favorite foods and drinks. This is particularly important when a child is too sick to eat or drink much. 
  • Don’t be pushy. Gently remind patients 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 interaction for most families. Continue family meal traditions even if the child is eats something different or nothing at all.
Pizza oven with three pizzas cooking by a wood fire

To support nutrition goals during pediatric cancer, try to be flexible during meal times. Offer choices, follow cravings, and don't get stuck on having to follow a "normal" schedule.

Nutritional Supplements

Nutritional supplements or meal replacements may be used if the child has trouble meeting nutrition needs through foods. These are usually liquid meal replacements and are available in a variety of flavors. Talk to the 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. You care team may suggest help from a nutrition professional. In some cases, clinical nutrition support may be needed.

Weight Gain

Although weight loss and malnutrition are a main concern for many families, children may also gain weight during cancer treatment. Increased inactivity and fewer opportunities to exercise may be a cause. Or it may be due to eating more high-calorie, high-fat foods.

Some medications, such as steroids, can cause weight gain. This is because steroids increase the appetite, cause the body to make fat instead of muscle, and cause the body to retain water.

Talk with the child’s care team to decide the best course of action about weight gain.

Tips to help with weight gain include:

  • Eat more fruits and vegetables.
  • Cut back on high fat, high calorie foods. Choose:
    • Low-fat or skim dairy products
    • "Light" and fat-free products
    • Lean meats
    • Foods that are baked, broiled, grilled, boiled, microwaved, or roasted foods, with minimal amounts of fat
  • Limit sweet drinks, including cola, juice, punch, sweet tea, lemonade, and Kool-Aid. Substitute diet or sugar-free drinks if recommended by the care team.
  • Limit portion sizes.
  • Increase physical activity level.
  • Make healthy choices as a family.
  • Eat slowly. Take time to enjoy foods.
  • Eat only when you are hungry.

Good nutrition helps pediatric cancer patients achieve normal growth and weight gain, continue taking 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.

Eating Hints from National Cancer Institute

Reviewed: June 2018