Feeding a child with cancer: 5 goals to keep in mind

Having a child who is seriously ill is a very stressful situation. It is very challenging to make a child eat during treatment. Every child is different and may eat differently or may have a much harder time eating at all. If the only thing you accomplish is a less stressful mealtime for a child who is going through treatment, then you have accomplished a lot.

If to avoid making food the center of a “war” is the 1st goal, you will find here under step by step, the different priorities you and your medical team will work on to ensure the proper nutrition of your child during treatment.

GOAL #1: PEACE, NO STRESS

ESTABLISH PRIORITIES

Food should not become the center of a war or a struggle. We have to acknowledge that a child who is in the hospital has no control over what is happening to him or her and many times has a poor understanding of what is going on. Some children realize that the only thing they can control is what they do or do not eat. Refusing to eat, can be a way for the child to try to control the situation.

Children undergoing treatment for cancer have many reasons for not eating. The side effects of chemotherapy and radiation include dry mouth, nausea, vomiting, diarrhea, constipation, lack of appetite, and taste changes. All those side effects can contribute to poor dietary intake, resulting in weight loss.

Establish priorities with the medical team in your child’s nutrition during treatment. For each day or part of the treatment, have goals or priorities. Those priorities and goals will change during the treatment. Key priorities are peace, no stress; food safety; gut stimulation; caloric requirements; and nutrition.

YES, COMFORT FOOD IS OK!

When a child gets sick, it is a crisis situation. Therefore, our priorities are different from when a child is healthy. When a child is healthy, we know that a diet high in fresh fruit, vegetables, legumes, whole grains, and fish is beneficial. Those dietary recommendations are not realistic for a child undergoing treatment for cancer. Our first priority is to avoid making food the center of a “war.” The child is already exposed to many stressors, and it is not desirable to add another one.

The more relaxed the parent is regarding dietary intake of their child, the more comfortable the child feels trying new things and expressing his or her feelings regarding food.

Some children while in the hospital (a foreign place) want to have something that is familiar to them. They want a food prepared by their mother or request a “comfort food,” which is food that is simply prepared and associated with a sense of home or contentment. Some examples of comfort foods are: pizza, pasta, cookies, chocolate...

This food makes us “feel good.” Comfort food is usually high in carbohydrates and fat. This “feeling good” also has a physiological explanation. Carbohydrate-rich food increases the availability of tryptophan, which increases the level of serotonin in the brain and results in a better mood. Another explanation for the link between food and mood is that foods that taste good may promote the release of endogenous opioids and thereby alter one's mood.

Another important aspect of comfort food is the social dimension. Comfort foods are those familiar to the child and associated with safety and emotional comfort. Therefore, it is absolutely normal for a child who is in the hospital to consume food that provides comfort but may not provide the best nutrition.

Many times it is easier to drink than to eat. Therefore some patients “drink” their calories in form of shakes, juices, or other drinks. Many commercially prepared dietary supplements are available.

GOAL #2: FOOD SAFETY

LOW-BACTERIA DIET

Patients undergoing treatment for cancer are often neutropenic. This means that they have a very limited ability to fight infection. A low-bacteria Diet, sometimes called neutropenic diet, may reduce the risk of bacterial infection in immunocompromised patients. There are a lot of controversies about the low-bacteria diet and questions about whether it is beneficial or whether standard food safety alone is enough to protect the patient. Some hospitals in the United States and in Western Europe do not educate patients about the low-bacteria diet and have not seen any increase in infection. In general, the low-bacteria diet is recommended in countries with low sanitary standards, probably all low-income countries and in countries with a hot climate.

FOOD SAFETY FIRST

The St. Jude Children’s Research Hospital of Memphis (USA) recommend the low-bacteria diet to all patients with acute lymphoblastic leukemia during induction, reinduction, and any time their absolute neutrophil count is less then 500; to all patients with acute myeloblastic leukemia during the entire time of treatment; and to all patients after allogeneic bone marrow transplant until their T cells return to the normal range. Solid tumor patients and patients undergoing autologous transplant do not have to follow low-bacteria diet, but are educated about food safety.

GOAL #3: GUT STIMULATION

The gut is a muscle that needs to be working; otherwise, it will atrophy. If a patient even takes small bites of food or if enteral nutrition (tube feeding) is initiated, it will prevent atrophy. The wall of the small intestine contains villi, and on top of the villi are microvilli, which make the surface of the gut extremely large for appropriate absorption of nutrients. If the gut is not stimulated, those villi will atrophy in a couple of days, making future absorption of nutrients difficult. For gut health, it is important that patients continue to eat at least bites of food and sips of drink, even on days when eating is difficult.

If patient is on parenteral nutrition, but not on nothing by mouth (NPO) for a medical reason, the patient should be encouraged to eat. On some occasions the patient has to be NPO either for a procedure or because of a medical condition. In that case, NPO status is medically appropriate and necessary. This decision will depend on the doctor’s orders.

GOAL #4: CALORIC REQUIREMENTS

Calorie requirements during treatment are usually higher. Children already have significantly higher calorie requirements than adults if calculated per kilogram of weight. The younger the child is, the higher the calorie requirement is per kilogram of weight. It is because of the rapid development during childhood, growth, and greater physical activity.

During treatment, it can be quite challenging to provide all the calories a child needs for appropriate growth, tissue repair, and development. Protein requirements are also higher because of growth.

In children up to about 10 years of age, the brain has the highest metabolic rate of all organs. At that age, brain development is very important, and we need to make sure that appropriate nutrients are provided. The situation is complicated by the fact that many drugs cause diarrhea or affect the digestion and absorption ability of the gut.

The dietitian calculates each patient’s resting calorie needs (those are needs when the child is sleeping) and adds a stress factor to estimate total calorie needs for each patient. In some medical conditions, calories need to be decreased or increased. Protein needs also may need to be adjusted, depending on renal and liver function. Those recommendations are done based on the recommendations of the medical doctor, the dietitian, or both working together.

GOAL #5: NUTRITION

The last goal is nutrition. This does not mean that appropriate nutrition is not important during treatment; it means that when we have met all the previous goals, then we can finally focus on nutrients and appropriate nutritious food. Diet consists of macronutrients: carbohydrates, protein, and fat; and micronutrients: vitamins and minerals.

A healthy diet should include plenty of vegetables in cooked or raw form, fruit, protein in the form of lean meat (fish, chicken, etc.) or plant-based protein (soy, legumes, etc.), whole grains (brown rice, whole wheat, etc.), nuts and seeds, oils (olive oil), and dairy (yogurt, etc.). Well-balanced vegetarian and vegan diets are also appropriate.

Article extracted from a SIOP conference in March 2010 in Accra, Ghana by Terezie Mosby, St. Jude Children’s Hospital, Memphis (USA)

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