Make Every Bite Count

By Lita Lopez

Nutrition plays a vital role as your child goes through the process of cancer therapy. A well nourished child undergoing cancer treatment tolerates treatment better, tends to have less severe side effects of therapy, has fewer treatment delays and dose reductions of chemotherapy, heals more quickly and tends to feel better and stay more physically active.

It is best to maintain a nourished state or correct underweight or excess weight early in the cancer therapy so as to avoid a problem requiring specialized nutrition therapy. The emphasis is on providing good nutrition at home in between treatments. As one mother of a child undergoing treatment advised, “Stuff him to the gills” at home when your child is feeling well and where familiar and favorite foods are easily available.

The type of cancer and stage of treatment determine the risk for developing feeding problems and malnutrition. Cancers associated with high nutritional risk include advanced or metastatic neuroblastoma and Wilm’s tumor, acute myeloid leukemia, abdominal or nasopharyngeal sarcomas, and some types of brain tumors. Infants who are diagnosed with any type of cancer are also at high risk.

Malnutrition can develop as a result of radiation to the abdomen, poor appetite, nausea, vomiting, diarrhea, mucositis (mouth sores) and taste changes, intense frequent courses of chemotherapy (less than every 3 weeks), major abdominal surgery, advanced disease and lack of family or health care
support system.

To address a child’s decreased appetite and weight loss, suggestions include:

• Plan for 2-3 snacks in addition to 3 meals daily; avoid letting your child drink and eat all day. However, there may be exceptional days when your child feels good and you want to give any food your child requests at whatever time of the day or night. The child who eats only a few select food items may need supplements to meet her caloric and protein needs.

• Practice the “division of responsibility” as defined by Ellyn Satter: you, as a caregiver, are responsible for offering nutritious meals and snacks at designated times and your child is responsible for how much and whether he will eat.

• Make every bite and every sip count. Serve foods that are rich in calories and protein. limit “empty” calorie foods and drinks that can cause the child to feel full quickly such as soda, juice and candy. If your child is overweight, serve low calorie foods with plenty of vitamins and minerals such as fresh fruits and veggies.

• Encourage regular mouth rinsing and brushing to keep the mouth clean.

• Make mealtime an enjoyable experience. Avoid arguing, punishing or bribing a child who cannot or will not eat. It is better to preserve your relationship than waste your time and energy with food struggles.

• Many children don’t eat as well when they are in the hospital. Do not offer favorite foods while your child is getting chemo. If she gets sick eating that  food, she will most likely refuse to eat it thereafter.

• Sometimes an oral nutritional supplement such as Pediasure, Kid Essentials, Carnation Instant Breakfast or Resource Breeze may be necessary
to help with poor intake.

Another form of nutritional risk is excess weight. Children with leukemia who receive corticosteroids as part of their treatment are at high risk for excess weight gain because of increased appetite and decreased physical activity. Steroids may also cause high blood sugars, high blood pressure and weak
bones. So what can you do?

• Limit salty foods to prevent fluid retention.

• Offer low-fat milk and water only. Limit sugarcontaining drinks including fruit juice, sweet tea, soda, Kool-Aid, lemonade, etc.

• Have plenty of fresh fruits and vegetables to offer for snacking.

• Use lower fat products such as skim or low fat milk. Avoid fried foods and junk foods.

• Keep your child active.

• Limit watching TV or video games to less than 2 hours per day.

• Be careful about food choices when eating out or buying prepared meals.

• Offer foods rich in calcium and in some cases, a calcium supplement may be necessary.

Types of Nutrition Support

1. Oral feeding is indicated in children with low nutritional risk, less advanced disease or if the disease is in remission on maintenance chemotherapy. However specialized nutrition support may be necessary if the child is malnourished or if the child has severe weight loss and not expected to eat sufficient amounts of food.

2. Tube feeding is indicated where it becomes too difficult for the child to eat and drink enough to maintain or gain weight or if calorie and nutrient needs have greatly increased. Most children feel better and start having more energy once they are getting enough formula.

3. Parenteral Nutrition provides calories and nutrients intravenously using the central line or the port. It is generally used after surgery of the gastrointestinal tract, complete blockage of the intestine, severe mucositis, severe nausea, vomiting or diarrhea despite medicines. PN should be started only if tube feeding is not a possibility because it poses higher risk for infections, can make the kidneys and liver work harder and does not maintain a healthy intestinal tract.

While your child is being fed through a feeding tube or intravenously to supplement his poor intake, it is important to see if your child will eat. Even if he eats a small amount, it is best to continue to offer food to prevent future feeding problems when the tube feeding or intravenous nutrition is discontinued.

Be sure to talk to your child’s doctor, nutritionist or any member of the oncology team for any specific questions and concerns you have regarding your child’s nutrition.

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