Special Nutritional Issues For Children with Cancer

Weight loss

Staying at a healthy weight can be difficult for some children during and after cancer treatment. Side effects of treatment, taste changes, fatigue, depression or anxiety can all decrease a child’s appetite and make eating difficult. And even if a child is eating enough calories, they may not be getting all the nutrients they need to tolerate and recover from treatment.

Ways to help your child get more protein and calories:

• Encourage your child to eat more when they feel well.
• Serve your child small meals and snacks throughout the day, rather than 3 large meals. Good snacks are peanut butter and crackers, cheese sticks, pudding, fruit roll-ups, and cereal and whole milk.
• Avoid low-fat versions of foods such as low-fat ice cream or low-fat cookies. 
• Try to schedule a snack or meal for when you know your child will be hungry. Be sure to include high-calorie, high-protein foods and some high-fat foods
• Have your child eat their biggest meal when they are hungriest. For example, if they are hungriest in the morning, make breakfast the biggest meal.
• Try to get your child to drink most of their fluids between meals instead of with meals. Drinking fluid with meals can make your child feel full too soon.
• Use colorful cups, mugs, and straws to encourage your child to drink water and other fluids throughout the day.
• Offer water and avoid sugary beverages which can reduce appetite. 
• Use cookie cutters to cut shapes in sandwiches, gelatin, meats, and cheeses.
• Make faces out of fruits and vegetables. (Many children’s cookbooks have examples.)
• Serve food in unusual containers or on cartoon character plates.
• Have picnics. (You can go outdoors or have the picnic in the living room or even the attic.)
• Let your child help plan meals and prepare the food. Help with planning can be as simple as letting the child choose between vegetables.
• Invite your child’s friends to share meals.
• Plan ahead for meals missed because of things like doctors’ appointments and treatment appointments. Take along water, a sandwich on whole wheat bread, fruit or other healthy snacks.
• Encourage your child to be physically active. Activity may increase their appetite.

Don’t force your child to eat but work with them to come up with an eating plan that works for both of you. Don’t make eating a power struggle. Talk to the cancer care team if you don’t think your child is eating enough.

Weight gain

Some children gain too much weight during or after cancer treatment. Studies show that many children getting treatment for cancer eat enough calories, but don’t follow a healthy diet. In fact, the average child with cancer does not eat enough fruits, vegetables, whole grains or dairy foods and eats too many sugary and salty foods. Without the healthy foods, children with cancer may not get all the nutrients they need to tolerate treatment and stay on track with normal growth and development. In addition, these types of diets tend to lead to weight gain which can have negative health effects later in life.  

Your cancer care team can also give you tips on planning meals and snacks that are satisfying, but not high in calories. Ask to meet with the dietitian on your team if weight gain is a concern.  Offer your child fresh, nutritious, filling foods, such as fruits and vegetables, homemade soups, non-processed meats, dairy products, whole grain breads, and whole grain pastas. Your child does not have to feel deprived of their favorite foods, but some changes in the recipe might be wise. Consider thin crust pizza with low sodium cheese for the pizza lover, and baked chicken tenderloin strips and potato fries for the chicken nugget and french fry lover. No food is especially bad, but how it is prepared or the portion size can be unhealthy.  Another option is to have some favorite foods less often, but on a regular schedule (for example once a week).   

If your child has been gaining weight during or after treatment, your focus should be on helping them make healthy food choices and increase their physical activity level. This will help them not only lose the extra weight but will help them learn healthy habits that they can use for the rest of their lives. Cancer treatment may have interfered with their sports activities or school activities and getting them back out there as soon as you can will help. 

Here are some suggestions to increase healthy food choices and increase physical activity. 

• Offer scheduled healthy snacks between meals and avoid “grazing.”
• Encourage your child to be as active as possible, especially once they have finished treatment.
• Go for walks together with your child walking or on a scooter (or riding toy). 
• Check out the local YMCA or community center.
• Go to the park together as a family.
• Try to get active toys for birthdays and important events (basketball, soccer ball, frisbee, riding toy or maybe even a trampoline)  
• Outside the hospital, limit the time on video games, phones and other screens. 
• In the hospital, try to get out for daily walks around the hospital gardens when your child is feeling well enough. 
• Ask your doctor to consult the physical therapy team during admissions, to help with gaining back muscle mass, strength and flexibility. 
• Include plant-based foods like vegetables, whole grains, fruits, and beans in your child’s diet.
• Avoid sugar sweetened beverages such as sodas, sports drinks and some juices. 
• Cut back on sweet sauces (dressings and bbq sauce).
• Avoid frying foods and purchasing foods that have been fried. 
• Limit high-sugar snacks between meals.
• Look at the MyPlate website for ideas for healthy meals and snacks. 

For more ideas about how to help your child include more healthy options in their diet, ask to talk with a dietitian.

Steroids

Some children with cancer take steroids, such as prednisone or dexamethasone, as part of their treatment. The steroids may cause them to gain weight and retain fluid in the face and belly. And children taking steroids usually feel hungry and need to eat often.

You can help your child by making some diet changes to help reduce fluid retention and weight gain. Your doctor, nurses, or dietitian can help you know what to do. They may recommend foods lower in sugar because prednisone can increase the chances of elevated blood glucose levels. They may also suggest foods low in salt (sodium).High-sodium foods, such as most snack chips and pretzels, processed foods, or frozen meals should be avoided. (Those labeled “reduced sodium” are usually OK.) Instead, have your child try foods seasoned with spices instead of salt.

The appetite changes and fluid retention caused by steroids will go away when treatment ends. When steroid treatment ends many children will lose their appetite for a short time. The weight loss that may come with this is expected and will be closely watched. But some children, especially teens, may have a hard time losing the weight gained during treatment. Encouraging them to make healthier food choices while on prednisone (especially lower sugar foods and drinks) and being as active as possible may help.