Louise Henry, Advanced Dietetic Practitioner (Paediatrics and TYA) at The Royal Marsden Hospital, gives an overview on nutrition while a child is receiving cancer treatment, including its challenges and tips to support families.
Nutrition is an important part of supportive care for all children receiving cancer treatment. Research tells us that patients who are well nourished, which means not too thin or too overweight, tolerate treatment better and may even spend less time in hospital. Having good nutrition, which includes all the energy, protein, vitamins and minerals they need, supports the child throughout treatment and beyond.
How is diet and nutrition affected by cancer and its treatment?
Every child’s different when it comes to the impact of their cancer and its treatment on their appetite and diet. For some, the challenges may resolve themselves quickly, while for others they may come and go depending on their treatment cycle, and for a few, they may exist throughout treatment. Usually, children will return to their pre-diagnosis eating and drinking patterns at the end of treatment.
Many factors affect how children feel about eating and drinking when on treatment and it can be very stressful for patients and their families. Younger children are often diagnosed at a stage in their development when they’re exploring foods and developing their own food habits, likes and dislikes.
Having treatment that affects appetite, taste and bowel function means the normal development of food behaviours can be affected, leaving some children with very selective eating habits. For older children, they may already be selective eaters, or they may use what they’re willing to eat or not eat as a way of trying to make a statement or control one aspect of their care. At any age, the key is to work together with your healthcare team to support your child and use different strategies to encourage a balanced diet. Unfortunately, there isn’t a quick fix, but it can be helped by being consistent and trying some of the tips on the opposite page.
Who is most likely to have problems eating and drinking?
Every child is different, and it’s difficult to say who will have the hardest time eating and drinking. Younger children, children undergoing transplant or highdose chemotherapy, children having radiotherapy affecting the mouth or throat, and those with larger tumours are at higher risk of struggling to eat and drink enough. Children who have steroids throughout treatment or have problems with mobility have a higher chance of gaining too much weight.
What can I do if my child is losing weight or won’t eat?
Nutrition isn’t only about keeping a healthy weight. We also need to make sure that children have enough protein, vitamins and minerals in their diets, too. If you’re worried about your child’s diet, ask to speak to the dietitian who’ll be able to make a full assessment and provide advice on how to improve the balance of their diet, how to enrich or fortify foods, and if you need to give your child extra vitamins or minerals. If eating and drinking is difficult, they may recommend a form of ‘nutrition support’ (see page 16). Its aim, no matter what type is used, is to return to eating and drinking as soon as possible, although many factors affect how quickly this may happen.
What if my child’s gaining too much weight?
This can be a problem for some children, especially if they’re taking steroids. Research has shown that some children find it difficult to have a balanced diet or lose any excess weight at the end of treatment, so it’s a good idea to look at their diets early on in treatment and to try to avoid excessive high fat, salty snacks if they have a good appetite. Try to keep a balanced diet with plenty of fruit and vegetables and wholegrain carbohydrates to keep your child feeling fuller, for longer. Aim to stick to three meals per day with two or three ‘healthy’ snacks in-between and encourage your child to keep active, where possible. The NHS website has lots of useful tips and ideas for promoting healthy eating for children and you can speak to your dietitian for more individual advice.
Should any foods be avoided?
Children having treatment for cancer can become very unwell if they develop food poisoning. The NHS recommends avoiding foods known to have a higher risk of causing food poisoning.
Good food hygiene is essential for all patients and the NHS website and Food Standards Agency have some great advice on the safe preparation, cooking and storing of foods. The food hygiene rating scheme in England and Wales (the free ‘Scores on the Doors’ app) is very useful if you chose to eat out.
Helping with selective eating
- Make sure your child’s symptoms are well controlled: speak to your team about medication to control nausea or vomiting, mouth ulcers and infections, constipation and diarrhoea
- Try to keep normal food routines: encourage regular meals and, if possible, try eating together (even in hospital, parents, brothers and sisters are great role models for encouraging eating and making mealtimes fun)
- Never force-feed children or follow them around with food as this can add to stress and anxiety around food and doesn’t usually help them eat more
- Mealtimes should last no longer than 20-30 minutes. Remove any leftover food without comment or fuss
- Taste changes are very common: experiment with lots of flavours and textures, especially if your child reports that food doesn’t taste nice or as it should
- Involve your child in preparing and cooking food. This is a great family activity and often inspires children to try new foods
- It can be helpful to limit food choices at mealtimes – children often don’t know what they want to eat, so having a couple of easy-to-make choices can help them decide
- Clear the table, have a break and offer some food later if a mealtime is getting too stressful
Other useful resources
Download or order our ’Helping your child to eat well during cancer treatment’ publication
Or visit:
- Scores on the doors
- NHS Inform
- Home food fact checker
- The Infant & Toddler Forum CIC
- BDA All Food Fact page
From Contact magazine issue 101 - Winter 2023
