By Guest Blogger Hilary Woo, Dietetic Intern, Texas Woman’s University
Fighting with food has been a motto that I’ve had ever since deciding to pursue a career as a registered dietitian. In fact, the moment I decided to be a dietitian was during a volunteer program in high school at the MD Anderson Cancer Center. I’ve always known that I wanted to work in pediatrics in some field whether it be as a nurse, doctor, dietitian, teacher, etc. However, MD Anderson helped me to find my passion in nutrition, and for that reason as well as personally being impacted by cancer through family members, I’ve been drawn to the idea of working in pediatric oncology.
In this blog post, I’ll be discussing the importance of nutrition and how to overcome some of the side effects that childhood cancer patients may experience that may inhibit adequate nutrition. Nutrition is important in all children to promote healthy and strong bodies. The phrase that many of my undergraduate professors would emphasize is “growth is the goal for children,” and the way to aid children in proper growth is proper nutrition. In childhood cancer patients, nutrition is especially important since these children have higher nutrition needs (calories, protein, fat, carbs, water, vitamins, minerals- the whole ordeal) and many times treatments can interfere with a child’s eating habits. Research has shown that depending on the type of cancer, the prevalence of malnutrition in pediatric cancer patients can be as high as 50%.
Malnutrition is defined as the lack of proper nutrition, and it can affect pediatric oncology patients’ treatment tolerance, risk of infection, proper growth & development, and quality of life. Therefore, it is important that these children are eating properly during and after treatment. Many time treatments and medications can diminish a child’s intake and cause digestive problems that make them feel uncomfortable after eating. These can cause the child to be malnourished and not properly grow/develop. Therefore, I will be highlighting some of the common side effects of treatment and how to combat them.
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Changes in appetite
Many cancer patients will find that their usual appetite is decreased from treatments. One of the ways to overcome this is to serve the child smaller, more frequent meals so that their stomachs aren’t as stuffed after each meal. If you think about in your personal experience, eating a big meal may leave you uncomfortably full and not hungry for the rest of the day; however, if you’re snacking throughout the day, you may find yourself not realizing how much you ate because you don’t have that uncomfortably full stomach. Additionally, involving the child in the meal planning and preparation is a way to get them excited about eating the food that they helped to prepare. This could look like having them pick out their favorite dishes, letting them tag along during the grocery store trip, and even helping around the kitchen by either mixing some ingredients. Allowing them to be involved works as an incentive to eating their creation! Another way to overcome changes in appetite is to incorporate nutrition supplements (Kate Farms, Abbott, Nestle products) since these products pack around 350 calories into a single drink. These companies all have pediatric formulas and it allows for children to get their calories in a smaller
volume compared to a full meal so that they can avoid weight loss.
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Changes in taste and smell
During treatment, the child may feel nauseous and uneasy to certain tastes and smells, which make foods unappealing. The main thing that the child’s caretaker can do to alleviate this is to reduce these smells as much as possible since it’s estimated that 80% of taste is based off of smell. Serving foods that don’t give off strong odors, avoiding serving hot foods, and ensuring that the eating area is well ventilated are great ways to reduce odors that can make food unappealing to the child. I think that an example that many people can relate to for understanding the importance of ventilation is that being in a small gym without open windows or much ventilation is much less pleasurable compared to working out with others in an outdoor gym or even a large gym with good ventilation. Additionally, many children experience a metallic taste during treatment which can be avoided by avoiding red meat and metal silverware. Other alternatives for protein instead of red meat could be chicken, fish, eggs, cheese, etc. Since each
child is different, much of figuring out what the child likes and can tolerate is trial and error.
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Constipation
Many children may experience constipation due to treatments and different medications. To treat constipation, it is important to incorporate high fiber foods such as raw, whole fruit and vegetables as well as whole grains. I’ll use this section to emphasize the importance of whole fruit compared to fruit juices. A medium apple contains about 4.4 grams of fiber, and although apple juice tastes great, a cup of apple juice only contains 0.5 grams of fiber. Therefore, while fruit juices are a great way to increase calorie intake in children with cancer and can be used to ensure hydration, whole fruits are important to consume for fiber. Additionally, it is important for the child to drink adequate fluid throughout the day as well as engage in physical activity when possible.
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Diarrhea
On the opposite side of the spectrum, children may also experience diarrhea. Therefore, the recommendation in this case is to avoid high fiber foods as well as greasy foods. Excess dairy can often trigger diarrhea, so in episodes of diarrhea it is suggested to limit dairy to 2 cups per day. Additionally, since the child would lose excess fluid due to diarrhea, it is important that they sip on fluids throughout the day to replenish the lost fluid.
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Nausea and vomiting
Lastly, nausea and vomiting are common with chemotherapy as well as with some medications. Much like the recommendation for diarrhea, replenishing fluids will be very important since our bodies need adequate fluid to function properly. Foods that are soft, bland, and odorless are recommended in hopes to avoid triggering nausea. Along with this, foods that are easy to digest are recommended, such as clear liquids (soups, broths, Gatorade), bread, crackers. It’s also important for the child to rest after each meal so that the food can digest and not come back up. I think that everyone knows that warrior’s pediatric cancer patients are. As a future registered dietitian my hope is that I can work to help improve their quality of life/care and provide ways for these children to be adequately nourished so that they can grow and heal properly. While we currently don’t live in a world free of childhood cancer, we can help to provide them the best care and resources so that these kids can go back to being kids.
Resources:
1. Co-Reyes, E., Li, R., Huh, W., & Chandra, J. (2012). Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatric blood & cancer, 59(7), 1160–1167. https://doi.org/10.1002/pbc.24272
2. The Importance of Child Nutrition. Medical Associates of Northwest Arkansas. (2018). https://www.mana.md/the-importance-of-child-nutrition/.
3. Fullmer, M. (Ed.). (2016). Nutritional Needs for Kids With Cancer (for Parents) – Nemours KidsHealth. KidsHealth. https://kidshealth.org/en/parents/cancer-nutrition.html.
4. American Cancer Society. Nutrition for Children with Cancer. https://www.cancer.org/treatment/children-and-cancer/when-your-child-has-cancer/nutrition.html.
5. Ben H. The Top High Fiber Foods- How Many Do You Eat? Swanson Vitamins. (2015). https://www.swansonvitamins.com/blog/health-news-and-opinion/high-fiber-foods.