Possible Side Effects of Chemotherapy, Radiotherapy and Surgery on a Child’s Diet

Changes in Taste and Smell
Chemotherapy, radiation therapy or surgery to the head and neck area can cause temporary changes in your child's ability to taste and smell. Your child may be able to best tolerate foods served cool or at room temperature, because the foods have less taste and smell than hot items. Try using plastic utensils if your child has a metallic taste while eating. Also, try experimenting with foods or drinks that are different from ones your child usually eats. Children seem to like salty foods, such as chips and crackers. Maybe try adding a little extra soy sauce to their food. In addition, keep your child's mouth clean by regular rinsing and brushing.

Poor Appetite
Cancer and its treatments often cause loss of appetite and changes in a child's eating habits. If this happens to your child, try giving him or her small, frequent meals and snacks. Keep nutritious snacks handy to eat when your child does feel hungry. ·

• Try to make mealtime an enjoyable experience and encourage and praise your child at each mouthful.
• Keep your child's mouth clean with regular rinsing and brushing.
• Provide high-calorie, high-protein foods to help your child make the most of each snack or meal.
• If your child is able let them help you shop and prepare the foods.
• Be very patient and try not to get distressed. Avoid arguing, nagging or punishing a child who is unwilling to eat.

Constipation
Medications, changes in eating habits and decreased physical activity can cause constipation and infrequent bowel movements. If your child is constipated, you need to increase the fibre in their diet to help stimulate the bowels. Examples of high-fibre foods include wholegrain breads and cereals, raw fruits and vegetables, dried fruits, seeds and nuts. Drinking plenty of fluids throughout the day, eating at regular times and being physically active can also help relieve constipation. Often a glass of very warm water, first thing in the morning, helps bowel movements. If your child is constipated as result of chemotherapy drugs that slow the movements of the gut, you may be advised to put your child on a low-residue diet instead of a high-fibre diet.

Sore or Irritated Mouth or Throat
Some people with cancer may have a sore mouth, mouth sores or a sore throat. If you have these problems, eating soft, bland foods and lukewarm or cool foods can be soothing. Consequently, foods that are coarse, dry or scratchy should be avoided. In addition, you may find that tart, salty or acidic fruits and juices, alcohol and spicy foods may be irritating and should be avoided. Rinsing your mouth regularly with 1 teaspoon of baking soda dissolved in  8 ounces or 250ml of water or salt water can help prevent infections and improve healing of a sore mouth and throat. 

What to Do for a Sore or Irritated Throat:

• Avoid tangy, acidic or salty foods and drinks such as citrus fruit juices (grapefruit, orange, lemon and lime), pickled and vinegary foods, tomato-based foods and some canned soups.
• Avoid rough-textured foods, such as dry toast, muesli and high fibre cereal and raw fruits and vegetables.
• Choose lukewarm or cool foods that are soothing. Very hot or very cold foods can cause discomfort.
• Stay away from alcohol, caffeine and tobacco.
• Avoid irritating spices such as chilli powder, cloves, curry, hot sauces, nutmeg and pepper.
• Season foods with herbs.
• Eat soft, creamy foods such as cream soups, porridge, cheeses, mashed potatoes, yoghurt, eggs, custards, puddings, cooked cereals, ice cream, casseroles, gravies, syrups, milkshakes and commercial liquid food supplements.
• Blend and moisten foods that are dry or solid. Use in soups or with sauces, gravies and casseroles.
  

• Eat soft, bland foods such as creamed soup, cooked cereal, porridge, macaroni and cheese, yoghurt and custard.
• Puree or liquefy foods in a blender to make them easier to swallow.
• Serve foods cold or lukewarm, rather than hot, to reduce mouth irritation.
• Tilt your head back and forth to help foods and liquids flow to the back of the throat for swallowing.
• Drink through a straw to avoid the sore spots.
• Avoid irritating spices, seasonings and condiments such as pepper, chilli powder, cloves, nutmeg, salsa, pepper sauces and horseradish.
• Avoid rough, dry or coarse foods, which can scratch an irritated mouth or throat.
•  Eat high-protein, high-calorie foods to speed healing.
• Avoid alcohol, carbonated beverages and tobacco.
• Rinse your mouth often with baking soda mouthwash (made with ¼ water and 1 tablespoon baking soda) to remove food and germs.
• Use a child’s toothbrush to clean your teeth gently.
• If you wear dentures, leave them soaking in a denture cleaning solution overnight and leave them out for as long as you can during the day to prevent them chafing your sore gums.

Suggestions for Increasing Calories and Protein for Children :

• Serve your child small meals and snacks rather than large ones.
• Serve food when your child feels hungry and be sure to include high-calorie, high-protein foods.
• Encourage your child to be physically active, as activity may increase appetite.
• Also, encourage your child to eat more when he or she feels well.

Eating Tips for Children
The following tips may help your child eat better. Remember do not make food a battleground. 

• Encourage your child to eat high-calorie, high-protein foods. Don't worry too much about the amount of fat at this time. High-fat items such as hamburgers, fries, pizzas and ice cream provide calories, protein and other essential nutrients.
• Serve frequent snacks, such as peanut butter, cheese or kaya on bread or crackers, hard boiled eggs, high calorie drinks such as milk shakes and cereals with milk.
• Use the Food Guide Pyramid as a guide for good nutrition. (See the Nutrition Society of Malaysia Guidelines at http://nutriweb.org.my)
• Use colourful cups, mugs and straws to encourage your child to drink fluids throughout the day.
• Make "faces" out of fruits and vegetables to encourage your child to eat. (Many children's cookbooks have examples.).
• Serve food in unusual containers or on cartoon character plates.
• Let your child help prepare the food.
• Invite your child's friends to share meals or eat out.
• Plan ahead for meals missed because of doctors' appointments, and treatment appointments. Take along juice packets, plastic bags with snacks.
• Arrange to allow your child to eat snacks in school. Call your doctor if your child has treatment-related problems, such as constipation, diarrhoea, or vomiting.

How to Add Protein to Meals and Snacks Milk products:  

• Use milk instead of water when cooking hot cereal and soups.
• Add powdered milk to soups and milk and fruit shakes.
• Add milk powder to scrambled eggs 
• Eggs: · Keep hard-cooked eggs in the refrigerator.
• Chop and add hard-cooked eggs to curries, noodles, soups, and vegetables. (Cook eggs thoroughly to avoid exposure to harmful bacteria.). 
• Meats, poultry and fish: · Add meat, chicken or fish to soups, porridge, curries, noodles, casseroles and soups. If it is difficult to chew , blend it first. 
• Beans, Peas, nuts and seeds: · Use as snacks in between meals.
•  Have desserts like bubur cha cha and bubur kacang merah.

The Complete Guide to Nutrition and Physical Activity
Use this information to maintain good nutrition and an active lifestyle. The advice is suitable for the whole population, not just those diagnosed with cancer.

Eat a variety of healthy foods, with an emphasis on plant sources. Eat up to nine servings of a variety of vegetables and fruits each day.

• Include vegetables and fruits at every meal and for snacks.
• Eat a variety of vegetables and fruits.
• Limit F rench fries, snack chips and other fried vegetable products.
• Choose 100% juice if you drink fruit or vegetable juices. ( Check the label)

Choose whole grains in preference to processed (refined) grains and sugars:

• Choose whole grain rice, bread, pasta and cereals.
• Limit consumption of refined carbohydrates, including pastries, sweetened cereals, condensed milk, kuehs, soft drinks and sugars.

Limit consumption of red meats, especially those high in fat and processed:

• Choose fish, poultry or beans as an alternative to beef, pork and lamb.
• When you eat meat, select lean cuts and smaller portions. Always remove the fat and skin.
• Prepare meat by baking, steaming or poaching, rather than by frying or charbroiling.

Choose foods that help maintain a healthful weight:

• When you eat away from home, choose food low in fat, calories and sugar and avoid large portions.
• Eat smaller portions of high-calorie foods. Be aware that “low fat” or “fat free” does not mean “low calorie” and that low-fat cakes, cookies and similar foods are often high in calories from sugar.
• Use vegetables, fruits and other low-calorie foods instead of calorie-dense foods such as French fries, cheeseburgers, pizza, ice cream, doughnuts and other sweets.

Adopt a physically active lifestyle

Adults: Engage in at least moderate activity for 30 minutes or more on 5 or more days of the week; 45 minutes or more of moderate to vigorous activity on 5 or more days per week may further reduce the risk of breast and colon cancer.

Children and adolescents: Engage in at least 60 minutes per day of moderate-to-vigorous physical activity for at least 5 days per week.

Ways to Provide Good Nutrition for your Child

Adequate nutrition may provide the following benefits to children with cancer:

• Increase their ability to cope with therapy.
• Decrease the side effects of treatment.
• Promote healing of tissues.
• Prevent or reverse nutrient deficiencies.
• Promote normal growth and development.

Maximize quality of lifeBy Mouth
If at all possible ; eating and drinking nutrient-rich foods and beverages should meet your child’s nutrient needs. Your child may be able to get enough nutrients by eating high-calorie, high-protein meals supplemented with snacks, commercial liquid nutrition products and homemade drinks and blended shakes. However, if it is too difficult for your child to eat and drink enough foods and fluids to maintain and gain weight, or if his or her calorie and nutrients needs have greatly increased, your child may need to use a feeding tube.

By Tube Feeding
Tube feeding involves threading a thin, flexible tube through the nose and into the stomach. Once the tube is in place, liquid nutrition formulae can be pumped through it. If necessary, such formulae can provide 100% of your child's needs for calories, protein, vitamins and minerals. Children who have feeding tubes can usually continue to eat, because the tubes are so small they do not interfere with swallowing. If your child needs a feeding tube, every effort should be made to allow him or her to eat by mouth. For example, he/she may be tube fed at night while sleeping to allow him or her to eat during the day. Keep your child's mouth clean through regular rinsing and brushing. Once tube feedings begin, children usually feel better because their nutrition needs are being met. Most young children get used to tube feedings within a few days. But older children and teenagers may need longer. Talking with another child who has also had a feeding tube may help children who find adjusting to the tube difficult. Tube feedings are usually used to increase weight in children with a poor appetite and for those who are unable to eat and drink. A more permanent type of tube can be surgically placed directly into the stomach (gastrostomy) or the intestines (jejunostomy).

By Total Parenteral Nutrition
Tube feedings may not be able to provide needed fluids and nutrients for children with serious digestive problems. In these cases, nutrient solutions can be given directly through a vein, a type of therapy called intravenous hyperalimentation or total parenteral nutrition (TPN). TPN is most often used in children:

• Who have had surgery in the digestive system
• Who have complete blockage of the intestines
• Who suffer severe vomiting or diarrhoea
• Who experience complications from cancer or treatment that prevent eating or use of a feeding tube.

TPN solutions can usually meet 100% of a child's nutritional needs. Ask your doctor about the nutrients being provided via this method to ensure they are meeting your child’s needs. Like tube feedings, TPN can be given at home.