Navigating Nutrition During Cancer Treatment
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Navigating Nutrition During Cancer Treatment

ByChloe Carter, RN, BSN

Food and water are the most basic physiological needs to sustain life. Food and water give us the energy to think, move, grow, and interact in the world. For these reasons, nutrition is an important focus for optimizing your child’s health, especially when undergoing cancer treatment. Children with cancer are at high risk for under- and overnourishment due to the underlying disease processes and side effects from treatment. Your child’s nutritional status can affect overall treatment tolerance, quality of life, and risk for infection. Thankfully, there are ways to combat these nutrition problems. 

Cancer treatments like chemotherapy, radiation, and even surgery can cause unpleasant side effects like nausea, vomiting, dry mouth, change of taste or smell, and mucositis. These symptoms can affect your child’s ability to eat or drink. Here are some ways to combat these problems:

Side Effects from Cancer Treatment

Nausea/Vomiting

Nausea and vomiting are not only unpleasant symptoms but they can be dangerous, leading to dehydration and accidental inhalation of food, water, or gastric contents which can cause choking or aspiration pneumonia. Here are some tips for managing your child’s nausea/vomiting (Eating problems caused by your child’s treatment: ACS, 2022):

  • Talk to your healthcare team. They may be able to prescribe medication to help control nausea.
  • Have your child take anti-nausea medicine at the first signs of nausea so that it has time to work and prevent vomiting.
  • Pay attention to triggers. For example, certain smells can induce nausea. To reduce food triggers:
    • Use kitchen vents to pull smells out of the house while cooking.
    • Try plastic utensils instead of metal. Metal can create a bitter taste.
    • Eat cold foods. Heating food intensifies aromas.
  • If nausea happens in between meals, do not skip meals. Try to have your child eat something small in between meals.
  • Eat a small meal or snack before chemotherapy treatment.
  • Offer clear liquids (apple juice, ginger ale, broth, tea) and bland foods (crackers, bread). 

Dry Mouth

Dry mouth occurs when there is not enough saliva or saliva production slows. Radiation to the head and neck and some types of chemotherapy can damage salivary glands, causing this to occur. Here are some tips and tricks to help you manage your child’s symptoms (Eating problems caused by your child’s treatment: ACS, 2022):

  • Have your child drink lots of water and eat moist foods.
  • Have your child sip liquids with meals to aid in swallowing and help moisten food.
  • Have your child brush their teeth and tongue and/or rinse their mouth often.
  • Avoid sugar and caffeine.
  • Try sugar-free candies or gum to stimulate saliva production. Cinnamon, mint, or citrus flavors work well.
  • Try ice chips.

Change of Taste and/or Smell

Changes in taste and/or smell can occur from certain cancer treatments. It may last as long as the treatment or linger for some time after treatment ends. Here are some tips and tricks to help you manage your child’s symptoms (Eating problems caused by your child’s treatment: ACS, 2022): 

  • Rinse your child’s mouth with a mouthwash mixture of baking soda, salt, and water before eating to help foods taste better.
    • To create this mixture at home, mix 1 teaspoon of salt and 1 of teaspoon baking soda in 4 cups of water. 
  • Freeze fruits of your child’s liking for a frozen treat.
  • Counter a salty or bitter taste by adding sweeteners. Counter a sweet taste by adding something sour and/or salty like lemon juice or salt.
  • If there is a lack of taste, try new seasonings for added flavor.

Mucositis

Mucositis is inflammation of mucous membranes in the mouth or the gastrointestinal (GI) tract, which includes the throat, stomach, small intestines, and large intestines. This appears as mouth sores and can make eating and swallowing painful. Here are some tips and tricks to help manage your child’s symptoms related to mucositis (Eating problems caused by your child’s treatment: ACS, 2022):

  • Have your child use a soft toothbrush or mouth swab to keep the mouth clean.
  • Avoid very spicy, salty, acidic, and/or sugary foods, which can further irritate sore areas.
  • Consult your child’s doctor. They may prescribe medication for pain.
  • Have your child use a straw, which can help guide liquids away from mouth sores.
  • Try chilled foods and fluids for comfort.

What to Expect if Your Child is Undernourished

The best way to get nourishment is through the GI tract by chewing, swallowing, and digesting food as it passes from the stomach to the intestines. However, your child may not be eating enough due to the side effects of various cancer treatments. If your child is losing weight and not able to eat at least fifty percent of the recommended nutritional intake for more than five consecutive days, then your child is at risk of being undernourished. Your healthcare provider will be able to assess further whether alternative forms of nourishment are required.

Tube Feeding

An alternative way to increase caloric intake is through enteral nutrition, also known as tube feeding, which sends the nutrients straight to the digestive tract. Some forms of tube feeding include nasogastric tubes, nasoduodenal tubes, nasojejunal (NJ) tubes, or in more serious cases a gastrostomy tube. The nutritional formula administered through the tube is chosen based on your child’s age and gastric function. The formula will give your child all the required calories, protein, vitamins, and minerals they need. Tube feedings can be given in the comfort of your home. Your healthcare team will teach you how to do this. Enteral nutrition may not be possible if your child has severe vomiting, mucositis of the GI tract, GI obstruction, or GI bleeding. 

Parenteral Nutrition

Another feeding alternative is parenteral nutrition, which is the administration of nutrients via an intravenous line (IV). This is usually the last resort, as it is more invasive and is administered for a short amount of time. Once your child’s stomach or intestinal issues resolve, an effort will be made to move back to tube or oral feeding (Pedretti et al., 2023).

What To Do If Your Child is Overnourished

There is a possibility that your child can gain weight during cancer treatment from steroid therapy. Steroids cause fluid retention, increase blood sugar levels, and usually increase hunger cues, causing the urge to eat more often. Encourage your child to avoid salty foods, foods high in sugar, and heavily processed foods. Usually, once the steroid treatment ends any fluid retention or appetite changes will resolve. Some overall tips to help manage your child’s weight are (Pedretti et al., 2023):

  • Offer healthy snacks and avoid grazing when bored or not truly hungry.
  • Encourage physical activity like playing sports, going to a park, walking, riding bikes/scooters/toys, etc.
  • Limit time spent on electronic devices.
  • Add in vegetables with every meal and snack.
  • Avoid sugary snacks, fried foods, and processed foods.

Nutrition is an important part of the health of your child during cancer treatment. Overall, consuming foods and liquids are the most ideal way to get the nutrients you need. However, advancements in medicine have made it possible to get nutrients in other ways such as with feeding tubes and IVs. Consistent calorie intake is important. Focus on high-calorie, high-protein meals, snacks, and drinks to maximize nutritional intake with each feeding. Regular nutritional monitoring should occur at diagnosis and throughout treatment. Make sure to work with your healthcare team to create a nutritional plan and provide updates along the way so that diet changes can be made if needed. 

References 

American Cancer Society. (2022, June 22). Eating problems caused by your child’s treatment: ACS. Eating Problems Caused by Your Child’s Treatment | ACS | American Cancer Society. https://www.cancer.org/cancer/survivorship/children-with-cancer/nutrition/treatment-side-effects-taste-and-smell-changes.html

Pedretti L, Massa S, Leardini D, Muratore E, Rahman S, Pession A, Esposito S, Masetti R. Role of Nutrition in Pediatric Patients with Cancer. Nutrients. 2023; 15(3):710. https://doi.org/10.3390/nu15030710

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