CHILDHOOD CANCERS DIET
Monica Adhikari*
Consultant Dietician, Great Ormond Street Hospital, London.*
What is cancer?
Cancer is the collective term given to a growth of body cells beyond the control of normal growth regulatory mechanisms (neoplasm or new growth). A neoplasm may then form into a mass of these 'rebel' cells with abnormal cell division pattern (tumour).

What happen to the nutritional status in cancer?
Cancerous cells compete with other bodily cells for nutrients and therefore put the body in a state of hyper metabolism. This condition of increased nutrient requirement that is unsatisfied by an increased food intake in cancer is called cachexia. Cancer cachexia is quite unlike starvation, which is rather hypo metabolism with decreased energy that is reversed with adequate nutrition.
Cancer cachexia is characterized by loss of appetite, progressive tissue wasting, weight loss and anaemia. Commonly experienced is a change in taste, particularly for sweet and bitter sensations.

Why is nutrition important?
Good nutrition is very important when a child is treated for cancer. Children with cancer often have poor appetite due to one or more following reasons:

- The hospital environment
- Side effects of chemotherapy or radiation
- Depression
- Change in cells of mouth which may alter the way food tastes
- Inadequate absorption of calories, vomiting and diarrhoea

How do I know if my child is nutritionally at risk?
The dietician assesses the nutritional status by comparing your child's weight with the height. Your child will need nutritional support if: -

- He/she has a 5-10%body weight loss.
- He/she has poor weight gain over 2-3 months
- He/she have poor oral intake.

Nutritional management:
Children with cancer have increased calories and protein needs. Protein is needed for growth and to help the body repair itself. Getting enough calories can help body grow, heal and prevent weight loss.

Following ideas /suggestions on how to increase your calories and proteins:
Fat gives us twice number of calories of proteins and carbohydrates foods therefore using foods high in fat will help.

1 Butter, oil, and ghee: -
- To spread thickly on bread, toast, paratha, chapattis, to add on rice
- To cook vegetables, meat with extra ghee or oil
- To have sweets made with ghee and butter

2 Use fortified milk (making it richer): -
- To add 4 tsp of milk powder to usual milk to increase its calories and protein.
- To use this milk to make: kheer, ice cream, milk shake, Vegetables, dhal, soups, Coffee, tea.
3 Always use:
· Full fat milk (buffalo's milk)
· Cream (malai)
· Cheese
· Dahi (yoghurt)
· Ghee
· Eggs
· Honey sugar
· Condensed milk
· Nuts
· Beans and legumes (dal)

A suggested meal plan for a 5yr old child with cancer and undergoing chemotherapy:
Usual requirements are 1600 calories but increased requirements are 1900 calories:
To use fortified milk in all preparations.

Breakfast 1 cup milk with 1tsp sugar
Egg scrambled with one slice bread
Or
1 small paratha stuffed with cheese /paneer
Or
1 small bowl of ragi porridge/ rava porridge Or1 bowl of cornflakes with milk
Mid morning 1 glass banana milkshake and two biscuits
Lunch 1 chapatti¼ katori rice¼ katori vegetable¼ katori dal½ katori curd
Afternoon 1 cup milk½ katori poha or upma (with added sprouts)
Or
1 potato patties with cheese
Or
1 fruit (apple or banana)
Dinner Same as lunch but dal could be substituted with fish curry or chicken curry or any meat based curry)
Bedtime 1 cup of complan or milkshake

- katori - 150ml/gm
- glass - 200ml
- cup- 150 ml
- tbsp- 15gm/ml
- tsp- 5gm/ml

The common problems related to treatment and their management: -

Loss of appetite
  • Try small frequent meals/snacks 5-6 per day
  • Do not put too much food on the plate or use smaller plate
  • Try to make meals interesting e.g. Colourful, well arranged on the plate, cut in different forms and shape.
  • Avoid fatty rich foods
  • Involve child in shopping and preparing meals
Nausea
  • Try small amounts of food at a time
  • Cold foods may be better tolerated
  • Avoid fatty or greasy foods
  • Avoid hot and spicy foods
  • Dry foods e.g. dry biscuit toast may be tolerated
  • Avoid cooking smell
Vomiting
  • Have mouth washes regularly to help remove the taste
  • Take sips of clear cool fluids/drinks
  • Nibble on dry biscuits or toast
  • Try easily digestible foods like juice, clear broth, rice or dhal water weak tea
Sore mouth/throat
  • Soft foods like mashed potato mashed vegetables, mashed rice/dhal dahi, rice kheer, ice cream Avoid citrus fruits, spicy or salty food
  • Use straws for drink
  • Cut food in small pieces
  • Serve food with more sauces and gravies since easier to swallow
Dry mouth
  • Have frequent drinks
  • Crushed ice or ice cubes to suck may help Suckling boiled sweets or mint may help stimulate saliva production
  • Cold foods can be soothing, ice-cream, dahi, milkshakes, jelly
Taste changes
  • To use spices and fresh herbs like coriander, pudina (mint)
  • Use different things to add flavour like maggi flavour cubes, sauces
  • Vary the colour and texture of the food.
  • Offer foods that look and smell good

The treatment of cancer can be difficult for any one and any age. Supportive care (treatment of disease side effects or symptoms from various members of health care team, including dieticians and child life therapists can make nutritional aspects of treatment less difficult. Making tasty high calories snacks and possible alternative to oral nutrition are part of supportive care.
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