NUTRITION IN CHILDHOOD CANCERS
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).
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
- Side effects
of chemotherapy or radiation
- Change in cells
of mouth which may alter the way food tastes
absorption of calories, vomiting and diarrhoea
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.
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.
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.
oil, and ghee: -
· To spread thickly on bread, toast, paratha, chapattis, to add on
· To cook vegetables, meat with extra ghee or oil
· To have sweets made with ghee and butter
fortified milk (making it richer): -
· To add 4 tsp of milk powder to usual milk to increase its calories
· To use this milk to make: kheer, ice cream, milk shake, Vegetables,
dhal, soups, Coffee, tea.
· Full fat milk (buffalo's milk)
· Cream (malai)
· Dahi (yoghurt)
· Honey sugar
· Condensed milk
· Beans and legumes (dal)
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.
1 cup milk with 1tsp sugar
Egg scrambled with one slice bread
1 small paratha stuffed with cheese /paneer
1 small bowl of ragi porridge/ rava porridge Or1 bowl of cornflakes
1 glass banana milkshake and two biscuits
1 chapatti¼ katori rice¼ katori vegetable¼ katori
dal½ katori curd
1 cup milk½ katori poha or upma (with added sprouts)
1 potato patties with cheese
1 fruit (apple or banana)
as lunch but dal could be substituted with fish curry or chicken
curry or any meat based curry)
of complan or milkshake
- 1 katori -
- 1 glass -
- 1 cup- 150
- 1 tbsp- 15gm/ml
- 1 tsp- 5gm/ml
common problems related to treatment and their management: -
small frequent meals/snacks 5-6 per day
not put too much food on the plate or use smaller plate
to make meals interesting e.g. Colourful, well arranged on the
plate, cut in different forms and shape.
fatty rich foods
child in shopping and preparing meals
small amounts of food at a time
Cold foods may be better tolerated
Avoid fatty or greasy foods
hot and spicy foods
Dry foods e.g. dry biscuit toast may be tolerated
Avoid cooking smell
mouth washes regularly to help remove the taste
Take sips of clear cool fluids/drinks
Nibble on dry biscuits or toast
easily digestible foods like juice, clear broth, rice or dhal
water weak tea
Soft foods like mashed potato mashed vegetables, mashed rice/dhal
dahi, rice kheer, ice cream Avoid citrus fruits, spicy or salty
straws for drink
food in small pieces
food with more sauces and gravies since easier to swallow
ice or ice cubes to suck may help Suckling boiled sweets or mint
may help stimulate saliva production
foods can be soothing, ice-cream, dahi, milkshakes, jelly
To use spices and fresh herbs like coriander, pudina (mint)
Use different things to add flavour like maggi flavour cubes,
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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