Why Nutrition Matters
Children undergoing treatment for cancer face a unique set of metabolic and physiological stresses. Adequate nutrition supports:
- Growth and development, which can be impaired by both disease and therapy.
- Immune function, helping to reduce infection risk.
- Tolerance to chemotherapy, radiation, and surgery.
- Overall quality of life, including energy levels and emotional wellbeing.
- Recovery and longterm survivorship outcomes.
Common Nutritional Challenges
Several factors interfere with normal intake and metabolism:
- Loss of appetite caused by nausea, taste changes, or medication sideeffects.
- Gastrointestinal toxicity such as mucositis, vomiting, diarrhea, or constipation.
- Metabolic alterations that increase energy expenditure while reducing nutrient absorption.
- Psychosocial issues including anxiety about food, peer pressure, and family stress.
- Steroid use leading to increased hunger, weight gain, and altered glucose control.
Nutrition Assessment: What to Look For
A systematic assessment should be performed at diagnosis and repeated regularly.
Clinical Screening
- Weightforage and BMI percentiles (or weightforheight in infants).
- Growth velocity over the previous 23 months.
- Physical signs of malnutrition (muscle wasting, edema, hair changes).
- Dietary intake recall (24hour or 3day food record).
Laboratory Indicators
- Serum albumin and prealbumin.
- Complete blood count (focus on hemoglobin and lymphocytes).
- Electrolytes, especially calcium, magnesium, and phosphate.
- Blood glucose and lipid profile when steroids are used.
Risk Tools
Validated tools such as the Pediatric Subjective Global Assessment (PSGA) or the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) help quantify risk and guide intervention.
Practical Nutrition Strategies
1. Energy and Protein Targets
General recommendations for children with cancer are:
- Energy: 100150kcal/kg/day (adjusted for age, activity, and disease status).
- Protein: 1.52.0g/kg/day; higher (up to 3g/kg) during intensive therapy or if there is significant weight loss.
2. Tailored Meal Planning
- Offer small, frequent meals (68 times per day) rather than three large meals.
- Include caloriedense foods: nut butters, avocado, fullfat dairy, and smoothies blended with protein powder.
- Address taste changes by using mild seasoning, cold foods, or novel textures.
- Incorporate the childs favorite foods whenever possible to improve palatability.
3. Managing SideEffects
Nausea/Vomiting: Give clear liquids first, eat bland foods, and consider antiemetics before meals.
Mucositis: Soft, nonacidic foods; avoid citrus, spicy or rough textures; use topical oral rinses.
Diarrhea: Lowfiber, lowfat diet with adequate hydration; probioticrich foods if appropriate.
Constipation: Highfiber foods, adequate fluids, and regular physical activity.
4. Supplemental Nutrition
When oral intake falls below 6070% of needs for more than 57 days, consider:
- Oral nutrition supplements (e.g., highprotein, highcalorie shakes).
- Enteral feeding via nasogastric or gastrostomy tube if the gastrointestinal tract is functional.
- Parenteral nutrition only when enteral feeding is impossible or contraindicated.
5. Micronutrient Considerations
- Vitamin D and calcium: important for bone health, especially with steroid use.
- Iron: monitor anemia; supplement only if deficiency is documented.
- Fluids: maintain hydration; adjust for renal function and treatmentrelated fluid restrictions.
6. Family and Psychosocial Support
Educate caregivers on the importance of nutrition, involve them in meal planning, and address economic barriers. Referral to a dietitian trained in pediatric oncology should be routine.
Resources & Further Reading
- Childrens Oncology Group Nutrition Guidelines (PDF)
- Academy of Nutrition and Dietetics Pediatric Oncology Nutrition Toolkit
- World Health Organization Nutritional Care for Children with Cancer
- Local hospital dietitian services contact information
For personalized advice, always consult the childs oncology team and a registered dietitian experienced in pediatric cancer care.
