Nutrition In Children With Cancer

Nutrition in Children with Cancer

Pediatric patients can sometimes maintain adequate nutrition while dealing with cancer and the myriad of treatments. However, at least half of these children have trouble maintaining their normal weight and level of activity and are more prone to frequent infections ("Nutrition in children", 2005). Children who suffer from cancer often have problems with nutritional deficits due to side effects of chemotherapy, radiation or surgery. These children often have difficulty maintaining an adequate diet because of cachexia, stomatitis, xerostoma, aphagia, nausea, vomiting, and diarrhea. Some of the options for correcting nutritional imbalances include nutritional counseling, total parenteral nutrition, IV therapy, supplements, and pharmacological treatments.

Progressive deterioration in nutrition status is often termed cancer cachexia, a wasting syndrome characterized by weight loss, anorexia, early satiety, progressive debilitation, and malnutrition that result in a greater risk of organ dysfunction and death (Esper, D., & Harb, W., 2005). Experts are unsure of the specific cause of cancer cachexia. Often, a multidisciplinary approach can help improve the outcome of the child's treatment. A multidisciplinary team consists of a dietician, nurse, physician, social worker, and occupational and physical therapists. Play therapy and music therapy are good, holistic approaches as well. Each member of this team provides their area of expertise in dealing with all aspects of the patient's illness. Assisting the family of the child to increase their awareness of the side effects of treatments and ideas on how to improve the child's quality of life, as well as maintaining a sense of normalcy is important.

Stomatitis, an inflammation of the mouth, is a common side effect of chemotherapy. Patients may have difficulty eating due to sores in the mucosal lining of the mouth. Sometimes these sores become infected and may take considerably longer to heal due to the immunosuppression that often occurs with chemotherapy treatment. They may also experience thrush, which is a yeast infection in the mouth. Some medications can cause xerostoma, or dry mouth, which alters the taste of food and can cause difficulty swallowing. The absence of saliva can interfere with digestion, especially of carbohydrates.

Preventative measures taken before starting a chemotherapy regimen should include a visit to the child's dentist to clear up any dental problems and to gain specific recommendations from the child's dentist for oral care during and after treatments. The dentist may prescribe a fluoride rinse or daily fluoride supplement to prevent tooth decay as chemotherapy may increase the likelihood of forming new cavities ("Nutrition and cancer", 2005). Using an extra soft toothbrush, daily flossing and rinsing with a mild mouthwash that is free of alcohol will also help with the prevention of mouth sores becoming infected.

Treatments for stomatitis include medications such as Stanford solution or Magic mouthwash, which contain analgesics; the child should swish this solution in his mouth and either swallow or spit it out according to the physician instructions (Deglin, J. & Vallerand, A. 2005). Viscous lidocaine, used as a mouth rinse to coat the lining of the mouth and numb the sores, is often helpful to some cancer patients when given before meals. These solutions help reduce pain so the child will be able to tolerate eating. Physicians may also prescribe pain medications 30 minutes prior to eating. A Nystatin rinse is prescribed if the child is suffering from oral thrush. The child should swish the solution around in his mouth for 30 seconds and then swallow the solution (Deglin, J. & Vallerand, A. 2005). Swallowing this medication is helpful because the esophagus probably has thrush as well.

Treatments for xerostoma include regular rinsing of the mouth, good oral hygiene, and plenty of liquids. Chewing sugarless gum or sucking on hard candy may help with dry mouth. Adding gravy, butter or sauces to foods help moisten dry foods and makes them easier to chew and swallow. Lip balm or petroleum jelly on the lips may also be helpful. Occasionally, a physician may prescribe an artificial saliva solution to help maintain moisture in the mouth and throat ("Nutrition in cancer", 2005).

Non-medicating treatments include providing foods that are bland and easy to chew. Soft or even liquid diets may be necessary. Children usually prefer cooler temperatures ("Nutrition in children", 2005). Milkshakes, ice cream, puddings and fruit smoothies are usually tolerated well. Soft fruits such as bananas and applesauce, oatmeal, mashed potatoes and Jell-O are other easy to eat foods. Foods that are high in protein and have a smooth texture are soft boiled or scrambled eggs, cottage cheese, and macaroni and cheese. Some foods to avoid due to the irritating or acidic nature of the food; tomatoes or tomato sauces, orange juice and other citrus fruits or juices, hard foods such as toast or crackers, some raw vegetables and spicy or salty foods. Sometimes thickened liquids are easier to swallow ("Nutrition in cancer", 2005).

Another issue is aphagia, or a lack of appetite. This is a common side effect of chemotherapy, some types of radiation, especially of the digestive tract, and surgeries, often because of delayed eating combined with side effects of medications (Olsson, U., & Bergbom, I & Bosaeus, I, 2002). Children may also not feel hungry because of inactivity.

Small, frequent meals and nutritious high protein, high calorie snacks can help with the child who gets full quickly ("Nutrition and cancer", 2005). Good oral hygiene is extremely important to avoid developing thrush and stomatitis. Rinsing the child's mouth often can help alleviate the dry mouth associated with some chemotherapy medications. Other tips for parents include letting the child plan for meals and participate in shopping. Being flexible in the types of

food served and allowing the child to share meals with friends may help to encourage eating. And most important, "avoid arguing, nagging or punishing a child who is unwilling to eat." ("Nutrition and cancer", 2005).

Nausea and vomiting are common complaints when the child has chemotherapy treatments or radiation of a tumor in the digestive tract ("Nutrition in children", 2005). Some of the pain medications prescribed can have the side effect of nausea. Having the child eat a snack or drink a glass of milk before the administration of pain medication may reduce or eliminate the nausea caused by pain medicines. There are numerous medications to counteract