Changes in taste and smell

Cancer and its treatment may cause changes in your child's senses of taste and smell. These changes can affect your child's appetite. Here are some tips that may help you get your child to eat:

• Serve foods cold or at room temperature. This can decrease the foods’ tastes and smells, making them easier to tolerate.

• Try using plastic flatware and glass cups and plates if your child has a metallic taste in his mouth while eating.

• Try foods or drinks that are different from ones your child usually eats. Children seem to like salty foods, such as chips, pretzels, and crackers. (Remember, if your child is getting steroids this may be a problem.)

• Freeze fruits such as cantaloupe, grapes, oranges, and watermelon, or buy frozen blueberries and strawberries and eat them as frozen treats.

• Eat fresh vegetables. They may be more appealing than canned or frozen ones.

• Try marinating meats to make them more tender.

• If red meats taste strange, try other protein-rich foods such as chicken, fish, eggs, or cheese.

• Blend fresh fruits into shakes, smoothies, ice cream, or yogurt.

• Keep your child's mouth clean by regular rinsing and brushing.

To lessen smells:

• Cover drinks and have your child drink through a straw.
• Choose foods that do not need to be cooked.
• Do not cook food with strong odors when your child is around.
• Do not eat in rooms that are stuffy or warm.

Poor appetite

Cancer and its treatments often cause changes in a child’s eating habits and loss of appetite. Not eating can cause your child to lose weight and can cause weakness and fatigue. Helping your child eat as well as she can is an important part of helping her through treatment. If your child has been having trouble eating or has had a poor appetite, talk to your health care team. Some general guidelines for when to do this:

• an infant with a poor appetite for more than 3 days
• a toddler or preschooler with a poor appetite for more than 5 days
• a school age/adolescent with a poor appetite for more than 7 days

If your child doesn't want to eat, try giving her small, frequent meals and snacks. Keep nutritious snacks handy to eat when she does feel hungry. Try hard-cooked eggs, peanut butter, cheese, ice cream, granola bars, liquid nutritional supplements, puddings, nuts, canned tuna or chicken, or trail mix. Also try these tips;

• Try to make mealtime fun and praise a healthy appetite or good eating habits. Setting the table with pretty dishes, playing your child's favorite music, watching television, or visiting with friends while eating can also help.

• Offer small meals and snacks throughout the day.

• Keep your child’s mouth clean with regular rinsing and brushing. And keep her mouth moist – don’t let it get dry.

• Let your child eat her favorite foods any time of the day; for example if she really likes breakfast foods, let her eat them for dinner.

• Let your child help you shop and prepare the foods.

• Avoid arguing, nagging, or punishing a child who is unwilling to eat. Talk to the doctor if you are worried that your child isn't eating enough.

Constipation

Certain medicines, changes in eating habits, and being less active can cause your child's bowels to move less often and stools to become harder to pass (constipation). If your child is constipated, your doctor, nurses, or dietitian may suggest adding high-fiber foods to your child’s diet. Examples of high-fiber foods include whole grain breads and cereals, raw fruits and vegetables, dried fruits, beans, and nuts. Drinking plenty of fluids throughout the day, eating at regular times, and increasing physical activity can also help relieve constipation.

Laxatives should only be used if OK'd by your doctor first. Talk to your doctor or nurse about how long your child can go without a bowel movement before you need to do something.

Diarrhea

Cancer treatments and medicines can cause your child's bowels to move much more often and become very loose (diarrhea). Uncontrolled diarrhea can lead to weight loss, dehydration, poor appetite, and weakness. If your child has diarrhea, try these tips:

• Avoid high-fiber foods, like nuts, seeds, whole grains, legumes, dried fruits, and raw fruits and vegetables.

• Avoid high-fat foods, like fried and greasy foods.

• Avoid gassy foods, fizzy drinks, and chewing gum.

• Limit milk or milk products to 2 cups a day. Yogurt and buttermilk are OK.

• Limit apple juice and drinks that contain caffeine.

• Be sure to have your child sip on fluids throughout the day to prevent dehydration.

• If OK with the doctor, have your child drink and eat high-sodium foods, such as broths, soups, sports drinks, crackers, and pretzels.

• If OK with the doctor, have your child drink and eat high-potassium foods, such as fruit juices and nectars, sports drinks, potatoes with the skin, and bananas.

• Increase soluble fiber foods such as applesauce, bananas, canned peaches and pears, oatmeal, and white rice.

Call the doctor if diarrhea continues or increases, or if your child's stools have an unusual odor or color. Once the diarrhea has stopped, talk to your health care team about how to slowly add fiber-containing foods to your child's diet.

Sore or irritated throat and sores in mouth

Some cancer treatments can cause a sensitive mouth, mouth sores, or a sore throat. If your child has these problems, soft, bland foods and lukewarm or cool foods can be soothing. If he is old enough, help your child rinse his mouth regularly with a salt solution (1 teaspoon of baking soda and 1 teaspoon salt mixed in 1 quart water--swish and spit--do not swallow) or other mouth rinse your doctor suggests. This helps prevent infections and improves healing a sore mouth and throat. Also try these tips:

• Try serving milk, ice cream, homemade shakes or smoothies, or canned liquid food supplements or shakes that are high in calories and protein when your child can’t eat enough regular foods.

• Have your child try soft, creamy foods such as cream soups, cheeses, mashed potatoes, macaroni and cheese, yogurt, eggs, custards, puddings, cooked cereals, or casseroles.

• Blend and moisten foods that are dry or solid. Use in soups or with sauces, gravies, and casseroles.

• If your child is in a lot of pain, your doctor may have you give him pain medicine about 30 minutes before meals. (For more information on pain control, please see our booklet, Pain Control: A Guide for Those with Cancer and Their Loved Ones.)

• Have your child use a straw to bypass mouth sores.

• Avoid tart or acidic foods and drinks like citrus fruit juices (grapefruit, orange, lemon, and lime), pickled and vinegary foods, tomato-based foods, and some canned broths.

• Avoid rough-textured or hard foods, such as dry toast, granola, and raw fruits and vegetables.

• Puree or liquefy foods in a blender to make them easier to swallow.

Trouble swallowing

Cancer and its treatment can sometimes cause trouble with swallowing. If your child has this problem, give her soft, liquid, easy-to-swallow foods. Sometimes children may be better able to swallow thicker fluids than thin liquids. Serving high-calorie, high-protein drinks can help boost your child’s nutrient intake during times when he or she is unable to eat enough regular foods. Your doctor may refer you to a speech therapist. She can teach your child how to swallow easier and how to decrease coughing and choking while eating and drinking. Talk to your health care team if you are worried that your child is not eating enough. They can help you figure out if and when nutrition support (such as tube feeding) is needed. Here are some other things that may help:

• Try to get your child to drink the recommended amount of fluid each day and thicken the fluid to the consistency that is easiest for her to swallow. Talk to your health care team about how much fluid your child should try to take in each day.

• Call your doctor right away if your child coughs or chokes while eating, especially if she has a fever.

• Offer small, frequent meals.

• Use canned liquid nutritional supplements if your child is unable to eat enough food to meet her needs.

• Chop or puree your child's food in a blender or food processor.

Thickening products

Talk to your health care team about using thickening products to help your child swallow. Here are some of the things you can use to make liquids thicker and easier to swallow.

• Gelatin: Use to form a soft gel with cakes, cookies, crackers, sandwiches, pureed fruits, and other cold food. Mix 1 tablespoon unflavored gelatin in 2 cups liquid until dissolved; pour over food. Allow food to sit until saturated.

• Tapioca, flour, and cornstarch: Use to thicken liquids. Note that these must be used in cooked foods.

• Commercial thickeners: Follow labeled instructions and use to adjust a liquid’s thickness.

• Pureed vegetables and instant potatoes: Use in soups. Note that these change the food’s flavor.

• Baby rice cereal or instant pudding: Use to make a very thick product.

Nausea and vomiting

Be sure to tell the doctor or nurse if your child feels nauseated or is vomiting. There are medicines that can control this very well. These medicines should be taken on a regular schedule – around the clock-- as prescribed by your doctor. And if a certain medicine does not work, the doctor or nurse should be able to give you another one that might.

If your child has nausea and vomiting, here are some things you can do:

• Be sure to encourage him to drink plenty of fluids to prevent dehydration. Have him sip water, juices, sports drinks, fruit drinks, and other clear calorie-containing liquids throughout the day. Clear cool liquids are usually better than very hot or icy liquids. Gelatin and popsicles are also good ways to get fluids in your child.

• When vomiting has stopped, encourage your child to eat easy-to-digest foods, such as clear liquids, crackers, bread sticks, gelatin, dry cereal, and plain toast.

• Do not give foods that have a strong odor.

• Eat cool foods instead of hot, spicy foods.

• Avoid foods that are overly sweet, greasy, fried, or spicy, such as rich desserts and french fries.

• If your child needs to rest, have him sit up or recline with his head raised for at least 1 hour after eating.

• Try bland, soft, easy-to-digest foods on treatment days. Foods such as Cream of Wheat® and chicken noodle soup with saltine crackers may be easier to keep down than heavy meals.

• Avoid eating in a room that is warm, or that has cooking odors or other smells. Cook outside on the grill or use boiling bags to reduce cooking odors.

• Help your child rinse his mouth before and after meals.

• Older children can try sucking on hard candy, such as peppermints or lemon drops if there is a bad taste in their mouth.

Dry mouth or thick saliva

Surgery and radiation therapy to the head and neck area, some kinds of chemotherapy, and certain other medicines can cause your child to have a dry mouth. Some children may also have thick and sticky saliva. Dryness can be mild or severe, and a dry mouth can increase the risk of cavities or mouth infection.

If your child has either of these side effects, have her drink plenty of fluids throughout the day and eat moist foods as much as possible. Also get her to brush her teeth and rinse her mouth often. Have her brush her tongue, too.

Here are some more things you can try to help your child's mouth feel better:

• Use a straw to drink liquids.

• Have her take small bites and chew her food well.

• Give soft, moist foods that are cool or at room temperature. Try blenderized fruits and vegetables, soft-cooked chicken and fish, well-thinned cereals, popsicles, smoothies, and slushies. Avoid foods that stick to the roof of the mouth.

• Moisten foods with broth, soup, sauces, gravy, yogurt, or creams.

• Give your child sugarless candy or sugarless gum to stimulate saliva. Lemon drops often work well.

• Avoid commercial mouthwashes and acidic drinks.

• Limit drinks with caffeine, such as coffee, tea, colas, and chocolate.

• Use a cool mist humidifier to moisten room air, especially at night. (Be sure to keep the humidifier clean to avoid spreading bacteria or mold in the air.)

• Saliva substitutes are helpful if your child's salivary glands have been removed by surgery or damaged by radiation therapy. These products add moisture to the mouth.

• Talk to the doctor about how well your child has been eating. Nutritional supplements, such as liquid meal replacements, may be helpful during this time.

Unwanted weight gain

Some children do not lose weight during treatment. They may even gain weight. This is often true for those taking certain medicines or some types of chemotherapy. You may find that your child craves unusual foods and may be hungry at unusual times, or even all the time.

If you notice your child is gaining weight, tell your doctor so you can find out what may be causing it. Sometimes, he may gain weight because certain cancer-fighting drugs cause his body to hold extra fluid. If this is the case, the doctor may ask you to talk with a registered dietitian for help limiting the amount of salt he eats. This is important because salt causes the body to hold extra water. The doctor may also want to give your child a diuretic or "water pill." This is a medicine that causes the body to get rid of excess fluid and it will make him have to go to the bathroom a lot.

Increased appetite and food intake and decreased physical activity can also cause weight gain. If this is the case and you want to help your child stop gaining too much weight, here are some tips that can help:

• Try to walk every day your child is able to, if it is OK with your doctor.

• Limit the size of food portions.

• Include plant-based foods like vegetables, whole grains, fruits, beans, and peas in your child's diet.

• Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt).

• Cut back on added butter, mayonnaise, sweets, and other extras.

• Choose low-fat and low-calorie cooking methods (like broiling and steaming).

• Limit high-calorie snacks between meals.

• Talk with a registered dietitian for other suggestions.

Fatigue

Fatigue can be a problem for some children during cancer treatment. If your child feels tired all the time, talk to the doctor or nurse. Fatigue can have many causes, including the cancer treatment, not eating enough, lack of sleep, depression, low blood counts, and certain medicines. Along with treating what's causing the fatigue, there are many things you can do to help your child cope.

• Talk to the doctor or nurse about your child's fatigue. If the fatigue has a medical cause, there might be treatment for it.

• Have your child take short walks or get regular exercise, if possible. More and more research tells us that being moderately active can help decrease cancer-related fatigue.

• Be sure your child drinks plenty of fluids. Dehydration can make fatigue worse. Talk to your health care team about how much fluid your child should get each day. If your child is losing weight, be sure to include some fluids that have calories, such as juices or milk.

• Make sure your child gets enough rest. Have him take some short naps or rest breaks during the day instead of 1 long rest. Plan his day to include rest breaks. Make rest time special with a good book in a comfortable chair or a favorite video with a friend.

• Ask for a referral to a dietitian who can work with you to choose the best diet for your child.

• Try to avoid sugary foods. These foods may give your child a quick energy boost but when it wears off, he will be even more tired.

• Get your child to eat some protein, fat, and/or fiber with each meal and snack. Protein, fat, and fiber can help keep blood sugar more stable. This will give him a more sustained feeling of energy from the food he eats. For example instead of eating 2 pieces of fruit, try giving him 1 piece plus a small handful of walnuts, almonds, peanuts, or other nuts. Or try fruit with cottage cheese.

• Be sure your child gets enough protein. His body needs protein to repair and build new tissue.

• Be sure your child gets the calories he needs.

• Be sure he gets enough vitamins and minerals. A multivitamin supplement that contains no more than 100% of the RDA of each nutrient may help meet this goal. Always check with the doctor or nurse to make sure it is OK for your child to take a multivitamin. Some dietary supplements can interfere with your child's cancer treatment and large doses of some can have harmful effects.

Last Medical Review: 02/06/2009
Last Revised: 02/06/2009