Cancer and its treatment weaken your child's immune system by affecting the white blood cells that protect us against disease and germs. As a result, your child's body cannot fight infection, foreign substances, and disease as well as a healthy person’s body can.

Nutrition tips for children with weak immune systems

During your child's cancer treatment, there will be times when her body's natural defenses may not be able to protect her. While her immune system is recovering, you may be told to try to avoid exposing her to possible infection-causing germs. For example, she may need to avoid some foods that are likely to have high levels of bacteria.

The following dietary suggestions, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, were developed for patients with decreased immune function caused by chemotherapy and radiation therapy. These tips were used by their bone marrow transplant patients who had extremely weakened immune systems.

The purpose of these suggestions is to help you avoid giving your child foods that are more likely to contain germs that could cause infection, but still give her healthy food choices. Your child may not need to follow this diet during her entire cancer treatment. Talk with the doctor or nurse about these suggestions and if and when your child should follow this diet.

Foods your child should NOT eat during this time:

• raw and undercooked meat (includes game), fish, poultry, tofu, eggs, and egg substitutes
• cold smoked fish (salmon, lox, and pickled fish)
• meats and cold cuts from a deli
• cured hard salami in a natural wrap
• unpasteurized milk and milk products, including cheese and yogurt
• cheeses with molds such as blue, Roquefort, Gorgonzola, and Stilton
• cheeses containing chili peppers or uncooked vegetables
• sharp cheddar, brie, camembert, feta cheese, and farmer’s cheeses
• fresh salad dressings (those stored in a refrigerated case) that contain aged cheese (such as blue or Roquefort) or raw eggs
• unwashed raw vegetables and fruits and those with mold that you can see
• all raw vegetable sprouts, such as alfalfa and mung beans
• unpasteurized commercial fruit and vegetable juices
• raw or non-heat treated honey and honey in the comb
• all miso products, tempeh, and maté tea
• all moldy and outdated food products
• raw, uncooked brewer's yeast
• well water, unless it is tested every year and found safe
• herbal preparations and nutrient supplements
• unroasted nuts and roasted nuts in the shell
• salads from delicatessens
• commercial salsas stored in the refrigerated case
• raw grain products
• cold brewed tea made with warm or cold water
• unrefrigerated, cream-filled pastry products (not shelf-stable*)

* "Shelf-stable" means unopened canned, bottled, or packaged food products that can be stored before opening at room temperature but require refrigeration after opening

Also talk to the doctor or nurse about whether or not your child should eat in restaurants. It is hard to know how "safe" the food is when you eat out because employees may handle food when they are sick and food storage also could be an issue.

Food safety considerations

When your child's immune system is weak, be especially careful when buying foods, preparing meals, and dining out. Following food safety guidelines reduces the risk of your child taking in germs that could multiply and cause a serious infection when her immune system is weak.

Food handling tips

• Wash your hands with warm soapy water for 20 seconds before and after preparing food and before eating.

• Have your child wash her hands before eating.

• Refrigerate foods at or below 40° F.

• Keep hot food hot (warmer than 140° F) and cold food cold (cooler than 40° F).

• Thaw meat, fish, or poultry in the microwave or refrigerator in a dish to catch drips. Do not thaw at room temperature.

• Use defrosted foods right away and do not refreeze them.

• Put perishable foods in the refrigerator within 2 hours of buying or preparing them. Egg dishes and cream- and mayonnaise-based foods should not be left unrefrigerated for more than 1 hour.

• Wash fruits and vegetables under running water before peeling or cutting. Do not wash produce with soaps, detergents, or chlorine bleach solutions.

• Commercial produce rinses are not recommended. Using a clean vegetable scrubber, scrub produce that has a thick, rough skin or rind (cantaloupe, potatoes, etc.) or that has visible dirt on the surface.

• Rinse leaves of leafy vegetables one at a time under running water.

• Packaged salads, slaw mixes, and other prepared produce, even when marked pre-washed, should be rinsed again under running water; use a colander to make this easier.

• Throw away fruits and vegetables that are slimy or show mold.

• Do not give your child produce that has been cut at the grocery store (such as melon or cabbage halves).

• Wash tops of canned foods with soap and water before opening.

• Use different utensils for stirring foods and tasting them while cooking. Do not taste the food (or allow others to taste it) with the same utensil used for stirring.

• Cook eggs until the whites are completely hard and the yolks begin to thicken. The yolk should no longer be runny, but it does not need to be hard.

• Throw away eggs with cracked shells.

• Boil tofu, in ½-inch cubes, for 5 to 10 minutes before using.

• Throw out foods that look or smell strange.

Do not cross-contaminate foods and surfaces

• Use a clean knife to cut different foods.

• In the refrigerator, store raw meat sealed and away from ready-to-eat food.

• Keep foods separated on the countertops. Use a different cutting board for raw meats (see the section, "Work surfaces and kitchen equipment.")

• Clean counters and cutting boards with hot soapy water, or you can use a fresh solution made of 1 part bleach and 10 parts water. Moist disinfecting wipes may be used if they can be used around food.

• When grilling, always use a clean plate for the cooked meat.

Cook foods well

• Put a meat thermometer into the middle of the thickest part of the food to test for doneness. Test a thermometer’s accuracy by putting it into boiling water. It should read 212° F.

• Cook meat until it is no longer pink and the juices run clear. The only way to know for sure that the meat has been cooked to the right temperature is to use a food thermometer. Meats should be cooked to 160° F and poultry to 180° F.

• Even though they are already cooked, heat all hot dogs, luncheon meats, cold cuts, and other deli-type meats until steaming (165°F) before your child eats them.

• Do not give your child raw, lightly cooked, or soft-boiled eggs.

• Do not let your child eat uncooked foods made with raw or undercooked eggs, such as raw cookie dough, cake batter, or salad dressings that contain raw or coddled eggs. Pasteurized eggs or liquid pasteurized egg products may be used in recipes for foods that will not be cooked and call for raw eggs.

Water safety

• Water from your home faucet is considered safe if it is from a city water supply or municipal well serving a highly populated area.

• Well water is not safe to drink unless it is tested daily and found safe.

• If your water is not from a city water or municipal well, use boiled, distilled, or bottled water. (Bring tap water to a rolling boil for 1 minute.) Most water filters will not make the water safe if the water supply has not been chlorinated.

Microwave cooking

• Rotate the dish a quarter turn once or twice during cooking if there is no turntable in the microwave oven. This helps prevent cold spots in food where bacteria can survive.

• Use a lid or vented plastic wrap to thoroughly heat leftovers. Stir several times during reheating.

Grocery shopping

• Check "sell by" and "use by" dates. Pick only the freshest products.

• Check the packaging date on fresh meats, poultry, and seafood. Do not buy any products that are out of date.

• Reject damaged, swollen, rusted, or deeply dented cans. Be sure that packaged and boxed foods are properly sealed.

• Select unblemished fruits and vegetables.

• Avoid deli foods. In the bakery, avoid unrefrigerated desserts and pastries that contain cream or custard.

• Avoid foods from self-serve or bulk containers.

• Avoid yogurt and ice cream products from soft-serve machines.

• Do not let your child eat free food samples.

• Reject cracked or unrefrigerated eggs.

• Select frozen and refrigerated foods just before you check out at the grocery store, especially during the summer months.

• Refrigerate groceries right away and never leave food in a hot car.

Dining out

• Eat early to avoid crowds.

• Ask that food be prepared fresh in fast food restaurants.

• Ask for single-serving condiment packages (mustard, ketchup) and avoid self-serve bulk condiment containers.

• Do not allow your child to eat food from high-risk food sources including salad bars, delicatessens, buffets and smorgasbords, potlucks, and sidewalk vendors.

• Do not let your child eat raw fruits and vegetables.

• Ask if fruit juices are pasteurized.

• Be sure that your child's utensils are set on a napkin or clean tablecloth or placemat, rather than right on the table.

• If you want to keep your leftovers, ask for a container and put the food in it yourself rather than having the server take your food to the kitchen to do this.

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