Low white blood cell counts
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 may be times when the body’s natural defenses will not be able to protect him. While his immune system is recovering, you may be told to try to avoid exposing him to possible infection-causing germs. For example, he may need to avoid some foods that are likely to have high levels of bacteria.
The following recommendations were developed for patients with decreased immune function caused by chemo and radiation therapy. You want to avoid giving your child foods that are more likely to contain germs that could cause infection, but still let him choose healthy foods. Your child may not need to follow these recommendations during his cancer treatment, or may only have to use them at certain times. Talk with the doctor or nurse about these tips and if and when your child should follow them.
Recommendations for when your child’s white blood cell count is low+
Avoid (do not allow your child to eat these)
Meat, poultry, fish, tofu, and nuts
Ensure all meats, poultry, and fish are cooked thoroughly.
Use a food thermometer to be sure that meat and poultry reach the proper temperature when cooked.
When using tofu from the refrigerated section (not shelf-stable), cut it into 1-inch cubes or smaller and boil 5 minutes in water or broth before eating or using in recipes. This is not necessary if using aseptically packaged, shelf-stable tofu.
Vacuum-sealed nuts and shelf-stable nut butters
Raw or lightly cooked fish, shellfish, lox, sushi, or sashimi
Raw nuts or fresh nut butters
Cook eggs until the yolks and whites are solid, not runny.
Pasteurized eggs or egg custard
Raw or soft-cooked eggs – this includes over-easy, poached, soft-boiled, and sunny side up
Foods that may contain raw eggs, such as Caesar salad dressing, homemade eggnog, smoothies, raw cookie dough, hollandaise sauce, and homemade mayonnaise
Milk and dairy products
Only pasteurized milk, yogurt, cheese, or other dairy products
Soft, mold-ripened, or blue-veined cheeses, including Brie, Camembert, Roquefort, Stilton, Gorgonzola, and blue cheese
Mexican-style cheeses, such as queso blanco and queso fresco, since they are often made with unpasteurized milk
Breads, cereal, rice, and pasta
Breads, bagels, muffins, rolls, cereals, crackers, noodles, pasta, potatoes, and rice are safe to eat as long as they are purchased as wrapped, pre-packaged items, not sold in self-service bins.
Bulk-bin sources of cereals, grains, and other foods
Fruits and vegetables
Raw vegetables and fruits and fresh herbs are safe to eat if washed carefully under running water and lightly scrubbed with a vegetable brush.
Fresh salsas and salad dressings found in the refrigerated section of the grocery store – choose shelf-stable salsa and dressings instead
Any raw vegetable sprouts (including alfalfa, radish, broccoli, or mung bean sprouts)
Desserts and sweets
Fruit pies, cakes, and cookies; flavored gelatin; commercial ice cream, sherbet, sorbet, and popsicles; sugar; commercially prepared and pasteurized jam, jelly, and preserves; syrup; and molasses are safe to eat.
Unrefrigerated, cream-filled pastry products
Raw honey or honeycomb – select a commercial, grade A, heat-treated honey instead
Water and beverages
Use only water from city or municipal water services or commercially bottled water.
Pasteurized fruit and vegetable juices, soda, coffee, and tea
Water straight from lakes, rivers, streams, or springs
Well water unless you check with your doctor first
Unpasteurized fruit and vegetable juices
Sun tea – make tea with boiling water and use commercially prepared tea bags
Vitamin- or herbal-supplemented waters (these provide little, if any, health benefit)
+ Adapted from Grant BL, Bloch AS, Hamilton KK, Thomson CA. American Cancer Society Complete Guide to Nutrition for Cancer Survivors, 2nd Edition. Atlanta, GA: American Cancer Society; 2010.
Also talk to the doctor or nurse about whether your child should eat in restaurants. It’s 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.
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 their 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. Dry with paper towels or a clean towel (that is only used to dry clean hands)
- Have your child wash her hands before eating. To be sure that handwashing lasts a full 20 seconds, you can sing the alphabet song with her before rinsing.
- 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 an hour.
- Wash fruits and vegetables well under running water before peeling or cutting. Do not use soaps, detergents, chlorine bleach solutions, or commercial produce rinses. Using a clean vegetable scrubber, scrub produce that has a thick, rough skin or rind (melons, potatoes, bananas, etc.) or any produce that has dirt on it.
- 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.
- Do not give your child raw vegetable sprouts.
- 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, pineapple, or cabbage).
- 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 any utensil that will be put back in the food.
- Throw away eggs with cracked shells.
- 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, and clean in dishwasher (or as noted below) after each use.
- 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.
- Rotate the dish a quarter turn once or twice during cooking if there is no turntable in the microwave. This helps prevent cold spots in food where bacteria can survive.
- Use a lid or vented plastic wrap to thoroughly heat leftovers. Stir often during reheating.
- Water from your home faucet is generally safe if it comes from a city water supply or municipal well serving a highly populated area.
- Well water is not safe for a child with a weak immune system to drink unless it is tested daily and found safe.
- If your water is not from a city water or municipal well, your child should use boiled, distilled, or bottled water to drink, as ice, and for brushing teeth. (Bring tap water to a rolling boil for a full minute.) Most water filters will not make the water safe if the water supply has not been chlorinated.
- 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 products that are out of date.
- Don’t use damaged, swollen, rusted, or deeply dented cans. Be sure that packaged and boxed foods are completely sealed.
- Choose unblemished fruits and vegetables.
- Don’t give your child deli foods. In the bakery, avoid unrefrigerated desserts and pastries with cream or custard.
- Don’t give your child foods from self-serve or bulk containers.
- Don’t buy yogurt and ice cream products from soft-serve machines.
- Don’t let your child eat free food samples.
- Don’t use cracked or unrefrigerated eggs.
- Pick up your frozen and refrigerated foods just before you check out at the grocery store, especially during the summer months.
- Refrigerate groceries right away. Never leave food in a hot car.
- 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.
- Don’t allow your child to eat food from high-risk food sources including salad bars, delicatessens, buffets and smorgasbords, potlucks, and sidewalk vendors.
- Don’t let your child eat raw fruits and vegetables when eating out.
- Ask if fruit juices are pasteurized. Don’t let your child drink “fresh-squeezed” juices in restaurants.
- Be sure that your child’s utensils are set on a napkin or clean tablecloth or placemat, rather than right on the table.
- Ask for a container and put the food in it yourself rather than having the server take the food to the kitchen to do this, if you want to keep leftovers. Get them home and in the fridge quickly.
- Why good nutrition is important
- Benefits of good nutrition
- What children with cancer need: Nutrients
- How your child can take in nutrients
- When your child is taking steroids
- Cancer treatment side effects and what you can do about them
- Appetite changes
- Mouth pain, throat pain, or mouth sores
- Trouble swallowing
- Nausea and vomiting
- Dry mouth or thick saliva
- Unwanted weight gain
- Low white blood cell counts
- Ways to help your child take in more protein and calories
- Recipes to try
- Choose My Plate for children
- To learn more