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Patients learn to balance diets, treatments

feature image Shawn White (front, left, with his two brothers) was diagnosed with a medulloblastoma in 2007. It has affected his mobility, speech and ability to eat. His mom, Patricia Rollins-Granims, says that pouring Hershey’s chocolate syrup over his food was the only way to get him to eat during treatment.

Imagine every bite of food tasting bitter or metallic, or having no flavor at all.

For children undergoing chemotherapy and/or radiation treatments, that’s how a typical meal tastes. While certain medications present taste changes, other side effects of treatment may include mouth sores, nausea and vomiting, and a general lack of appetite, says Emily Garber, a clinical pediatric dietician at Duke Children’s Hospital.

Change in taste When patients are in treatment, Garber says, it’s important for them to mix up the types of foods they consume to help maintain adequate caloric intake.

    Tricks to try:
  • Rinse out mouth with water, or a water-juice blend, before eating.
  • Try sugar-free mint gum or hard candies to mask bad tastes.
  • Choose foods that smell and/or taste good, even if the food is unfamiliar.
  • Add lemon, lime, vinegar, mint or salt to foods that seem too sweet. Add sugar to decrease salty and bitter tastes.
  • Zinc tablets may help taste buds return to normal after treatment. Ask a dietitian or doctor for dosage recommendations.
    If food tastes metallic:
  • Use plastic utensils instead of metal ones.
  • Avoid canned foods and try to limit items that come packaged in metallic wrappers.
  • Cook foods in glass containers and cover in plastic wrap, not aluminum foil.
  • Eat colder foods. Cold, cooked meat tends to taste less metallic than hot meats.
  • Include citrus fruits and juices along with food intake, if no mouth sores are present.
    If food tastes bitter:
  • If the flavor of beef seems bitter or unappealing, substitute chicken, turkey, fish, eggs, soy, cheese and other dairy products for protein.
  • Serve meat with something sweet, such as cranberry sauce, honey, jelly or applesauce.
  • Try high-protein recipes in a vegetarian cookbook if meat is unappetizing.
  • If food tastes bland:
  • Add spices, herbs and other strong flavors (onion, garlic and vinegar) to sauces and foods. Marinate proteins to increase their flavor.
  • Hot sauce often gives foods more flavor, even for some people who may not have liked hot sauce in the past. Also try curries and other spicy dishes.
  • Tart flavors like lemon, other citrus fruits, green apples or sour foods (as long as mouth sores are not present) may help perk up taste buds and increase saliva.

Four-year-old Sunny Norman discovered that she enjoyed chocolate milk for breakfast while undergoing chemotherapy treatments. She continues to fight a pilomyxoid astrocytoma that was diagnosed when she was 5 months old.

Mouth sores Oral mucositis is a common side effect of treatment that ranges in severity and causes painful mouth sores, Garber says.

When sores are widespread, Garber recommends replacing food with supplement drinks like PediaSure. She also recommends drinking through a straw so that liquid can go directly to the back of the mouth without passing over sores.

What to eat: Bland foods and cold items such as ice creams and ices. Avoid: Salty, crunchy and acidic foods.

Nausea and vomiting “There’s going to be a baseline of nausea for most of these kids,” Garber says.

Children with nausea may be able to tolerate dry, crunchy foods such as crackers, toast or pretzels. If mouth sores are present, try simple starches like soft bread, noodles, room-temperature creamy wheat cereal, or plain cereals like Kix or Cheerios soaked in milk. Sips of lemonade and ginger ale may .

    Tricks to try:
  • Nausea can be triggered by cooking smells, so ask others to prepare meals and snacks outside the home or kitchen.
  • Scratch a lemon peel or squeeze the juice to produce a refreshing scent that can help whisk away nausea.
  • Get fresh air by taking a stroll outside or eating near an open window.
  • Hot foods tend to have stronger smells, so serve food cold or at room temperature. When the child is hospitalized, take off the top of the meal tray outside the room to let the steam and smells escape.
  • Eat several smaller meals per day instead of three large meals. Snacking helps reduce nausea.
  • Eat and drink slowly.
  • If possible, stay upright for at least one hour after eating.
  • If taking a nutritional supplement drink, try drinking it through a straw to reduce the smell.

Lack of appetite In addition to nausea, appetite can be reduced by depression, or simply feeling sick, Garber says.

Her main priority is to keep calories coming in, because children undergoing treatments tend to lose weight quickly.

“Eat balanced meals, get enough protein and make sure [patients] are eating fruits and vegetables,” the nutritionist says. “These kids are already sitting in hospital beds and experiencing muscle loss. We recommend they get an adequate amount of protein.”

    Tricks to try:
  • Bring in favorite foods from outside the hospital.
  • Try new foods when the child is feeling best.
  • Encourage the patient to eat regularly throughout the day as able.
  • Eat with family or friends in a pleasant environment as often possible; use attractive dishes and colorful foods; shift focus with a positive environment to encourage eating.
  • Go for a short walk before or after eating to help stimulate appetite and improve digestion.

Do you have tricks that helped you or a patient maintain a healthy appetite during treatment? Share it with us at facebook.com/curethekids.