In some homes, mealtimes turn into battlegrounds, with worried parents resorting to threats or bribery to get their child to eat. Parents rarely win these battles—eventually they give in, exhausted and frustrated, and serve the sick child whatever she will eat (often to the dismay of the siblings who still have to eat their vegetables). The next several sections are full of methods used successfully by many parents to make mealtimes both fun and nutritious.

How to make eating more appealing

Many children are finicky eaters at the best of times. Cancer and its treatment can make eating especially difficult. Here are some general suggestions for making eating more appealing for your child:

• Give your child small portions throughout the day rather than three large meals. Feed your child whenever she is hungry.
• Remember that your child knows best which foods he can tolerate.
• Explain clearly to your child that eating a balanced diet will help her fight the cancer.
• Make mealtimes pleasant and leisurely.
• Rearrange eating schedules to serve the main meal at the time of day when your child feels best. If he wakes up feeling well most days, make a high-protein, high-calorie breakfast.
• Don’t punish your child for not eating.
• Set a good example by eating a large variety of nutritious foods.
• Have nutritious snacks available at all times. Carry them in the car, to all appointments, and in backpacks for school.
• Serve fluids between meals, rather than with meals, to keep your child from feeling full after only a few bites of food.
• Limit the amount of less nutritious foods in the house. Potato chips, corn chips, soda, and sweets with large amounts of sugar may fill your child up with empty calories.
• If your child is interested, include her in making a grocery list, shopping for favorite foods, and food preparation.

Make mealtime fun

Here are some suggestions for making mealtime more fun:

• Try to take the emphasis off the need to eat food “because it’s good for you.” Focus instead on enjoying each other’s company while sharing a meal. Encourage good conversation, tell stories and jokes, and perhaps light some candles.
• Make one night a week “restaurant night.” Use a nice tablecloth and candles, allow the children to order from a menu, and pretend the family is out for a night on the town.
• Because any change in setting can encourage eating, consider having a picnic on the floor occasionally. Order pizza or other takeout, spread a tablecloth on the floor, and have an in-home picnic. One parent even sent lunch out to the treehouse.

• Some families have theme meals, such as Mexican, Hawaiian, or Chinese. They use decorations, wear costumes, and cook foods with exotic spices.
• Some children seem to eat better if food is attractively arranged on the plate or is decorated in humorous ways. Preschoolers enjoy putting a smiley face on a casserole using strips of cheese, nuts, or raisins. Sandwiches can be cut into funny shapes using knives or cookie cutters.

How to serve more protein

Because many children cannot tolerate eating meat while on chemotherapy, below are suggestions for increasing protein consumption:

• Add 1 cup of dried milk powder to a quart of whole milk, then blend and chill. Use this extra-strength milk for drinking and cooking.
• Use extra-strength milk (above), whole milk, evaporated milk, or cream instead of water to make hot cereal, cocoa, soup, gravy, custards, or puddings.
• Add powdered milk to casseroles, meat loaf, cream soups, custards, and puddings.
• Add chopped meat to scrambled eggs, soups, and vegetables.
• Add chopped, hard-boiled eggs to soups, salads, sauces, and casseroles.
• Add grated cheese to pizza, vegetables, salads, sauces, omelets, mashed potatoes, meat loaf, and casseroles.
• Serve bagels, English muffins, hamburgers, or hot dogs with a slice of cheese melted on top.
• Spread peanut butter on toast, crackers, and sandwiches. Dip fruit or raw vegetables into peanut butter for a quick snack.
• Spread peanut butter or cream cheese onto celery sticks or carrots.
• Serve nuts for snacks, and mix nuts into salads and soups.
• Serve yogurt and granola bars for extra protein. Top pie, Jell-O®, pudding, or fruit with ice cream or whipped cream.
• Use dried beans and peas to make soups, dips, and casseroles.
• Use tofu (bean curd) in stir-fried vegetable dishes.
• Add wheat germ to hamburgers, meat loaf, breads, muffins, pancakes, waffles, and vegetables, and use it as a topping for casseroles.

Ways to boost calories

Parents need to change their perceptions about what constitutes healthy food when they are struggling to feed a child who is on chemotherapy. Many parents have ingrained habits about serving only low-fat meals and snacks. While your child is on chemotherapy, it is necessary to reverse that focus. Your mission is to find ways to add as many calories as possible to your child’s food. Here are some suggestions:

• Add butter or margarine to hot cereal, eggs, pasta, rice, cooked vegetables, mashed potatoes, and soups.
• Use melted butter as a dip for raw vegetables and cooked seafood such as shrimp, crab, and lobster.
• Use sour cream to top meats, baked potatoes, and soups.
• Use mayonnaise instead of salad dressing on salads, sandwiches, and hard-boiled eggs.
• Add mayonnaise or sour cream when making hamburgers or meat loaf.
• Use cream instead of milk over cereal, pudding, Jell-O®, and fruit.
• Make milkshakes, puddings, and custards with cream instead of milk.
• Serve your child whole milk (not 2 percent or skim milk).
• Sauté vegetables in butter.
• Serve bread hot so it will absorb more butter.
• Spread bagels, muffins, or crackers with cream cheese and jelly or honey.
• Make hot chocolate with cream and add marshmallows.
• Add granola to cookie, bread, and muffin batters. Sprinkle granola on ice cream, pudding, and yogurt.
• Serve meat and vegetables with sauces made with cream and pan drippings.
• Combine cooked vegetables with dried fruit.
• Add dried fruits to recipes for cookies, breads, and muffins.

Nutritious snacks

Try to always bring a bag of nutritious snacks whenever you leave home with your child. This allows you to feed her whenever she is hungry and avoid stopping for non-nutritious junk food. Examples of healthful snacks include:

• Apples or applesauce
• Baby foods
• Breakfast bars
• Burritos made from beans or meat
• Buttered popcorn
• Celery sticks filled with cheese or peanut butter
• Cookies made with wheat germ, oatmeal, granola, fruits, or nuts
• Cereal
• Cheese
• Chocolate milk
• Cottage cheese
• Crackers with cheese, peanut butter, or tuna salad
• Custards made with extra eggs and cream
• Dips made with cheese, avocado, butter, beans, or sour cream
• Dried fruit such as apples, raisins, apricots, or prunes
• Fresh fruit
• Granola mixed with dried fruit and nuts
• Hard-boiled and deviled eggs
• Ice cream made with real cream
• Juice made from 100 percent fruit
• Milkshakes made with whole milk or cream
• Fruit smoothies made with frozen fruit, sherbet, or ice cream
• Muffins
• Nuts
• Peanut butter on crackers or whole wheat bread
• Pizza
• Puddings
• Protein bars
• Sandwiches with real mayonnaise or butter
• Vegetables such as carrot sticks or broccoli florets
• Yogurt, regular or frozen

Vitamin supplements

The nutritional needs of kids with cancer are higher than other children’s, yet kids on treatment often eat less food. Most children and teens with cancer are unable or unwilling to eat the variety of foods necessary for good health. In addition, damage to the digestive system from chemotherapy alters the body’s ability to absorb the nutrients contained in the food your child does manage to eat. As a result, vitamin supplements are usually necessary.

Vitamin supplementation should only be done after consultation with your child’s oncologist and nutritionist. Oversupplementation of some vitamins, folic acid for example, can make your child’s chemotherapy less effective. But providing other vitamins can make the difference between a pale and listless child and one with bright eyes and a more positive attitude. Vitamin supplements should be individually tailored for your child in consultation with the oncologist and nutritionist.