Eating is tremendously affected by chemotherapy, radiation, and stem cell transplants. Listed below are several common side effects of treatment that often prevent good eating. Other side effects that impact eating—nausea, vomiting, diarrhea, constipation, and mouth and throat sores—are covered in detail in Chapter 14, Common Side Effects of Treatment.

Loss of appetite

Loss of appetite is one of the most common problems associated with cancer treatment. If your child loses more than 10 to 15% of her body weight, she may need to be fed intravenously or by nasogastric tube. Sometimes this can be avoided if parents learn how to increase calories in small amounts of food. In addition to simple loss of appetite, your child may have a side effect of chemotherapy called early filling. This means the child has a sense of being full after only a few bites of food. If your child is suffering from early filling and only eats when he feels hungry, he may begin losing weight and become malnourished.

My son looked like a skeleton several months into his protocol. I used to dress him in “camouflage” clothes—several layers thick. This kept him warm and prevented stares.

Increased appetite and weight gain

When children are given high doses of steroids such as prednisone or dexamethasone, they develop voracious appetites. They are hungry all the time, develop food obsessions, and frequently wake parents up during the night begging for another meal.

Early in her treatment, when Carrie Beth was taking dexamethasone, she would start hitting me in the face in the middle of the night demanding food. I learned to have a bag of snacks and a bottle sitting next to the bed, so I could just hand them over and go back to sleep.

A moon face with chubby cheeks and a rotund belly are classic features of a child on high-dose steroids. Much of the extra weight is fluid, which steroids cause the body to retain. There are two important points for parents to remember about treatment with steroids. First, when the steroids stop, the extra fluid is excreted and weight drops. Second, your child’s appetite may go from voracious to poor after the steroids stop, so it is unwise to limit food when your child is taking steroids. Instead, try to make the most of this brief time of good appetite to encourage consumption of a variety of nutritious foods. A well-balanced diet now will help your child withstand the rigors of the treatments ahead.

My daughter didn’t sleep when she was on steroids, and she gained a lot of weight. She’d sit in bed and demand, all day and all night long, “toast with butter spread on it like icing on a cake.” So, I gave it to her. When she was off the steroids, she’d rapidly lose the weight and she’d look skeletal. Both extremes were really hard on all of us emotionally.

If you are concerned about the weight gain, consult your child’s oncologist. If the fluid retention is extreme, the doctor may have you restrict your child’s salt intake.

Lactose intolerance

Lactose intolerance is when the body cannot absorb the sugar (lactose) contained in milk and other dairy products. Antibiotics and chemotherapy can each cause lactose intolerance in some children. The part of children’s intestines that breaks down lactose stops functioning properly, resulting in gas, abdominal pain, bloating, cramping, and diarrhea when dairy products are ingested. If your child develops lactose intolerance, it is important to talk to a nutritionist to learn about low-lactose diets and alternate sources of protein and calcium. The following are suggestions for parents of children with lactose intolerance:

• Add special enzyme tablets or drops to dairy products to make them more digestible. Some of these products are over-the-counter additives, but others require a prescription. Discuss these products with the oncologist before giving them to your child.
• Children who cannot tolerate the lactose in cow’s milk often can manage acidophilus milk, soy milk, rice milk, coconut milk, almond milk, goat’s milk, or lactose-free milk. These are easier to digest and come in a variety of flavors.
• Remember that milk is a common ingredient in other foods, such as bread, candy, processed meats, and salad dressings. Read ingredient lists carefully.
• If your child cannot tolerate any dairy products, add calcium to his diet by serving canned salmon, sardines, spinach and other green leafy vegetables, or calcium-fortified fruit juices. Consult your child’s oncologist and nutritionist about calcium supplements. Many children like the taste of a chewy calcium supplement called Viactiv®, which is available at most drug stores.

My daughter is severely lactose intolerant, but she can eat hard, aged cheeses and vegan dairy products. I make her grilled cheese sandwiches with Swiss or vegan cheeses, spread her bagels with vegan cream cheese, and put vegan sour cream on her tacos. If you go to speciality markets, they often have a large selection of vegan products that taste the same as, or similar to, the milk-based product.

Altered taste and smell

One common reason children on treatment do not eat is because, for them, food has no taste or tastes bad. If food tastes bland to your child, try serving spicy cuisines, such as Italian, Mexican, or Greek foods. Chemotherapy can causes foods, particularly red meats, to taste bitter and metallic. If that happens, avoid using metal pots, pans, and utensils, which can magnify the metallic taste. Serve your child’s food with plastic knives, forks, and spoons. You can also replace red meat with tofu, pork, chicken, turkey, eggs, and dairy products.