Appetite

Some anticancer treatments can cause appetite loss.7 In some cases, loss of appetite may be due to other treatment-related side effects such as mucositis or nausea. Parents can help encourage their children to eat by making mealtime fun, such as having a picnic, playing music, or watching a favorite TV show. Children should be allowed to eat whenever they are hungry, rather than enforcing mealtimes. Some children may prefer smaller meals or snacks throughout the day instead of larger meals.

If appetite loss has resulted in weight loss, parents can try to maximize calories at each meal by adding calorie- or nutrient-dense foods or condiments to the following to snacks or meals: avocado, butter, whole milk or heavy cream, cheese, cream cheese, sour cream, salad dressings, mayonnaise, honey, jam, ice cream, yogurt, eggs, peanut butter, meats, and legumes (these can be mashed into soups or casseroles).7


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For children who have mucositis specifically, foods that are soft and easy to swallow may be help them eat, such as yogurt, milk, milkshakes, bananas, applesauce, cottage cheese, mashed potatoes, puddings and custards, scrambled eggs, gelatin, oatmeal, and pureed or mashed vegetables or meats.7

Nausea and Vomiting

Anticancer treatment–related nausea and vomiting should be well controlled by the oncology care team.8 Therefore, parents should contact the oncology care team if children are experiencing nausea and vomiting. In addition, approaches such as eating smaller and more frequent meals; avoiding food with strong aromas; avoiding spicy, fatty, or highly salty foods may help ease nausea.

Fatigue

Anticancer treatment can cause children to feel tired. Parents can guide children through physical activity, such as active play, children’s yoga, bike riding, or other outdoor activities, but caregivers should recognize that children may need frequent breaks or may only be able to be active for short periods of time.9 Relaxation or mindfulness techniques may also be helpful. Parents can guide children through such activities on their own or with the help of a smartphone app. Examples of relaxation and mindfulness apps for children include: Breathe, Think, Do with Sesame; Breathe2Relax; Smiling Mind; Headspace; Mindshift; and Kindoma Storytime.10

Rash

Different types of rashes, which can look like acne, can occur with some targeted therapies.11 The oncology care team may prescribe an antibiotic, but skin care routines are also important to help prevent and treat rashes. Skin should be cleansed using mild cleansers, and regular moisturizing is important. For rashes on the hand and/or feet, thick moisturizing creams can be applied at night with cotton gloves or socks. Moisturizing is also beneficial for itchy skin, and can be applied while the skin is still damp after a shower or bath to prevent dryness. In addition, sunscreen use is important as many of these targeted therapies or antibiotics to treat rash can increase skin sensitivity to sunburn.

References

  1. American Cancer Society. Chemotherapy for childhood leukemia. Revised February 12, 2019. Accessed November 16, 2020.
  2. American Cancer Society. Targeted therapy drugs for childhood leukemia. Revised June 16, 2020. Accessed November 16, 2020.
  3. Hong GHL, Gueiros LA, Fulton JS, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27(10):3949-3967. doi:10.1007/s00520-019-04848-4
  4. Riley P, Glenny A-M, Worthington HV, et al. Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev. 2015;12:CD011552. doi:10.1002/14651858.CD011552.pub2
  5. American Cancer Society. Cooling caps (scalp hypothermia) to reduce hair loss. Revised October 1, 2019. Accessed November 16, 2020.
  6. National Cancer Institute. Diarrhea and cancer treatment. Updated August 9, 2018. Accessed November 17, 2020.
  7. Memorial Sloan Kettering Cancer Center. Helping your child eat during treatment. Updated June 27, 2019. Accessed November 17, 2020.
  8. Children’s Oncology Group. Guidelines on chemotherapy-induced nausea and vomiting in pediatric cancer patients. July 21, 2020. Accessed November 17, 2020.
  9. Children’s Oncology Group. Guideline for the management of fatigue in children and adolescents with cancer and in pediatric recipients of hematopoietic stem-cell transplants. Updated October 10, 2018. Accessed November 17, 2020.
  10. Weekly T, Walker N, Beck J, et al. A review of apps for calming, relaxation, and mindfulness interventions for pediatric palliative care patients. Children (Basel). 2018;5:16. doi:10.3390/children5020016
  11. Fleishman SB, Fox LP, Garfield DH, et al. Tips for managing treatment-related rash and dry skin. New York, NY: CancerCare. 2009. Accessed November 17, 2020.