Every 20 days, Anjali has a date with Chemotherapy. She’s all of 8 and at T- cell Leukaemia. While the chemo goes through without much difficulty, the side effects often take a toll on not just her but also her mom. Chemotherapeutic drugs cannot distinguish between cancer cells and healthy cells. As a result, along with the cancer cells they also damage healthy cells including those responsible for digestion. Until the healthy cells regenerate, Anjali, like most children, experiences diarrhoea in varying intensities.

What to feed her, how to make her eat, how to make sure she has enough energy to battle both cancer and diarrhoea, are some of the questions that nag most mothers and caregivers.

The first step to defeating your demon is to recognize it.

As a mother and caregiver, keep a look out for the frequency and consistency of your child’s motions. If she’s passing three or more loose or liquid stools per day or more frequently than is normal for her – then it’s diarrhoea.

How to manage diarrhoea in children fighting cancer.

With loose stools your child loses a lot of water and electrolytes such as sodium and potassium from the body, leading to dehydration.

  1. Increase the fluid intake. Give your child fluids every half an hour. It is very important to use boiled water only. If your child’s refusing water, add ORS powder to water; serve lime juice, thin buttermilk, coconut water, rice kanji etc. You could also make lime juice popsicles (ice cubes) – a great source of both Vitamin C and hydration.
  2. Start the BRAT diet – BRAT stands for Banana, Rice, Apple and Toast. Start slow and increase the meal as per your child’s response to it. Banana is a great source of energy, potassium and pectin when not over ripe. Rice in the form of steamed rice, rice kanji, and rice pudding is a good simple carbohydrate source helping bind intestinal water to form more solid stools. Apple in the form of apple stew, applesauce is great for its pectin content and texture to encourage eating. Toast is white bread (maida) toasted and should be eaten without accompaniments like jam. This helps bind water for better motions.
  3. If you have a toddler, introduce Amylase Rich Food (ARF) in her diet. ARFs can be made at home from cereals and pulses. Soak grains overnight in water. Drain the water and allow the grains to sprout. Once sprouted, dry roast the grains in a kadhai until you can smell the sweetness. Allow the grains to cool and then grind them into flour. You can sift the flour further to make it fiber-free for use during diarrhoea. You can prepare these in larger quantities and store them in a clean, dry, airtight container. Just before serving, cook it with an appropriate amount of water so that it has a ‘khichdi’ like consistency.
  4. Foods you should include into your child’s diet:
    • Boil root vegetables like potato, sweet potato, carrot etc. Add some salt and lime juice to them and serve them as cutlets to make them more appetizing. Remember just because your child is sick, his food does not have to look sick!
    • Sabudana is also a great source of starch. You can soak it overnight and serve it as kanji (with the starch water in it). This is a good semi-liquid food option helping bind the water in the intestine, and controlling the frequency and consistency of diarrhoea and providing quick energy.
    • Soluble fibers form gel like consistency when cooked with water and help in reduction of diarrhoea episodes. Isabgol, apple, oats are good sources of soluble fiber in the diet. You could also add oats flour to soup and other food batters such as idli/dosa batter, ravachilla batter, handwa batter etc. Or add Isabgol to curd.
    • Fruits and vegetables like apple, pear, guava, citrus fruits and carrot have a high content of pectin, a great soluble dietary fiber and rich in vitamins. Potato also contains pectin in smaller amounts.
    • Boiling and immediate cooling of potato helps develop resistant starch, which improves water and electrolyte absorption helping to control the diarrhoea. This also improves the immunity by supporting the growth of good bacteria in your child’s gut. Thus avoid recooking of potato.
    • Probiotics, like curd and buttermilk, help in regeneration of healthy cells in the digestive tract that have been damaged by chemotherapy.
    • Addition of zinc or zinc supplements also help in reducing the severity and duration of diarrhoea episode. Some good food sources of zinc are curd, rice, rajmah, spinach, garlic and fruits. If need be zinc supplementation would be advised
  5. Foods you should avoid:
    • Avoid milk, paneer and sweetened milk products such as kheer, sweets made from milk etc. They are concentrated sources of energy which may be difficult for the intestine to digest and absorb, creating a new condition like osmotic diarrhoea.
    • Avoid chewing gums containing sorbitol and use of artificial sweeteners.
    • Avoid spicy food. Mildly spiced food or use of whole masalas is better as they do not irritate the small intestine. Curd rice, khichdi, kadhi-rice etc. are some good options.
    • Consume cooked food only and avoid raw foods. Raw foods could act as a source of infection and are difficult to digest e.g. stew the apple rather than giving raw apple.
    • Avoid eating left over food or stored cooked food. Consume fresh food only. Stored cooked or refrigerated food can be a source of contamination and may aggravate your child’s condition.
    • Avoid fruit juices. If your child wishes to consume fruit juice, give small quantities at one time and increase quantity only if his body can tolerate it.
    • Avoid tea/coffee/sweetened beverages such as colas, aerated beverages etc. They may further aggravate dehydration (water loss).
  6. Maintain absolute hygiene while cooking food. Use clean boiled water, clean utensils and cook with clean hands.

You may or may not be able to follow all these tips. But try as much as you can. If the diarrhoea persists, it is important to consult your pediatric cancer nutritionist or oncologist or general physician. For immediate care and water restoration, it may be necessary to use IV fluids.

This article has been authored by Dr. Neha Paharia Agrawal, Consultant Nutritionist and Dietitian.

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