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Managing Nutrition For Childhood Cancer Survivors

In a child with cancer, it is very important to focus on nutrition through all phases of treatment so the child can grow into a healthy adult. Advances in cancer treatment have increased the number of survivors and hence their diet needs special attention too. Diet that’s tailor-made for a child during ongoing treatment is completely different from the diet of a cancer survivor. Understanding this transition and difference is very important.

Childhood cancer survivors have been exposed to extra-ordinary therapies that can impact their growth and development in future if not managed well. The kind of diet and physical activity that is followed for the child post-treatment will reflect on her health as she grows. Unhealthy diet from an early age can result in multiple lifestyle related diseases such as obesity, heart disease, diabetes, hormonal imbalances, etc.

Things you need to avoid

  • Pampering: It might sound harsh but meeting all the demands of the child irrespective of the type of food requested is not recommended. Stay away from the need to excessively pamper children with food or give in to tantrums – it isn’t easy, especially given what the child has been through, but it’s important. Children at this age are attracted to foods that are high in sugar, salt, preservatives, food colours, etc., or prepared unhygienically. These include chips, soft drinks, instant noodles, ready-to-eat or ready to make foods, fast foods, street foods like chaats, panipuris (golgapas) etc. Such food is also often considered a celebration for completing the treatment and should be restricted.
  • Diet of the family/siblings: Children learn through observations – the same applies to eating habits. If the child has a sibling with unhealthy eating habits, they tend to follow and adapt that too. Same goes for unhealthy eating habits of other close family members.
  • Inactivity: A child’s playing and activity is compromised during the treatment due to side-effects of the treatment and induced weakness. This long period of inactivity makes them less inclined towards playing and moving even after the completion of treatment.
  • Not knowing what to feed: If you are unaware or ignorant towards the type of diet to follow post treatment, this will affect the child’s eating habits.  Childhood is the time when eating habits are established. Hence, proper guidance from a professional nutritionist is crucial.

Things you need to do

  • Instill healthy eating habits: As mentioned earlier, diet for a child undergoing treatment and a child who has completed treatment are very different.

    • Diet during ongoing treatment is nutrient dense – high in calories and protein. Post treatment, a balanced diet should be planned with focus on all the five food groups (Cereals, Pulses, Milk and Non-veg food, Fruits and vegetables, Fats and Oils). Including traditional recipes with whole grains, seasonal fruits and vegetables is a good way to go.
    • Building healthy eating habits can be instilled by doing basic things like giving healthy food options to choose from, having family meals together, engaging the child in cooking, and reduced screen time, especially while eating.
    • Children like if it we experiment with spices and flavors. All our traditional Indian spices and flavors like turmeric, ginger, cinnamon, garlic, lime to name a few, not only have numerous medicinal properties but also make food more likable for kids.
    • It is very important to teach the child to eat timely. Instead of having only two or three major meals, child should be habituated for meals distributed throughout the day. Emphasize breakfast as the most important meal of the day as many children and teens nowadays try skipping it.
    • Avoid or minimize chips, soft drinks, sauces, tea, khari, rusks, biscuits, breads, pickles, food from fast food joints like burgers and fries, street foods, maida (refined flour), instant noodles/soups, sugary candies, chewing gums and many more. Eating out at restaurants should be minimized.
    • Avoid using food as a reward, especially the unhealthy ones. For example, a burger for completing school work.
  • Follow ups: Regular follow ups with the health care team – Doctor, Nutritionist, and if required, Physiotherapist, Psychologist or Occupational therapist is very important. Any signs and symptoms or discomfort the child might have has to be reported to the respective healthcare professional. It may include rashes, fever, lumps, aversion to food, loss of appetite, etc.
  • Physical activity and exercise: Many children gain weight during treatment due to some medications (steroids) but post treatment weight-gain is mostly observed due to unhealthy eating habits and inactivity. Weight gain paves the way for a host of other lifestyle diseases like obesity, heart disease, diabetes, etc. A young child should be encouraged to play with their siblings, friends and parents. When it comes to older children and teens, activities like brisk walking, jogging, skipping, badminton should be promoted. School-going children should be encouraged to join sports programs and practice whichever sport they like. Yoga can help develop flexibility and help calm their mind. For a physically-challenged kid due to surgery (eg. amputation in case of Ewing’s Sarcoma), exercise and activity should be followed as prescribed by their physiotherapist or occupational therapist. Screen time (television, mobile, and playstation) should be limited – instead more playtime or the habit of reading a book should be encouraged.

    Nandita Dhanaki, Pediatric Onco Nutritionist, Cuddles Foundation, Mumbai

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