A balanced diet

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A good diet includes sufficient calories to ensure a normal rate of growth, fuels the body's efforts to repair and replace damaged normal cells, and provides the energy the body needs to break down the various chemotherapy drugs given and excrete their by-products. Research has shown that a well-nourished body will:

• Tolerate more treatment

• Tend to have fewer side effects

• Maintain weight

• Recover faster from treatment

When the body becomes malnourished, body fat and muscle decrease. This leads to:

• Weakness, lack of energy, weight loss

• Decreased ability to digest food

• Limited ability to heal and fight infection

To keep your child's body well-nourished, foods from all of the five basic food groups are needed. The five groups are breads and cereals, fruits, vegetables, dairy products, and meats and meat substitutes.

Examples of foods contained in each group are listed in the following tables, with a small child's serving size in parentheses beside each food. Consult a nutritionist to determine the serving size appropriate for your child.

Meat and meat substitutes (two or three servings per day)

Fish (1 ounce) Peanut butter (2 tbsp.)

Poultry (1 ounce) Dried beans, cooked (^ cup)

These foods provide protein, which helps build and maintain body tissues, supply energy, and help form enzymes, hormones, and antibodies. Some typical one-ounce servings of meat and meat substitutes are: a meatball one inch in diameter, a one-inch cube of meat, one slice of bologna, a one-inch cube of cheese, or one slice of processed cheese. As you can see, two to three meatballs a day provide all the protein needed by a school-aged child.

Dairy products (two or three servings per day)

Breads and cereals supply vitamins, minerals, fiber, and carbohydrates. Try to use only products made with whole wheat flour and limited sugar to get more nutrients per serving. One sandwich made with two slices of bread provides four servings of this food group.

Fruits (two to four servings per day)

Fresh fruit (1 medium piece) Dried fruits (V4 cup)

Fruits provide vitamins, minerals, and fiber. Fruits can be camouflaged by pureeing them with ice cream in the blender to make a tasty milkshake or by adding them to cookie and muffin recipes.

Vegetables (three to five servings per day)

Raw vegetables (V4 cup) Cooked vegetables (V4 cup)

Vegetables, like fruit, are excellent sources of vitamins, minerals, and fiber. If your child does not want vegetables, they can be grated or pureed and added to soups or spaghetti sauce. If you own a juicer, add a vegetable to fruits being juiced.

Dairy products provide calcium, vitamin D, and protein.

Breads and cereals (six to eleven servings per day)

Bread (V2 slice) Oatmeal (V2 cup) Cream of wheat (V2 cup) Graham crackers (1 square) Rice (V2 cup)

Dry cereal (V2 cup) Granola (V2 cup) Cooked pasta (V2 cup) Saltines (3 squares) Potatoes (1 baked)

Fats (several servings a day)

Butter or margarine Mayonnaise Peanut butter or nuts Meat fat (in gravy) Ice cream

Cheese

Whipped cream Avocado Olives Chocolate

Although the food pyramid calls for fats to be used sparingly, higher consumption of fats is needed for children being treated for cancer. Experiment to find the fats that your child enjoys eating, and serve them frequently.

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 children's digestive systems from chemotherapy alters the body's ability to absorb the nutrients contained in the food they do manage to eat. As a result, vitamin supplements are usually necessary.

Vitamin supplementation should only be done after consultation with your childs 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 child with dull hair, no energy, and dry peeling skin to one with stronger hair, clear skin, and a better attitude. Vitamin supplements should be individually tailored for your child in consultation with the oncologist and nutritionist.

Halfway through maintenance, my daughter just looked awful. Her new hair began to thin out and break easily and her skin felt papery. I had been giving her a multivitamin and mineral tablet every day because her appetite was so poor, but it didn't seem to be enough. I talked to her doctor, then began to give her more of the antioxidant vitamins: betacarotene, E, and C. I bought the C in powder form, which effervesced when mixed with juice. She really liked her "bubble drinks." The betacarotene and E she swallowed along with the rest of her pills. Within a few weeks her hair stopped falling out, her skin stopped peeling, and she felt better.

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