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Chemotherapy destroys cancer cells, as well as any cells that are produced at a rapid rate such as those that line the mouth, stomach, and intestines. This damage can cause diarrhea, ranging from mild (frequent, soft stools) to severe (copious quantities of liquid stool). Diarrhea during chemotherapy can also be caused by some antinausea drugs, antibiotics, or intestinal infections. After chemotherapy ends and immune function returns to normal, the lining of the digestive tract heals and the diarrhea ends.

The following suggestions for coping with diarrhea come from parents:

• Do not give any over-the-counter drug to your child without approval from the oncologist. He may want to test your child's stool for infection prior to treating the diarrhea. Frequently recommended drugs for diarrhea are Kaopectate, Lomotil, or Immodium.

• It is very important that your child drink plenty of liquids. This will not increase the diarrhea, but will replace the fluids lost.

My 3-year-old had stopped drinking from bottles months before her diagnosis. When she first began her intensive chemotherapy, she had uncontrollable, frequent diarrhea. Liquid would just gush out without warning. It was hard for her to drink from a cup, so one night she said in a small voice, "Mommy, would it be okay if I drank from a bottle again?" I said, "Of course, honey." It was a great comfort to her, and she took in a lot more fluids that way.

• Hot or cold liquids can increase intestinal contractions, so serve lots of room-temperature clear liquids or mild juices such as water, Gatorade, ginger ale, peach juice, or apricot juice.

• Diarrhea depletes the body's supply of potassium. Provide foods high in potassium such as bananas, oranges, baked or mashed potatoes without the skin, broccoli, halibut, mushrooms, asparagus, tomato juice, and milk (if tolerated).

• Low potassium can cause irregular heartbeats and leg cramps. If these occur, call the doctor.

• Do not serve greasy, fatty, spicy, or sweet foods.

• Do not serve roughage such as bran, fruits (dried or fresh), nuts, beans, or raw vegetables.

• Serve bland, low-fiber foods such as bananas, white rice, noodles, applesauce, unbuttered white toast, creamed cereals, cottage cheese, fish, and chicken or turkey without the skin.

In the middle of maintenance, my son had severe diarrhea for a week. He had large amounts of liquid stools twenty times a day. I felt so sorry for him. The doctor cultured a stool specimen, but they never identified a cause. It cleared up after a week of the BRAT diet (bananas, rice, applesauce, toast). He had a problem with diarrhea almost weekly throughout his treatment.

• Keep a record of the number of bowel movements and their volume to keep the doctor informed. Call the doctor if you notice any blood in the stool, or if your child has any signs of dehydration such as dry skin, dry mouth, sunken eyes, decreased urination, or dizziness.

• Keep the area around the anus clean and dry. Wash with warm water and mild soap after every bowel movement. Pat dry gently.

• If your child's anus is sore, check with the doctor before using any nonprescription medicine. She may recommend using Desitin, A&D ointment or Bag Balm after each bowel movement.

While taking ARA-C my daughter had a terribly sore rectum, which was a big problem. It hurt to have bowel movements, she'd cry and have to squeeze our hands to go, then the urine would run back and burn. She was very itchy We carried around bags with Q-tips and every known brand of rectal ointment—A&D, Preparation H, Desitin, Benadryl. Thank goodness this cleared up quickly on maintenance.

• Call the doctor if your child has significant pain with bowel movements, especially if your child has low blood counts.

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