Tips for Handling Set-Backs to Good Nutrition During Therapy

Nausea and Vomiting

• Offer plain, bland foods. Examples of good choices include cereal, canned or fresh fruit, rice, noodles, toast, mashed or baked potato, soup, crackers, plain meat or chicken. Avoid spicy, heavy, or fatty foods. If food smells are a problem, pick cold or room-temperature foods. Use a cup with a lid. Open food containers in another room. Encourage the patient to avoid areas where food is cooking.
• Don't offer solid food and liquids at the same time. Have the patient eat solid foods for meals and snacks, saving liquids for 30-60 minutes before or after eating.

Diarrhea

• Offer plenty of liquids
• Try the BRATT (bananas, rice, applesauce, toast, and tea) diet. But only use this diet for 2-3 days because it is too low in some necessary nutrients.
• Avoid serving heavy, fatty foods and those with caffeine.
• Cut back on the amount of fiber in the diet. Use canned fruits or small amounts of juice, mild cooked vegetables (like carrots, green beans, squash, and potato), and "refined" cereals and breads (rather than whole-grain or bran-containing products).
• Serve several small meals throughout the day

Constipation

• Provide extra liquids
• Offer beverages that have caffeine (like coffee, tea, and cola)
• Increase fiber in the diet by serving plenty of fruits, vegetables, and whole grains
• Encourage the patient to increase his/her activity level

Poor Appetite

• Offer small amounts six times a day
• Save liquids for between meals
• Make every bite count by using "power packed" foods. These are foods that have a lot of nutrients in a small amount like milkshakes, stuffed potatoes, or casseroles.
• Start with small portions and increase gradually
• Try to obtain the foods and beverages that the patient asks for

Sore Mouth and Throat

• Offer soft foods like pudding, Jell-O, macaroni and cheese, applesauce, bananas, and ice cream
• Encourage good mouth care as directed by your health care team
• Avoid acidic (like oranges and tomatoes) or spicy foods
• Avoid hard foods and those that require a lot of chewing

Excessive Weight Gain

• Provide the recommended amount of fruits and vegetables. The current goal is a total of five servings each day. Make sure the patient eats all of these before having any "junk food."
• Cut back on fattening foods. Offer low-fat or skim dairy products. Take advantage of "light" and fat-free products. Use lean meats. Bake, broil, grill, boil, microwave, or roast foods, and use only minimal amounts of fat. Serve low-fat gravies, sauces, and dressings.
• Limit the amount of regular cola, juice, punch, sweet tea, lemonade, and Kool-Aid to one 4-8 oz serving each day. Substitute diet cola, sugar-free tea, sugar-free lemonade, sugar-free Kool-Aid, or water for other servings.
• Limit portion sizes to those appropriate for the child's age. If the patient wants second helpings, provide one extra serving of a low-fat fruit or vegetable. If the child is still hungry beyond that, offer "free foods," like raw salad vegetables (lettuce, onion, green pepper, cabbage, and celery) and sugar-free Jell-O, gum, and beverages.
• Encourage the patient to increase his/her activity level.
• When eating out, allow just one high-fat or high-calorie food. Make the remaining food choices healthier.
• Support the child by changing the eating habits of the whole family. The patient cannot be expected to eat low-fat foods while the rest of the family eats cheeseburgers, fries, and milkshakes. Set a good example.