What treatment looks like

Cancer treatment can affect your child’s appetite, taste and enjoyment of food. Some children may eat less than usual, while others may feel hungrier, particularly if they are taking steroid medicines. Changes in taste, nausea, a sore mouth or tiredness can also make eating more difficult.

There is no “perfect” diet during treatment. The most important goal is helping your child get enough nutrition and fluids to support their growth, recovery and energy levels. Your child’s appetite may change from day to day, so try not to worry if they eat well one day and very little the next.

Some ideas that may help include:

• Offer small meals or snacks more often rather than three large meals.
• Let your child choose from a variety of foods to find what appeals to them.
• Encourage regular drinks to help prevent dehydration.
• If your child’s mouth is sore, offer softer foods that are easier to chew and swallow.
• Avoid foods or smells that seem to make nausea worse.
• Try different settings such as a picnic outside or eating in another location.
• Make mealtimes as relaxed and enjoyable as possible by eating together when you can.

Speak with your healthcare team if your child is eating very little, is losing weight, cannot drink enough fluids or if you are worried about your child’s nutrition. A dietitian can provide personalised advice and suggest ways to help your child meet their nutritional needs during treatment.

Feeling sick or vomiting is a common side effect of some cancer treatments. It can also affect your child’s appetite, energy levels and ability to stay hydrated. The good news is that nausea can often be managed with medicines and some practical strategies.

For example, you may find it helpful to:

• Give anti-nausea medicines as prescribed.
• Offer small meals and snacks throughout the day.
• Encourage regular drinks and Icey-poles to help prevent dehydration.
• Choose bland foods or foods your child enjoys that don’t make nausea worse.
• Avoid strong cooking smells if they make nausea worse.
• Keep your child as comfortable as possible and encourage gentle activity if appropriate.

Your child may not always tell you they feel nauseous. They may refuse food, eat less than usual or become more sensitive to smells.

Contact your healthcare team if your child continues to vomit, cannot keep fluids down, shows signs of dehydration, if their medicines are not controlling their nausea and vomiting, or if they vomit shortly after receiving anti-nausea medicine.

Cancer treatment can make the lining of the mouth more sensitive, leading to soreness, ulcers or infections. Helping care for your child’s mouth can help reduce discomfort and make eating, drinking and speaking easier.

Good mouth care is an important part of treatment, even if your child does not have any mouth problems.

You can help by:

• Following the mouth care routine recommended by your child’s healthcare team.
• Keeping your child’s mouth and teeth as clean as possible.
• Encouraging regular drinks to keep the mouth moist.
• Offering soft foods if chewing or swallowing is uncomfortable.
• Giving pain relief as recommended if mouth sores become painful. Cool or frozen foods and drinks can help provide pain relief.

Contact your child’s healthcare team if your child cannot eat or drink, has severe mouth pain, cannot open their mouth properly, or shows signs of dehydration.

Feeling tired is one of the most common side effects of cancer treatment. Fatigue is different from normal tiredness and may not improve completely with sleep or rest. It can be caused by the cancer itself, treatment, low red blood cell counts (anaemia), pain, poor nutrition or emotional stress.

Some days your child may have plenty of energy, while on other days they may need extra rest. This is expected during cancer treatment.

You can help by:

• Encouraging a balance of rest and gentle activity.
• Supporting healthy sleep routines.
• Offering nutritious food and plenty of fluids.
• Planning important activities for times when your child has more energy.
• Letting your child rest when they need to.

Speak with your child’s healthcare team if fatigue suddenly becomes worse, stops your child from doing everyday activities or is accompanied by dizziness, shortness of breath or increasing paleness.

Some cancer treatments may reduce your child’s ability to fight infections. This means even common illnesses can become more serious and may need prompt medical attention.

Your child’s healthcare team will regularly monitor your child’s blood counts and let you know if extra precautions are needed. Neutrophils are a type of white blood cell that fight infection. If your child’s neutrophil blood count is low, your child at risk of an infection.

You can help reduce the risk of infection by:

• Encouraging regular hand washing.
• Keeping your child away from people who are unwell whenever possible.
• Following your healthcare team’s advice about food safety and hygiene.
• Limit your child’s contact/play with soil or dirt to reduce the risk of infections.
• Looking after your child’s mouth and skin to reduce the chance of infection.
• Monitoring for signs of infection, especially fever.

Contact your child’s healthcare team immediately if your child develops a fever or you are concerned they may have an infection. Always follow the advice provided by your treating hospital about when to seek urgent medical care.

Some cancer treatments can cause changes in your child’s appearance, including hair loss, weight changes, swelling from medicines such as steroids, or changes to the skin and nails. These changes are usually temporary, but they can be upsetting for children and families.

Giving your child choices can help them feel more in control.

Some ideas include:

• Choosing hats, scarves or wigs if they would like to use them.
• Having a haircut before hair loss begins.
• Wearing clothes that help them feel confident and comfortable.
• Looking after dry or sensitive skin using products recommended by your healthcare team.
• Talking openly about body changes and reassuring your child that many treatment-related changes improve over time.

If changes in your child’s appearance are causing ongoing distress, let your healthcare team know. Additional emotional support is available for children, young people and families.

Changes in sleep are common during cancer treatment. Medicines, hospital stays, pain, worry and changes to usual routines can all affect how well your child sleeps.

Helping your child maintain healthy sleep habits as much as possible may improve both their energy levels and wellbeing. However, it can be important to be flexible and adjust to temporary changes as your child’s treatments may affect their sleep patterns.

You can help by:

• Keeping regular bedtimes and wake-up times where possible.
• Following a calming bedtime routine.
• Reducing noise and bright light at bedtime.
• Limiting screen time before sleep.
• Encouraging gentle activity during the day if appropriate.

Speak with your child’s healthcare team if your child’s sleep problems continue for more than a couple of weeks or begin to affect their daily life.

Constipation and diarrhoea are common during cancer treatment. They may be caused by chemotherapy, other medicines, changes in diet or reduced physical activity.

Most bowel changes can be managed, but it is important to let your child’s healthcare team know if symptoms become severe.

You can help by:

• Encouraging regular fluids.
• Following your healthcare team’s advice about food choices.
• Encouraging gentle movement if appropriate.
• Giving medicines exactly as prescribed.
• Watching for signs of dehydration.

Contact your healthcare team if your child has severe tummy pain, ongoing diarrhoea, cannot pass a bowel motion for several days, or is unable to drink enough fluids.

Pain can be caused by the cancer itself, treatment or medical procedures. Every child experiences pain differently, and younger children may not always be able to describe how they are feeling.

Signs of pain may include changes in behaviour, crying, reduced movement, difficulty sleeping or becoming more withdrawn.

Ways to help include:

• Giving pain medicines as prescribed.
• Using distraction such as games, books or music.
• Trying relaxation techniques if appropriate.
• Encouraging your child to tell you when and where something hurts.
• Letting your healthcare team know if pain changes or becomes worse.

Pain should never be ignored. If your child’s pain is new, increasing or not controlled with their current treatment, contact your healthcare team.