This page explains about coping with eating problems during chemotherapy and what to expect when your child comes to Great Ormond Street Hospital (GOSH).
Different aspects of treatment for leukaemia or cancer can have a negative impact on your child’s eating. For example, having a naso-gastric tube can disrupt eating patterns that may have previously worked for your child.
The nausea associated with chemotherapy or having to be nil-by-mouth can also impact on your child’s eating. You may feel concerned that your child is not eating enough or that the food he or she is eating lacks variety or you may have other worries.
What should I do if I am worried about my child’s eating?
The first thing to do is to get a clearer picture about what is happening. For example, if you are worried about your child’s current food intake, you could keep a simple record of what your child does manage to eat during the day. Sometimes, parents are surprised to see that their child is eating more than they initially thought, which can reduce their level of worry.
If after investigating, you still think there is a problem, then talk to others involved in your child’s care, for example, doctors, nurses or dietitians and ask them for advice. Alongside that, you might want to try some of the ideas below.
Tips for managing mealtimes
Establishing a mealtime routine that suits your child and your family is important. It will help your child know what to expect and therefore to feel more relaxed. For example, you might want to decide on three mealtimes a day at specified times.
Try to model or set a good example of desired eating and mealtime behaviours. Children partly learn by copying so try to ensure that people at home behave at mealtimes as you would like your child to behave. For example, parents might demonstrate sitting at a table for meals or being confident about trying new foods.
Involving your child in meal preparation can help him or her to feel comfortable with and enjoy food. Also, giving your child restricted choices for meals, such as a choice between two or three menus, involves him or her and gives an element of control, while ensuring that your child eats something.
For example, you might deliberately include a food you know might tempt your child in one meal option, but also offer some other choices.
How can I help my child to eat?
Some parents find specific behavioural strategies are helpful in encouraging their child to eat. Here are a few suggestions that have worked for other families.
Positive reinforcement – praise your child for eating
Providing your child with positive attention, such as praise, hugs, pleasant conversation, in response to desired eating behaviour usually helps to increase that behaviour. Do this immediately and for any positive eating behaviour, however seemingly small and insignificant. Do not withhold praise until your child eats a whole meal or eats a varied diet.
Use a step-by-step approach to encourage them towards the longer-term goal of eating whole meals or of eating a greater variety of foods. Let your child know exactly what you are happy with, for example, trying a new food, eating another piece of food or sitting at the table. Alongside this, planned ignoring of eating refusal or other unwanted behaviours could be helpful.
Graded exposure – introduce or increase food gradually
For children who have become anxious about or unused to any part of the eating process, it will be helpful to gradually build up to normal eating.
Identify something that your child will eat or can manage, and then think about what might be a challenging but manageable next step. This gradual, step-by-step approach will avoid trying to move things on too quickly and will help your child to cope with and have a sense of mastery about each step.
Remember to include praise whenever your child achieves another step.
Appetite manipulation – increase your child’s appetite
If your child is still being fed via artificial means, for instance TPN or NG feeds then this will gradually have to be withdrawn to make your child feel hungry. If your child still needs to be fed partly by artificial means, then if possible try to do this at night or towards the end of the day so that your child is hungry during the daytime.
Cues – use prompts or cues to encourage eating
Use instructions or other cues when your child does eat something he or she enjoys. For example, if you say “Take a bite!” every time he or she is about to eat a favourite food, then eventually when you say “Take a bite!” with a new food, your child will be more likely to try it.
This is because the instruction becomes associated with something pleasurable, that is, eating something he or she likes, so when this instruction is given, your child is more likely to follow it again next time.
Managing your worries
Feeling worried about the impact of reduced food intake or disrupted eating patterns on your child’s health is understandable and completely normal.
In fact, it shows that you care. However, coping with your feelings is important because worry or frustration might impact on mealtimes, and lead to increased tension for everyone involved, including your child. This can increase your child’s anxiety about food, which can play a part in keeping any eating difficulties going.
Consider the expectations you have about your child’s eating
What are your expectations of your child’s eating? Are these realistic given the nature and stage of your child’s treatment?
Eating difficulties usually get better gradually as your child gets used to his or her normal eating pattern again but it will take time. Reminding yourself of this may help you to manage any anxiety or frustration you have about your child’s current progress.
Try to get a balanced view
It can be difficult to notice what is going well if you are feeling worried. Pay attention to any positive aspects of your child’s eating, as well as noticing any problems. This can help you obtain a realistic, balanced overview of your child’s eating, rather than a skewed perspective.
Take care of yourself
Having concerns about the health of your child can feel upsetting and draining, so it is important to take care of yourself too.
This will also help your child, as you will be better able to give him or her support. Think about what usually helps you to cope with stressful situations. It may be talking to friends, taking exercise or doing something you enjoy. Talking to other parents might be helpful since you may find that others have had similar experiences.
Who should I talk to for further advice?
There are many people at GOSH who can help, including your child’s:
- nurse or doctor for advice and support with all aspects of your child’s health
- dietitian for advice and support with your child’s eating and nutrition
- psychologist for advice and support with emotional and behavioural factors linked to eating problems
- social worker for general advice and support
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.