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How can you encourage eating well in children with cancer?

During cancer treatment it is often difficult for children to eat well and to eat enough. Research by Prof. Wim Tissing showed that a low weight at diagnosis and weight loss in the first three months is even a risk factor for more side effects and lower chances of survival. So how can you encourage eating well in children with cancer? During a fully digital parent information evening on February 9, 2021, some 45 parents logged in to hear from dietitians, researchers and caterer Hutten about nutrition in cancer. The Máxima hosted a digital parent information evening on this topic, in which dietitians, researchers and caterer Hutten shared their knowledge.

Good nutrition can contribute to a better treatment outcome for childhood cancer and is an important focus at the Máxima. In fact, the motto is to eat as healthy and as normal as possible, according to a ‘food pyramid’ with a balanced intake from basic food groups, says Tissing. But good and healthy eating is by no means self-evident for a child with cancer. Problems with eating can come from the tension and emotion that come with a cancer diagnosis. Side effects of treatment such as nausea or a sore mouth or throat, or simply a loss of appetite, can also make it difficult to eat well and enough.


Practical tips
Dietitians Nina van der Linden and Rianne Ruitenburg gave tips that can help to obtain and maintain a good nutritional status. It can be frustrating for a child if they fail to eat normally, they said. Forcing them can be counterproductive, so a calm attitude around eating times is very important. When there is a loss of appetite, the dietitians advise eating small amounts spread over the day, and for example offering full-fat instead of semi-skimmed dairy products or double sandwich fillings: this way you get as many calories and proteins as possible from the same eating moment. Many of these kinds of small adjustments together can make a difference at the end of the day.

Taste change
The underlying reasons for a reduced or changed appetite is a question that occupies PhD student Mirjam van den Brink. She talked about her research on changes in smell and taste in children with cancer. Because smell and taste cells divide quickly, just like cancer cells, they may also be killed by chemotherapy. By means of questionnaires and smell and taste tests, she is mapping out the problem of unpleasant taste changes.

Van den Brink hopes that her research will lead to awareness among healthcare professionals of the impact of changes in smell and taste, and to offer better (nutritional) advice on how to deal with this in future. She advises care professionals and parents to go along with the changed preference and to try out what children still find tasty. As a tip, she suggested offering more taste neutral foods such as cream cheese to children whose taste has intensified, and in the case of reduced taste, offer flavor enhancers such as ketchup, dressing or pickles.

Recognizable dishes
Finally, two employees of Hutten, the caterer at the Máxima, took the floor to answer questions from parents. Janiek Koolen said that at the opening the philosophy was still to entice children to eat (healthily) with interesting and colorful dishes. But gradually, and based on feedback from children and parents, the approach has shifted towards recognisability. When eating is difficult for a child, it helps to be able to choose from familiar options. These are now on the menu at the ‘Kanjerkar’, the food cart that visits the care department several times a day. There are two menus, one of which is especially energy-rich for children who have or are at risk of malnutrition.

A recurring theme during the information evening was the fine line between being satisfied that a child is eating, and keeping the food as healthy as possible. For example, one parent noted that healthy eating is not a priority for many children, as long as they can avoid tube feeding. It is important to take into account the wishes of the child, but also to set limits in the interest of their health, the experts said. In conclusion, parents, healthcare professionals, dieticians and catering work together in the Máxima to ensure the best and healthy nutrition possible for each child.