Feeding growing bodies is tricky enough for most parents, but for parents whose children are undergoing cancer treatment, getting them to eat enough to keep up strength and energy to face a normal day is the ultimate challenge.

According to Our Lady of the Lake Children’s Hospital Pediatric Dietitian Nutritionist Natalie Porta, children undergoing cancer treatment can face various difficulties with food. There may be nausea, vomiting and sore mouths — all things which hinder even the heartiest of appetites.

“We try to encourage supplements like shakes that are high in calories and protein,” she said. Nutritional supplements that are nutrient-dense can make each bite count.

Eating frequently thoughout the day with small meals and snacks can also help keep up nutrition needs and may be more tolerated by the child.

While they are experiencing sick stomachs, many children develop aversions to their favorite foods.

“We always try to keep in mind that even though we want them to eat, we sometimes try to avoid their favorite foods, like macaroni and cheese or pizza,” Porta explains. “We’ve all gotten sick after eating something and then never want to eat that food again.”

Some children find they have taste changes or have a hard time tasting foods. Sour or tart foods like orange juice, cranberry juice, pickles and lemons may appeal to these kids.

Radiation treatment can cause dry mouths so hard candies or popsicles may appeal to these patients.

Caution needs to be taken when preparing food for children who are neutropenic, that is, children who due to their treatment have a low white cell count making them high risk for infections.

“The immune system is weak, and what would normally be okay to eat can be unsafe during this time,” Porta said.

Hand washing before and during and after meal preparation is crucial. No raw or under-cooked foods should be served for this reason. All meats and eggs should be well done and no sushi should be served. Cheese containing mold (such as blue cheese, gorgonzola or Roquefort) should be avoided. Fruits (except berries) and vegetables can be served fresh if they have been washed thoroughly, but canned may be the safest bet during this time.

Scrutinize food packages. Do not buy products that are past the expiration, “sell by” or “best used by” date and don’t buy or use foods that have dents, holes or leaks.

Food should be thawed in the refrigerator, microwave or a sealed plastic bag in cold water.

No tea, black pepper, or fresh herbs and spices should be served, and pasteurized dairy products are a must.

It’s recommended that the child not be served food prepared outside of the home nor consume leftovers during this time.

“We realize that it is really hard to abide by these rules, but it is the safest way to be sure the food has been prepared properly,” Porta said. “These kids are already so sick, so we want to take all the precautions we can.”

Ice or frozen drinks from dispensers are risky, so it’s best to make ice or frozen drinks at home.

Porta said she encourages all families to check the temperature of their freezers and refrigerators. Frequently, homeowners don’t realize that there has been a power surge that may have thrown off the temperature of the appliances. Refrigerators should be 41 degrees or under.

A way to test for power surges, she said, is by freezing a cup of water and once frozen, putting a penny on top of the frozen water and putting it back in the freezer. If the penny slightly sinks into the cup, you know the power went out at some time.

It’s important to remain flexible with mealtimes and keep them pleasant. Remind the child to eat periodically, but never force-feed. Look forward to the day when the treatments end and appetites return.