Due to the amount of chemotherapy and radiation your child receives, he/she may experience mouth sores, diarrhea (loose, runny stools), nausea and vomiting, and loss of appetite. This is normal. You can try offering small, frequent meals during the day rather than three large meals. Foods such as Bananas, Rice, Applesauce and Toast (often referred to as the BRAT diet) are helpful if your child is experiencing diarrhea, nausea and vomiting. For mouth sores, your child may like liquids and foods that are easy to chew and swallow such as mashed potatoes, noodles, soup and pudding. If your child has lots of diarrhea he/she may need to be on a low-lactose (no milk products) or low-residue diet. Some foods that are allowed are white bread, saltine crackers, oatmeal, eggs, meat and cream soup. This type of diet leaves very little residue in the bowel (see diet appendix).

You will be able to fill out your child's menus each day for the next day's meals. These need to be completed by 11:00 a.m. each day. Substitutions can be written in on the menu from the additional food handout or from the next day's cafeteria menu printout, which is located at the front desk.

Snacks are available three times a day. When snacks are ordered, they will continue to come until they are cancelled. Please inform the unit clerk of changes or cancellations you wish to make. To limit the number of people coming to your room, we ask that Dietary leave all snacks in the kitchen area labeled with the patient's name on it.

Parents may bring food in. It should be marked with the name and date placed in the kitchenette. Avoid keeping any open food in patients' rooms. We have someone periodically clean the refrigerator, but you can help by keeping your food neat and labeled. All unnamed food is considered free for any patient and any undated food is considered to be expired and will be thrown out.

Supplementary Nutrition
It is possible that by the time your child is discharged, their appetite may not have returned to normal. Foods may still taste different and your child might not be hungry. There are several options to provide nutrition. One is central venous nutrition (CVN) and lipids. You can be taught to give these at home. CVN is a combination of protein, carbohydrates, electrolytes, and vitamins that infuse through the central line. Lipids provide necessary fats in IV form. Another option is nasogastric (NG) tube

feedings. A plastic tube is inserted in the nostril and down into the stomach. Tegaderm is then used to secure the tube to the child's face. These tubes are not painful but can be uncomfortable until the child gets used to it. A formula feeding is then given through the tube generally at night. Having formula in the stomach will re-acquaint the stomach with food and hopefully your child will then gradually start to eat (see NG procedure). The other option for providing nourishment is to add high calorie snacks to what your child is already eating. Some examples are milk shakes and Carnation(r) instant breakfast and Ensure.

Food Preparation

When you are preparing food for your child, you should:

• Make sure work area is clean.
• Rinse fresh fruits and vegetables.
• Cook meat thoroughly.
• Wash cutting boards between use.
• Wash can opener.
• Do not use dented cans.
• Do not leave leftovers in cans -- cover and refrigerate.

When your child's white blood cell count (WBC) is less than 1,000, he/she will not be allowed to have any fresh vegetables or pepper. Fresh fruits that are allowed are ones that have a thick peel such as oranges, watermelon or bananas. Fruits and vegetables that have been cooked or are frozen or canned can be eaten.

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