Ask the expert
childhood leukaemia
Question
My 12 year old daughter has acute lymphoblastic leukaemia. I find it hard to get her to eat any fruit/fruit drinks. At times she may only have 200 calories per day, her appetite can be very poor. I approached the hospital who would not allow me to give her any supplements. Can you give me any direction here? Is there any research which I can show them which proves my daughter needs good nutrition? Her muscles are very wasted and she has very bad oedema on her face due to the steroids. Any help at all would be greatly appreciated.
Answer
You are right to be concerned about your daughter's nutritional status, and I am sorry to hear that she is struggling. We know that poor nutritional status can have a detrimental impact on clinical outcomes (e.g. response to treatment), and there is a wealth of literature to support this.
Keeping you daughter well nourished will improve her tolerance to anti-cancer treatment, enable her to heal and repair, and give her a better sense of well-being. Additionally, at just 12 years old, she still requires extra calories to support growth and development.
I would recommend that you arrange to meet with the Consultant looking after your daughters care to discuss your concerns. In preparation for your meeting, you may find it helpful to make a list of the problems she's experiencing e.g. poor appetite, weight loss, nausea, fatigue, constipation. The doctor will be able to advise on any medication/intervention that can improve your daughter's symptom control and ultimately her nutritional intake.
Keep a list of all the food and drink your daughter has eaten over the last 3 or 4 days. This will be a useful reference just to see how much she is managing. 200 calories per day is certainly not enough to meet her nutritional requirements. The doctor can refer your daughter to see a registered dietitian. Many hospitals have paediatric dietitians available, and they will be experts in offering tailored nutritional advice. There certainly are nutritional supplements available that are suitable for young people, and your daughter may benefit from trialling these. The dietitian will be able offer advice here. If supplements are recommended, the dietitian can arrange a supply either through the hospital or through your daughters GP.
Try to encourage your daughter to eat little and often (small amounts of diet every 2 - 3 hours), choose higher protein/calorie snacks e.g. full fat yoghurts, cheese, ice cream and to drink nourishing fluids e.g. milk, milky drinks, milkshakes, smoothies, or fruit juice.
You may find the following link to the Leukaemia Research Fund http://www.lrf.org.uk/en/1/infnurfac1.html of interest. It contains further information on why nutrition is important for children with cancer, and offers some excellent practical advice as well as supporting references.
