Janice, the dedicated dietician for Four Diamonds, has been passionately advocating for and managing the nutritional needs of children battling cancer for over two decades at Penn State Health Children’s Hospital. She firmly believes that proper nutrition plays a pivotal role in the treatment process. Well-nourished children tend to experience fewer side effects and less treatment delays. As Janice puts it, “adequate nutrition not only aids in timely completion of their therapy but also expedites their return to feeling like a normal kid again.”

When Kids Are Feeling Sick

When a child is undergoing treatment and feeling very sick, there are limited options for nutritional intervention. However, hydration is crucial, and it’s important to find a healthy drink that can help them recover quickly. Janice discourages offering children their favorite foods when they’re feeling ill. Instead, she recommends ‘sick-day foods’ that are easy on the stomach, such as JELL-O and toast. The key is not to exert too much pressure on them during these challenging days.

Once the children start to feel better, Janice educates families on how to increase caloric intake in their regular meals, like adding extra cheese to a sandwich. Janice’s primary goal is to manage overall nutrition. Given that many children struggle with vomiting and diarrhea, she aims to maximize their caloric intake. One strategy she employs is enhancing their favorite foods with nutritious calories. For instance, a baked potato can be fortified with proteins like meats and cheeses, providing much-needed sustenance.

The Best and Worst Things to Be Consuming

Janice advocates for moderation in all aspects of diet, with the sole exception of soda. She views soda as merely empty calories that displace the much-needed and more nutritious foods in the diets of children undergoing cancer treatment. Also, while grapefruit isn’t typically a favorite among children, it’s particularly important to avoid it as it can interfere with medications. Janice encourages the consumption of fresh fruits and vegetables, particularly emphasizing berries, broccoli and members of the cabbage family. “These fresh foods are packed with beneficial nutrients,” Janice says, “but encouraging their consumption can be challenging, as many families don’t typically include a lot of fruits and vegetables in their diets.”

The Effects of Steroids

Steroid treatments often lead to children developing cravings for salt and sugar. Children are susceptible to weight gain during the initial month due to increased appetites induced by the steroids. Janice emphasizes the importance of maintaining a balanced diet during this phase of treatment. She advises, “It’s perfectly acceptable to have a cookie, but ensure it’s complemented with a glass of milk, and aim for a healthier option for the next snack.” Steroid treatments can also impact bone health, so Janice consistently recommends incorporating good sources of calcium into their diets. Parents who effectively assist their children in achieving this balance will likely observe less fluctuation in their children’s weight. Once the steroid treatment concludes, children’s appetites will naturally decrease. This change often concerns parents, but Janice reassures them that their children are simply reverting to their original eating patterns.

The Easy and the Difficult

Adapting to change can be challenging, and some changes are easier than others. Janice believes that the simplest change a family can make to benefit their child undergoing treatment is transitioning from low-fat to whole-fat products. She says, “switching to whole milk and whole-fat yogurt is an effortless change that provides children with the additional nutrition, calories and fats they require, without increasing their food intake.”

On the other hand, Janice observes that the most challenging adjustments families face are the inclusion of extra protein and the elimination of soda from their diets. Since young children typically aren’t big meat-eaters, incorporating this essential nutrient can be difficult. Similarly, removing soda, often a favorite among children, from their diets can also be a tough change.

What Cancer Takes Away and The Perfect Plate

When a child is undergoing chemotherapy or radiation treatment, they often lose their appetite, leading to a vicious cycle of weight loss and micronutrient deficiency. A well- balanced, high-calorie diet can help counteract these effects. Chemotherapy depletes micronutrients like vitamins A and C, as well as iron, necessitating their supplementation. Maintaining a well-balanced diet can minimize the need for such supplementation.

Janice’s concept of a well-balanced diet for a child undergoing treatment begins with her ‘perfect plate.’ She explains, “my perfect plate includes a small serving of starch, such as mashed potatoes, a small portion of chicken, a serving of fruit or vegetables and a glass of whole milk. For those seeking extra calories, consider adding butter to foods, consuming fruits in heavy syrup or pairing an apple with peanut butter.’ A well-balanced diet also entails ensuring that the portions are appropriate for a child. Often, parents expect their children to consume adult-sized portions, which is not suitable during treatment. Instead, Janice encourages families to serve six small meals a day as opposed to three large ones.

Research and A Legacy Left

When Janice joined Penn State Health Children’s Hospital two decades ago, the dietary regimen for bone marrow transplant patients was extremely restrictive. However, subsequent research indicated that some of these limitations were unnecessary. Janice gradually introduced changes to the diets of these children. Initially, these patients were not allowed fresh fruits and vegetables. Today at the hospital, the dietary guidelines for transplant patients have become significantly more flexible thanks to Janice. In addition to this, Janice has dedicated countless hours to educating the staff about tube feeding and intravenous nutrition, emphasizing their importance. The objective was to enhance the staff’s understanding of these treatments and foster a sense of confidence in recommending and administering them.

Retirement, How Things Started, Where Things Are Now

Two decades ago, treating certain cancers, such as neuroblastoma, was a formidable challenge. Janice reflects on the remarkable progress that has been made since then. She has witnessed the survival rate of patients surge from 70% to 80%, and ultimately to the current rate of 85%. “The majority of children are not only surviving but also thriving,” Janice says. “Our unit is not gloom and doom, but one of hope and resilience.” Janice firmly advocates for open communication with families who are coping well, believing that it is crucial for parents to be aware of these success stories. Janice concludes, “we continually reassure families that despite the current hardships, they will get through it. This is what keeps us all going. We are here for the kids.”

As Janice approaches her retirement this year, her greatest hope is that she has positively influenced the lives of these children and their families. “Witnessing these children in their most vulnerable state is heart-wrenching,” Janice admits. “However, contributing to their overall nutrition and observing their incredible journey is truly amazing. The ultimate reward is seeing them return to their normal lives, healthy, happy, and full of life. That is truly the best part of my job.”

To learn more about how Four Diamonds is helping families facing childhood cancer, click here.