The treatment your child received right before their blood and marrow transplant (BMT), which consisted of high-dose chemotherapy, with or without total body irradiation (TBI), destroyed the abnormal bone marrow cells in their body. Both the chemotherapy and the transplant put a lot of strain on your child’s organs and tissues.
Proper nutrition helps your child’s body to:
- repair any organ or tissue damage
- fight fever and infection
- take up (engraft) the donor cells that it received during the BMT
Eating nutritious, high-protein food can help keep the new marrow cells healthy. To make sure that your child is getting the proper nutrition, they may need to eat higher calorie foods, take oral supplements like Ensure or they may even need a nasogastric (NG) feeding tube.
How is your child’s nutrition monitored after a BMT?
Every day, your nurse and dietitian will look at how much your child is eating and drinking to make sure they are getting enough nutrients. Tell your child’s nurse about what your child is eating and drinking each day. To help you keep track, you may be asked to record the number of calories your child is consuming. Give these numbers to your nurse each day for the dietitian to review. Encourage your child to eat and drink (even if it is only small amounts) to keep their digestive system working well, but do not force them. It is very normal for children pre- and post-BMT to feel nauseous or not very hungry.
The low-bacteria diet
After your child’s transplant, they will be placed on a special diet to minimize any risk of infection. This diet is called the low-bacteria diet. The low-bacteria diet focuses on food safety and recommends avoiding certain foods that might cause infection (such as undercooked meat or raw fish). It is not very restrictive, or particularly difficult to follow, but it is important that your child stay on the diet for three to six months, as recommended by the BMT team. You will receive written information about the low-bacteria diet and the safe handling and preparation of food when you are admitted, and you can ask to see the dietitian if you have any questions.
Food brought to the hospital and storing food
- Food prepared from home is allowed inside your child’s hospital room, as long as it is completely cooked, and transported and stored properly.
- Never store food that is meant to be hot or cold at room temperature for longer than one to two hours.
- Seal and wrap any food you store in the patient fridge. Label it with the date and time that you stored it. Always use refrigerated foods within 24-48 hours, or before the “best before” date.
- Food that is commercially prepared and packaged is always allowed.
- Your child can eat food prepared by family and friends, and food from restaurants, so long as it is prepared according to the low-bacteria guidelines.
Nutrition support: Enteral and parenteral nutrition
There may be times when your child does not feel well enough to eat. Food may taste strange, they may have no appetite or eating may be too painful. Some children have vomiting and diarrhea that make it hard for them to tolerate food. When this happens, your medical team may recommend starting nutrition support. This is provided either through an NG tube, or intravenously through your child’s central line. Almost all children who have a BMT require some kind of nutrition support.
Enteral nutrition is a special formula of nutrients given through an NG tube. It can be delivered either as one slow infusion over the course of the day, or given as smaller amounts, multiple times daily. Enteral nutrition is the best way of providing nutrition support as it is delivered to your child’s gut, which is the most natural way of receiving extra nutrition. Your child’s NG tube can also be used to give medication. Some children do extremely well with NG tubes, and may even eat and drink by mouth in addition to their NG feeds. It is best to insert an NG tube early in treatment, before your child develops any mouth sores. Your medical team and dietitian can discuss this further with you.
Sometimes, children do not tolerate enteral nutrition or may only tolerate a small amount of the nutrients that they need each day. In this instance, your child’s health-care team might recommend that your child receive IV nutrition through their central line. This nutrition is called parenteral nutrition (PN). This will be ordered and monitored by your dietitian, and given by your nurse. Your dietitian will make sure that your child receives enough calories, protein, fat, carbohydrates, vitamins and minerals in both their enteral and parenteral nutrition, and will work with you when it is time for your child to start trying to eat again.
It may take a while for your child’s eating to improve enough to go home. If your child is still struggling to eat by the time they are discharged from the hospital, the health-care team might recommend that your child receive feeds at home through an NG tube. If this is the case, your dietitian will work with you to decide which feed, how much and how often is best. Your child will be followed by the clinic dietitian after they go home to make sure they keep growing and gaining weight.
Breastfeeding and use of expressed breast milk
Many babies who have a BMT are still breastfeeding. For some babies, continued breastfeeding is allowed and encouraged. If your baby stops breastfeeding well during their BMT, breast milk can be expressed and given to them orally or through a feeding tube during this time. If you are interested in breastfeeding your baby during their BMT, ask your BMT doctor or nurse coordinator if your baby can continue to breastfeed or receive expressed breast milk by mouth or feeding tube.
Mothers who are able to continue breastfeeding during the BMT, or who want to express breastmilk but are struggling, may benefit from a visit from a lactation consultant. Your nurse or any other member of the health-care team can ask the lactation consultant for suggestions and strategies on how to successfully continue breastfeeding or pumping breast milk.
