High-Calorie / High-Protein Diet

Good nutrition is very important for children being treated for cancer. Children with cancer often have poor appetites. Also, side effects from medications may make the body not tolerate foods well. This can contribute to poor nutrition and poor growth. If a child with cancer maintains adequate nutrition, then he/she may be more likely to:

• better tolerate chemotherapy or radiation and experience fewer side effects.
• heal.
• grow and develop.
• maximize quality of life.

Children with cancer often have increased calorie and protein needs. Protein is needed for growth and to help the body repair itself. Getting enough calories can help the body grow, heal, or prevent weight loss. If your child is having trouble eating enough calories and protein, your child's physician or dietitian may suggest serving high-calorie and high-protein foods (i.e., eggs, milk, peanut butter, and cheese).

Increasing calories and protein:

Listed below are some ideas for adding calories and protein to foods that your child may eat for meals and snacks:

• powdered milk (33 cal/Tbsp, 3 gm protein/tbsp):
  
  
  • Add 2 to 4 Tbsp to 1 cup milk.
    
    
  • Mix into puddings, potatoes, soups, ground meats, vegetables, cooked cereal, milkshakes, yogurt, and pancake batter.
    
    
• eggs (80 cal/egg, 7 gm protein/egg) or egg substitute (Egg Beaters® 25 cal per 1/4 cup, 5 gm protein per 1/4 cup):
  
  
  • Add to casseroles, meat loaf, mashed potatoes, cooked cereal, macaroni and cheese, and chicken or tuna salads.
    
    
  • Add extra to french toast and pancake batter.

Do not use raw eggs in uncooked items. Egg substitutes may be used in uncooked items, such as milkshakes or eggnog.

• butter or margarine (45 cal/tsp):
  
  
  • Add to pudding, casseroles, sandwiches, vegetables, cooked cereal, breads, and pasta.
    
    
• cheeses (100 cal/oz., 7 gm protein/oz.):
  
  
  • Give as snacks, or in sandwiches.
  • Add to casseroles, potatoes, vegetables, and soups.
    
    
• wheat germ (25 cal/Tbsp):
  
  
  • Add 1 to 2 Tbsp to cereal.
  • Mix into meat dishes, cookie batter, and casseroles.
    
    
• mayonnaise or salad dressing (45 cal/tsp):
  
  
  • Use liberally on sandwiches, salads, as a dip for raw vegetables or sauce on cooked vegetables.
    
    
• evaporated milk (25 cal/Tbsp, 1 gm protein/Tbsp):
  
  
  • Use in place of whole milk in desserts, baked goods, meat dishes, and cooked cereal.
    
    
• sour cream (26 cal/Tbsp):
  
  
  • Add to potatoes, casseroles, and dips.
  • Use in sauces and baked goods.
    
    
• sweetened condensed milk (60 cal/Tbsp, 1gm protein/Tbsp):
  
  
  • Add to pies, puddings, and milkshakes.
  • Mix 1 to 2 Tbsp with peanut butter and spread on toast.
    
    
• peanut butter (95 cal/Tbsp, 4 gm protein/Tbsp):
  
  
  • Serve on toast, bagels, crackers, bananas, apples, and celery.
    
    
• Carnation® Instant Breakfast™ (130 cal/pkt, 7 gm protein/pkt):
  
  
  • Add to milkshakes or milk.
    
    
• gravies (40 cal/Tbsp):
  
  
  • Use liberally on mashed potatoes, rice, noodles, and meats.

What foods are high in protein?

High-protein foods include:

• meats - beef, chicken, fish, turkey, lamb
• milk and cheese - yogurt, cottage cheese, cream cheese
• eggs
• peanut butter (with bread or crackers)
• dried beans and peas (with bread, cornbread, rice)

Children younger than 3 years of age should avoid chunky peanut butter, and fruits and vegetables with skin, due to the risk of choking.
 
Commercial nutrition supplements should only be used when recommended by your child's physician or dietitian. Below are some examples of supplements. Your child's physician or dietitian will suggest which ones are best for your child. Different flavors are available, including vanilla, chocolate, strawberry. Examples of supplements include the following:

• Pediasure®, Nutren Jr®, Kindercal™
• Ensure®, Resource®, Boost®,
• Ensure® Pudding, Boost® Pudding

High-calorie snacks:

The following snack ideas are a good source of calories for children older than 3 years of age. They can be eaten as a meal or in addition to meals.

• instant breakfast drink (280 cal):
  
  
  • 1 packet Carnation Instant Breakfast™, 8 oz. whole milk.
    
    
• instant breakfast shake (500 cal):
  • 1 packet Carnation Instant Breakfast™, 1/2 c. half & half, 3/4 c. ice cream mixed in blender.
    
    
• cheese toast (175 cal/slice):
  
  
  • 1 oz. cheese, 1 slice toast.
    
    
• peanut butter and jelly sandwich and milk (555 cal):
  
  
  • 2 sl. Bread, 2 Tbsp peanut butter, 1 Tbsp jelly, 8 oz. whole milk.
    
    
• bagel and cream cheese, jelly, and juice (510 cal):
  
  
  • Bagel, 1 oz. cream cheese, 1 Tbsp jelly & 12 oz. apple juice.
    
    
• pizza (300 cal):
  
  
  • 2 slices cheese pizza.
    
    
• egg and cheese on an english muffin (285 cal):
  
  
  • 1 egg, 1 oz. cheese, and 1 English muffin.
    
    
• yogurt smoothie (390 cal):
  
  
  • 8 oz. Yogurt, 1/2 c. half & half, 1 c. frozen strawberries.
    
    
• peanut butter and banana on toast (320 cal):
  
  
  • 2 Tbsp peanut butter, 1 banana, 1 slice of toast.
    
    
• granola bar and yogurt (480 cal):
  
  
  • 8 oz. fruit-flavored yogurt, and 2 granola bars.
    
    
• nachos with beans and cheese (560 cal):
  
  
  • 1 oz. tortilla chips, 1/2 c. refried beans, 2 1/2 oz. melted cheese and salsa to taste.
    
    
• tuna salad on crackers (440 cal):
  
  
  • 1/2 cup tuna salad, 5 crackers.
    
    
• trail mix (582 cal):
  
  
  • 1 cup Captain Crunch, 12 almonds, 2 Tbsp peanuts, 1/3 c. raisins, 1/2 c. chocolate chips or M&M's®.
    
    
• chili cheese fries (619 cal):
  
  
  • 1 c. french fries, 3 1/2 oz. chili, 2 1/2 oz. melted cheese.
    
    
• chips and dip and chocolate milk (507 cal):
  
  
  • 1 oz. chips, 1/4 c. onion dip plus 8 oz. chocolate Carnation Instant Breakfast™.
    
    
• buttered popcorn and grape slush (600 cal):
  
  
  • 2 cups popcorn with 2 Tbsp melted butter and 1 high-calorie slush (2 grape popsicles, 1/2 c. grape juice, 2 Tbsp corn syrup, and 1 Tbsp corn oil, mixed in blender.)

 

Recipes for high-calorie shakes and drinks:	Calories
Chocolate-Peanut Butter Shake	1070
1/2 c. heavy whipping cream 3 Tbsp creamy peanut butter 3 Tbsp chocolate syrup 1 1/2 c. chocolate ice cream Blend in blender.
Strawberry Crush	640
2 c. frozen strawberries 1/2 c. crushed pineapple 1/2 c. water 1/2 medium banana 6 Tbsp Sugar 1/4 c. lemon juice 2 Tbsp Honey Blend in blender.
Peaches and Cream	630
1 c. milk 1 c. canned peaches 1 c. vanilla ice cream 1/4 tsp Salt 1/4 tsp vanilla Blend in blender.
Apple Pie a la Mode	525
1 c. apple pie filling 1/2 c. milk 1 c. vanilla ice cream dash of cinnamon Blend in blender.
High-Calorie Breakfast Shake	505
1 c. half & half 1 packet Instant Breakfast 3/4 c. ice cream Blend in blender.
Grape Slush	493
2 grape juice bars 2 Tbsp corn syrup 1/2 c. grape juice or 7-Up 1 Tbsp corn oil Blend in blender.
Orange Sherbet Shake	480
3/4 c. orange sherbet 2 Tbsp corn syrup 1/2 c. 7-Up 2 Tbsp corn oil Blend in blender.
Old-fashioned Milkshake	420
1 c. whole milk 1 c. ice cream Blend in blender.
Hot Chocolate	416
3 oz. milk chocolate 1/4 tsp vanilla 1 tsp butter 1 c. half & half Melt chocolate and butter. Add vanilla and slowly stir in half & half, small amounts at a time. Reheat to desired temperature.
Carnation Instant Breakfast™	280
1 packet 1 c. whole milk

 
Other high-calorie drinks come ready-made and are available in most grocery stores and pharmacies, including the following:

Ready-made high-calorie drinks:	Calories
Ensure Plus®, 8 oz	360
Resource Plus®	355
Boost Plus®	355
Carnation Instant Breakfast™	280
Kindercal®	240
Pediasure®	240
Fast Food Shake	340 to 400

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