Cancer can be especially hard for children. They have a disease they often don’t understand and must undergo treatments that can be unpleasant. Adding to an already difficult experience, treatments such as chemotherapy or radiation can result in nausea, mouth sores, changes in taste, and difficulty swallowing — any one of which may impair the ability, and desire, to eat.
Children who are able to eat well and remain well nourished often weather cancer treatment better, while those who stop eating and are undernourished can have slower recoveries — to say nothing of the distress parents and caregivers feel when a child won’t eat.
But Memorial Sloan-Kettering Cancer Center’s chefs and dietitians are up to the challenge. Working together, they devise meals that satisfy both compromised appetites and finicky tastes, while adhering to the nutritional needs of individual patients.
“Our chefs have a gift of working around severe dietary restrictions so kids can still get joy out of eating,” says Nina J. Pickett, Administrator in the Department of Pediatrics. She explains that Memorial Sloan-Kettering’s ability to entice pediatric patients to eat was greatly enhanced with the arrival in December 2009 of Memorial Hospital Executive Chef Pnina Peled. “Pnina is a pioneer and has encouraged her staff to work closely with our registered dietitian, Dominique Symonette, who knows every child and family and what the clinical, physical, or psychological issues may be concerning food and eating.”
Although many pediatric patients are content to order from one of Memorial Hospital’s 75 menus, which range from kosher to halal to vegan, some children have special food needs or preferences. Each day, Ms. Peled confers with Ms. Symonette, who determines each child’s nutritional needs and appropriate interventions. Working together, they identify patients who would benefit from an individually tailored diet that will make mealtimes more enjoyable, while meeting the eating challenges posed by treatment.
“I can’t cure the disease, but I can bring a bit of calm to [children’s] lives… And to know I’m contributing toward their healing means everything to me.”
Executive Chef Pnina Peled
“The kids are excited to have their own personal chef and menu,” Ms. Peled says.
Lori Schneider, whose three-year-old daughter, Penelope, was reluctant to eat following a bone marrow transplant, was amazed at Ms. Peled’s dedication and accessibility. “We would reach out, and Pnina would respond to our questions or requests for a specific food,” Ms. Schneider says. “My husband and I feel she’s been just as concerned about Penelope’s eating as we have. She and the whole nutritional staff really took that pressure off us.”
Nutrition, Treatment, and Recovery
“Nutrition is vital for managing patients with cancer,” Ms. Symonette explains. “Poor nutritional status can result in delayed healing.”
Even when pediatric cancer patients are disposed to eat, restricted diets can make the prospect unappealing. For example, children with weakened immune systems require low-microbial foods, while other patients may need meals low in fat, sugar, or sodium. “As part of the patient’s care team, I make nutrition and meal-planning recommendations, and Pnina works within those guidelines as well as taking into account, in a very creative way, what a child is willing to eat,” Ms. Symonette says.
Ms. Peled is also adroit at disguising ingredients so children accept alternate — and healthier — versions of foods they crave. When one girl insisted on nothing but spaghetti with marinara sauce, Ms. Peled pureed carrots, cauliflower, and broccoli into the sauce. A boy who did not like green beans was happy to eat them if they were minced to look like scallions and served on sesame noodles.
Not surprisingly, children often yearn for takeout and fast food, so Ms. Peled prepares and serves pizza in a takeout box, or chicken with broccoli in Chinese food containers. Memorial Sloan-Kettering pediatric oncologist Susan E. Prockop recalls a young patient who wanted to eat chicken “nuggets” exclusively, so Ms. Peled devised a way to make them using pureed white chicken meat, cut into irregular shapes and mimicking the mouth feel and taste of those served in an outside restaurant.
Memorial Sloan-Kettering’s chefs and dietitians also work to accommodate the needs of adult patients, but Ms. Peled is especially passionate about children. “I can’t cure the disease, but I can bring a bit of calm to their lives,” she says. “And to know I’m contributing toward their healing means everything to me.”