Chewing Difficulties in Childhood Cancer

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Difficulty in chewing occurs when mouth pain, problems with the teeth, or stiffness or pain in the jaw muscles make it difficult for an individual to eat certain foods, especially hard foods. It is important to work with your child’s health care team to find ways to manage difficulty in chewing, as it may cause your child to avoid eating certain foods or to eat smaller amounts of food, which can keep them from getting the calories and nutrients that their body needs to fight the cancer and recuperate from treatment.

Causes

Difficulty in chewing may result from physical changes your child’s mouth, jaw, or tongue caused by cancer, especially oral and oropharyngeal cancers. It may also occur as a side effect of their cancer treatment, especially chemotherapy, radiation therapy, or surgery.

Side effects of cancer treatment that can cause chewing problems include:

• Gum Disease, Tooth Decay, or Tooth Loss, which are all possible long-term side effects of radiation therapy, high-dose chemotherapy, or dry mouth
• Infections of the mouth after radiation therapy or chemotherapy
• Mouth Pain, which is caused by nerve damage from some types of chemotherapy
• Mucositis, which is soreness, pain, or inflammation in the mouth
• Pain and Stiffness in the Jaw Muscles, either as a possible long-term side effect of radiation therapy to the head and neck or from jaw clenching or tooth grinding
• Physical Changes to the jaw, mouth, or tongue from surgery
• Inability to Wear Dentures because of pain or swelling in the mouth or gums
• Tissue and Bone Loss in the Jaw; a possible long-term side effect of radiation therapy to the head and neck
• Xerostomia (Dry Mouth) from chemotherapy, radiation therapy, or some antidepressant and pain medications

Management and Treatment

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment, therefore it is important that you let your child’s doctor, nurse, or another member of their health care team know immediately if they are experiencing any difficulty in chewing including any new symptoms or a change in symptoms, especially because chewing problems interfere with eating.

It is important that your child visit their dentist to find and correct any issues with their teeth and/or mouth that might affect their ability to eat before starting any cancer treatment. If your child’s cancer treatment plan includes surgery on their jaw, you should speak to their doctor about available options to help them maintain their ability to eat.

Your child may need to see a speech therapist (a professional who specialises in helping people use the muscles in the mouth and throat) to help them learn how to chew more easily, especially if surgery has changed the structure of their mouth or tongue.

It may also be a good idea to continue to take your child to see their dentist in order to treat tooth pain, gum pain, or denture problems and to avoid more complex dental problems.  If radiation is part of their treatment plan, the dentist may suggest a special fluoride gel or mouth rinse to help prevent tooth decay or gum disease.

The doctor or dentist may also prescribe medication to reduce pain and inflammation; some of them may be mouth rinses that are to be used directly before eating.

Chewing problems caused by jaw pain and stiffness are generally treated with muscle relaxants and physical therapy that may involve jaw exercises, massage, and moist heat. Surgery may be recommended, but this happens very rarely.

Diet and Eating Tips

Different approaches may work better for some patients than for others, depending on the severity and cause of the chewing problems. It is important that you continue to try giving your child different types of foods to ensure that they are eating a nutritious diet that contains sufficient proteins, calories, vitamins and minerals.

Try the following tips:

• Try giving your child soft, smooth foods, such as yogurt, pudding, or ice cream.
• Mash or blend foods, or add blended vegetables or ground meats to stews or soups.
• Moisten dry foods with broth, sauce, butter, or milk.
• Encourage your child to take sips of water or other liquids while eating to keep their mouth and food moist.
• Try giving your child softer versions of their favourite fruits or vegetables like applesauce or pureed carrots; switch to softer fruits and vegetables, such as bananas or peas; or consider eating baby food.
• Cut their food into small bites, and encourage them to chew slowly and thoroughly.
• If your child is losing weight, let them eat smaller, more frequent meals that are high in protein and calories, such as eggs, milkshakes, casseroles, and nutritional shakes.
• Avoid feeding your child dry, coarse, or hard foods and foods that need a lot of chewing

You may also want to enlist the help of a registered dietitian for additional help on feeding your child a balanced diet – your healthcare team could help with this.