It can be frustrating and disheartening to try to encourage a child to eat enough food to maintain weight, when the child, suffering from nausea, seems to have trouble eating at all, much less, enough.

Sometimes it simply is not possible to do two things at once. In this case that would be eating enough on a queasy stomach. There are things one can do to ease the discomfort and keep the calorie levels as high as possible so that the weight loss is as little as possible.

Select the most soothing foods that you can while still optimizing calories. This is generally done by avoiding spicy foods (bland will be better), by avoiding foods commonly associated with allergies and intolerances, by offering balanced quantities of carbohydrates, fats and proteins mixed together, by offering well pureed foods when necessary, and when clear fluids are necessary, by incorporating the maximum amount of nourishment into those fluids.

As you know, when someone has an upset stomach and can not keep anything down, it is not long before bile begins accumulating in the stomach. Bile acts as an irritant and can promote and prolong nausea. So, even when one has an upset stomach, it is not soothing to keep the stomach empty for a prolonged period of time. In the absence of food or fluids, irritants (eg, bile) will accumulate that will make the nausea worse. It is important to eat something even when nausea is severe or prolonged. Every time your child eats, he or she should eat as much as possible of bland, soothing foods, and then wait a little while before eating again.

1. Eliminate spicy foods and other foods that may be more difficult to digest. Bland foods are better tolerated when a child is nauseated. Avoid all spicy foods, all foods with high levels of fat, avoid milk products, avoid raw foods including raw vegetables and fruits.
   
2. Select foods well-tolerated by persons with extensive food allergies and sensitivities. Everyone probably suffers from mild food sensitivities and intolerances. For most people these are barely noticed and easily tolerated – except when one suffers from nausea. Then the mild problems can become much more noticeable. Foods well-tolerated by persons with extensive and severe food allergies and sensitivities, tend to be the best tolerated foods anywhere. These include well-cooked root vegetables, such as sweet potatoes, malanga, cassava and yam, and well-cooked meats such as chicken and turkey. Well-cooked sweet potatoes steamed or boiled with plenty of water tend to be soothing for a queasy stomach. The most well-tolerated food in the world is generally accepted to be malanga, its starch grains are smaller and the most easily digested.

   Serve well-cooked foods boiled in filtered water, seasoned with salt. Gently boil or poach well-tolerated foods until they are greatly overcooked, very tender, and falling apart. Cooking alters the food and breaks down much of the complex molecular structure of the food. The more that this occurs, the easier it will be for the food to be digested after eating. Cook the food in plenty of water, but then allow much of the water (although not all) to cook away. The consistency should be that of a watery cooked vegetable or meat, almost enough to be called a soup, but not quite.

   Filtered water, spring water and distilled water are slightly better tolerated that tap water, use this type of water for cooking for a person suffering from nausea.

   Use salt when you cook the food. Salt in moderation seems to be quite helpful. When moderate amounts of salt are used in cooking, the result is similar to the salt content of the isotonic saline solutions in the body. Foods that match the natural saline levels in the body tend to be better tolerated than overly salty brines or non-salty fluids, such as water.

   Serve the cooking liquid with the food so that all of the soluble substances, vitamins and minerals can be eaten. This is probably the most soothing and nourishing part of the food.
   

3. Cook balanced foods (meals). Especially for persons suffering from nausea, serve the well-tolerated, overcooked foods in balanced proportions. It may be best to cook the foods together.

   The previous section on regaining weight (When Your Child Needs to Gain Weight, Slimak 1997), emphasized the importance of eating optimal quantities of carbohydrates, proteins and fats. Even when a child is very nauseated, it is important to offer balanced quantities of foods; balanced meals are tolerated better. Neither carbohydrates, proteins, or fats alone are generally as well-tolerated by someone suffering from nausea as the foods in well-balanced combinations cooked together.

   By using Table 2 of the previous section, find the recommended daily amounts of carbohydrates (select from the root vegetables listed above), fats, and proteins (chicken or turkey ground or in very small pieces) for your child. When a child does not feel well, it is hard to know how much they will eat. Begin by preparing one fourth of each daily amount and then cook more as needed. Combine all of the portions and boil or poach them together.

   Add a small amount of chopped green vegetable if one is well-tolerated. You will end up with a fairly large quantity of watery, well-cooked carbohydrates, flavored by meat, vegetable and salt, with the fat difficult to know it is even there. This is the optimal type of food to serve to someone suffering from nausea.

   Depending upon how much of this type of ‘heavy soup’ is tolerated, you can then adjust the amounts of the same type of food you cook again.

   Continue to offer this type of food until the nausea subsides and foods in other forms can be tolerated.
   

4. If necessary serve the food pureed. Should you discover that your child is unable to tolerate the food described in step 4, above, try again with the added step of placing the well-cooked foods in a blender and blending thoroughly to a finely divided puree.

   The result of thorough pureeing will be a pudding-like consistency. If necessary add some extra water to prepare the puree. With added water, it may be necessary to add a little more salt. Try not to add much water during preparation, since the added water will reduce the caloric intake.

   The step of pureeing will break down the food into smaller particle sizes making the food easier to digest. Encourage your child to eat smaller bites and hold the food in his or her mouth to begin the process of digestion even before swallowing.
   

5. Encourage your child to chew thoroughly. Increasing the thoroughness of food digestion can increase caloric intake. This is important when nausea prevents a child from eating enough. Especially for carbohydrates, digestion begins in the mouth. If the food is swallowed quickly, this vital step can be missed. Encourage your child to keep the bites to a manageable size and chew slowly.
   

6. Create a clear broth. If a child is not able to tolerate the watery, well-cooked bland foods of suggestion 4, nor the puree of suggestion 5, then offer the child unlimited quantities of the following clear broth until the nausea subsides.

   Prepare the well-balanced foods described in suggestion 4, above, including the moderate amounts of salt; however, add a little more water and cook for two to three times longer. The intent is to cook the food for a very long period of time, being careful not to burn or scorch, until the food has virtually disintegrated and is hardly recognizable. At this point much of the nutritive value will have transferred into the water. Resist the urge to thin the broth, thicker is better.

   Strain to remove all particles from the liquid. Adjust to taste for salt and serve warm, approximately body temperature.

   The broth will be packed with nourishment, but also will be very well-tolerated and most easily digestible.

   When a child is able to retain nothing else, this nourishing broth is so soothing that it may be acceptable to even a severely irritated digestive tract.

   Should this not be the case, encourage the child the eat slowly, holding small mouthfuls in the mouth and swishing it very gently, to give digestive juices time to act and small amounts of absorption to occur even before swallowing. Encourage the child to swallow gently and slowly if possible. This will be the least upsetting way to eat.

   If the child continues to vomit, reintroduce this soothing, nutritious broth as soon as possible, even if the threat of continued vomiting exists. Each time some vital nutrients will be retained.
   

Sweet potatoes are particularly good choices for the well-tolerated carbohydrates in the soups, purees and broth suggested here. This is due to the unique combinations of sugars and complex carbohydrates and the high concentrations of vitamins and minerals they contain. Sweet potatoes are a particularly good choice because, of all of the well-tolerated root vegetables, sweet potatoes are the only ones common in the USA; they are also easily digestible; they contain high levels of vitamins and minerals, and they readily ‘fall apart’ when cooked thoroughly.

At the very least, these approaches will not cause further irritation and will provide much needed nourishment, at the very best the soothing goodness will help to greatly reduce the nausea and queasiness, thus making it possible to achieve higher levels of nourishment.

The best results for a child suffering from nausea can be obtained by assembling well-balanced combinations of carbohydrates, fats, and proteins from the most well-tolerated sources, boiling or poaching these foods with pure water, a few well-tolerated green leafy vegetables, and a little salt, until greatly overcooked, so that the majority of the nutritional value is now found in the cooking liquor, serving as ‘heavy’ soup, puree, or broth at body temperature, and encouraging the child to chew slowly and swallow gently.

©Karen Slimak, 1997, all rights reserved.

*This article, also with a focus toward children, is equally applicable to adults, and not only persons with food allergies, sensitivities, and intolerances, but for any person experiencing the unpleasantness of nausea. For example this article was originally written at the request of a writer preparing a book for parents of children suffering from various forms of cancer. The question was, during such a time of suffering, might there be highly nutritious foods that are particularly well tolerated, and what might be the least obtrusive ways to introduce those foods? What better place could there be to answer such questions than from the food allergy/sensitivity area.