The goals of nutritional intervention for a child with cancer are to prevent or reverse nutritional deficits, to promote normal growth and development, to minimize complications and mortality, and to maximize the child's quality of life. Helping a child with medical problems to stay well-nourished can be a challenging and even frustrating process at times. Fortunately, there are several options.
Oral
The first line of defense in meeting nutritional needs is by the oral route (eating and drinking). Special diets (high calorie, high protein) and oral nutritional supplements (commercial products, homemade milkshakes) are helpful, but even these may not always sufficient to prevent weight loss, or to meet a child’s nutritional needs.
Despite all efforts to provide nourishing foods, a child with cancer may not be able to gain enough weight or may experience weight loss. This can happen if the child’s appetite remains poor, if eating and drinking are too difficult due to illness or medical treatments, or if the child’s condition greatly increases his or her requirements for nutrients. Under such circumstances, tube feeding may be helpful and necessary.
Tube feeding
Tube feeding involves threading a thin, flexible tube through the nose right into the digestive tract. Once the tube is in place, nutritional formulas can be given directly. Tube feedings can be provided in the hospital and at home if needed. Parents can be trained to provide tube feedings at home.
Although it is possible to meet 100 percent of a child’s requirement for calories, protein, vitamins, and minerals with such formulas, a patient with a feeding tube in place can usually continue to eat. This is because feeding tubes are small enough not to interrupt the normal process of swallowing.
It is easiest to tube-feed at night while the child sleeps and encourage him or her to eat during the day. Eating with friends and family is also a very important part of a child’s social life, so it's always a good idea to allow the child to eat by mouth in addition to tube feedings.
If needed, medications to combat nausea and vomiting can also be given through the tube. In fact, when tube feedings are started, children often feel better since they are receiving nutrition, and begin to eat and drink more on their own. Another benefit is that normal intestinal function is maintained, since nutrition is delivered straight to the gastrointestinal tract.
Most young children adapt to tube feeding after a few days. Older children and teenagers have a more difficult time adjusting to the presence of a tube in their nose, perhaps because they are more sensitive to appearance and social issues. It often helps to have a peer who has experienced tube feedings visit with these patients.
In addition, a member of the treatment center can visit the child’s class at school and explain why tube feedings are necessary. Children should never be threatened with tube feedings as a punishment for not being able to meet their nutritional needs, and should participate as much as possible in the decision to begin tube feedings.
Tube feedings are most often used if poor appetite prevents adequate weight gain, but may also be used if eating and drinking by mouth are not possible. While the feeding tube can be inserted every night, most children prefer it simply be left in place. A more permanent type of tube can be placed directly into the stomach or intestines through the skin by a special procedure before the child leaves the hospital.
Nutrient solutions: total parenteral nutrition
If it's impossible for the child to eat and drink adequate amounts of food and fluids, and severe digestive system problems are present, tube feeding may not be the best option to provide a child with necessary nutrients.
In these cases, nutrient solutions can be given directly into the child’s veins. This type of therapy is called intravenous hyperalimentation (HAL) or total parenteral nutrition (TPN). Parenteral feedings are most often used when a patient has undergone surgery of the digestive system, when the intestines are completely blocked, when severe vomiting or diarrhea occurs, or when complications from the disease or treatment prevents eating or passing a feeding tube into the digestive tract. Parenteral nutrition solutions can usually meet 100 percent of a child’s nutritional needs for calories, protein, vitamins, minerals and fluids. This type of nutrition therapy can also be provided at home.
Nancy Sacks, MS, RD, The Children's Hospital of Philadelphia