The goals of nutritional intervention are to prevent or reverse nutritional deficits, to promote normal growth and development, to minimize complications and mortality, and to maximize quality of life for you, the patient. Staying well-nourished during treatment can be a challenging and even frustrating experience atimes. Fortunately, there are several options to stay well-nourished.
Oral
The first line of defense in meeting nutritional needs is simply by eating and drinking. Special diets (high calorie, high protein) and oral nutritional supplements (commercial products, homemade milkshakes) can help, but these are not always sufficient to prevent weight loss, or to meet all your nutritional needs.
Despite all efforts to provide nourishing foods, you may not be able to gain enough weight, or may even experience weight loss. This can happen if your appetite remains poor, if eating and drinking are too difficult, or if your condition greatly increases your requirements for nutrients. Under such circumstances, tube feeding may be necessary.
Tube feeding
Tube feeding involves placing a thin, flexible tube through your nose and into the stomach. Once the tube is in place, nutritional formulas can be given directly.
Although it is possible to meet 100 percent of your requirements for calories, protein, vitamins, and minerals with such formulas, you can usually continue to eat even when a feeding tube in place. 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 you sleep, and to eat regularly during the day.
If needed, medications to help combat nausea and vomiting can also be provided through the tube. In fact, when tube feedings are started, you will often feel better since you are receiving more nutrition. It may even help you to increase your food intake. Another benefit is that your normal intestinal function will be maintained, since nutrition is being delivered straight to the gastrointestinal tract.
Most patients adapt to tube feeding after a few days. If you are uncomfortable, it often helps to talk with a peer who has experienced tube feedings. In addition, a member of the treatment center can visit your school, and explain to your classmates why tube feedings are necessary for you.
Tube feedings are most often used if poor appetite prevents you from gaining enough weight, but they may also be used if eating and drinking by mouth is not possible. The feeding tube can be inserted every night, but most patients prefer that it just be left in place. A more permanent type of tube might be placed directly into your stomach or intestines through the skin by a special procedure before you leave the hospital. Tube feedings can be provided in the hospital and at home if needed. Patients and parents can learn to handle tube feedings at home.
Nutrient solutions: total parenteral nutrition
If eating and drinking adequate amounts of food and fluids are impossible, and severe digestive system problems are present, tube feeding may not be the best option to provide you with the nutrients you need.
In these cases, nutrient solutions can be given directly into your veins. This type of therapy is called intravenous hyperalimentation (HAL) or total parenteral nutrition (TPN). Parenteral feedings are most often used when you have undergone surgery of the digestive system, when the intestines are completely blocked, when you are having severe vomiting or diarrhea, or when complications from the disease or treatment prevent eating or passing a feeding tube into the digestive tract. Parenteral nutrition solutions can usually meet 100 percent of your 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