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Nutrition for children underdoing cancer treatment

Definitions

Supplementing/fortifying

If the child is able to eat and drink without assistance, but not enough to meet his/her nutritional needs, his/her diet should be supplemented with nutritional drinks and/or fortifying additives.

Enteral feeding (tube feeding)

Enteral feeding is used when the stomach and intestinal tract are functioning normally. Tube feeding is preferred over parenteral feeding (intravenous feeding) because it is more physiological and conserves the intestinal integrity. Even small amounts of enteral feeding are important to prevent intestinal atrophy. There is less risk for infection compared to parenteral feeding.

The need to start tube feeding is determined by an interdisciplinary team consisting of the treating doctor, clinical nutritionist, and nurse. If the child has oromotor problems, a physiotherapist/speech therapist should be contacted. When infants and small children are exclusively tube-fed, it is very important to stimulate oral motor skills to avoid eating problems problems later.

Feeding tube insertion

Nasogastric

  • Standard localization
  • Most physiological for hormone/digestion response
  • Allows for higher osmolarity of the feeding solution than the small than small intestine 
  • Maintains antimicrobial function in the stomach

Nasoduodenal/jejunal

  • If there is gastric dysmotility
  • For retention
  • Persistant vomiting
  • Increased risk for aspiration

Percutaneous endoscopic gastrostomy (PEG)

  • Should be assessed as needed for tube feeding > 3 months
  • In youth that refuse a nasogastric tube
  • Surgery/radiation to the head/neck area
  • Contraindicated for ascites, abdominal tumor, and increased risk of bleeding 

Parenteral feeding

Parenteral feeding is utilized when the child's nutritional need cannot be met by another method. This type of feeding is prescribed by a doctor in collaboration with a pharmacist and clinical nutrtionist.

Intravenous feeding is associated with a higher risk for infections in children with cancer. Still, the child's nutritional needs have the highest priority, if there is a possible way. Intravenous feeding alone is unfavorable. Even small amounts of food and drink will prevent intestinal atrophy.   

Reference

Ernæring til barn med kreft – Veileder for helsepersonell [Online]. Mars 2004 [hentet 1. desember 2007]; Tilgjengelig fra: URL:http://www.kreftforeningen.no/vp/multimedia/archive/00001/Ernaering_til_barn_me_1627a.pdf

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