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Nutrition for children underdoing cancer treatment

Preparation

Assessment of nutritional status

The child's nutritional status should be assessed regularly during the entire treatment and follow-up period in order to start necessary nutritional measures at the right time. The child's nutritional status should be surveyed at each hospital admission and outpatient visit.  

Registering weight

The child's normal weight must be registered in the growth curve. This is done by using the child's growth chart from the public health clinic.

In order to assess growth increase and risk for malnutrition/obesity, the following measurements are performed: 

Weight

  • Frequency 
    • Weight < 10 kg: 2 x per week
    • Weight > 10 kg: 1 x per week
    • Children on nutritional therapy: 2 x per week

Length

  • Frequency 
    • Age 1/2-1 years: 1 x per month
    • Age > 1 year: every 3rd month

Head circumference

  • Frequency 
    • 0-1/2 year: 1 x per month
    • 1/2-2 years: every 2 months 

These measurements should be performed until the child is 2 years of age.

Criteria for identifying malnutrition or obesity

If the child shows one or more of the following, nutritional therapy should be started:

  • Documented weightloss
    • ≥ 5 % in 1 month
    • 7,5 % in 3 months
    • 10 % in 6 months
  • Changes in the growth curve are equivalent to 1-2 percentile (underweight/overweight) 
  • Poor appetite without sign of improvement associated with expected long term illness and treatment period. Oral intrake of food in
    • children over 10 kg ® < 50 % of need x 5 days
    • children under 10 kg ® < 50 % of need x 3 days
  • Bone marrow transplantation
  • Expected intestinal dysfunction > 5 days for well nourished patients, for example
    • Graft Versus Host Disease (GVHD) from bone marrow transplant
    • operative procedure in the stomach/intestinal region
  • Patients with a high risk for malnourishment based on tumor type and treatment protocol
    • Wilms' tumor (stage III and IV)
    • Ewing sarcoma
    • Osteogenic sarkcoma
    • Hepatoblastoma
    • Rabdomyosarcoma (stage III and IV)
    • Cerebral tumor
    • Neuroblastoma (stage III and IV)
    • Acute myelogenous leukemia

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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