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Nutrition for children underdoing cancer treatment

General

Malnutrition and cachexia often occur in children with cancer. Both the illness and the treatment can reduce the child's appetite and tolerance for food.

Nutrition is very important when treating children with cancer. Good nutritional status facilitates tolerance for treatment. The immune system is improved, complications are reduced, and quality of life increases. Proper nutrition is also very important for normal growth.

It is also easier to prevent weight loss than to replace it afterwards. A small loss in weight may have great consequences for children since they have less energy storage than adults. 

Good nutritional status is crucial for optimal treatment. The child's nutritional status must be monitored closely during the entire treatment period and follow-up to ensure that proper measures are taken promptly, if needed.  

Calculation of energy and protein need for children with cancer

  • The energy need is calculated as 100% of the energy need of healthy children and is expressed in kcal/kg with the appropriate weight for the age. This must therefore be adjusted weekly and adjusted according to the increase of weight.
  • The protein need is calculated as 150% of protein need for healthy children. If the child eats a varied diet, the protein need will also be covered. Enteral feeding products also contain a sufficient amount of protein. Total protein intake should not surpass 4 g/kg body mass.

Treatment protocols and risk for malnutrition

Treatment protocols are developed for each cancer type. Treatment consists of chemotherapy, radiation, surgery, or a combination of these. Most chemotherapy causes side effects that can affect nutritional status, for example, nausea, vomiting, mucositis, diarrhea, constipation, and sensory changes.

The child will sometimes skip meals because of an increased need for sleep. It is possible, to a certain degree, to predict some of the nutritional problems associated with different treatment stages. It is therefore very important to know the patient's actual stage in the protocol to assess necessary measures to relieve side effects.

Indications for taking measures against malnutrition

Supplements/fortification

  • If the child's nutritional needs are not met even if they are able to eat and drink themselves.

Enteral nutrition (tube feeding)

  • Lasting weight loss or lack of weight gain despite additional nutritional measures
  • The child uses > 4 hours per day to eat
  • Highly intensive treatment protocols with known nutritional problems
  • Unbalanced diet that does not meet the child's total nutritional needs

Contraindications

  • Severe gastrointestinal failure
  • Obstructive conditions in the pharynx and esophagus
  • Ileus
  • Intestinal perforation
  • Intra-abdominal sepsis
  • Acute pancreatitis
  • Lasting nausea
  • Stomach retention >300-500 ml
  • Untreated bleeding disturbances

Parenteral nutrion (intravenous feeding)

  • If the child's nutritional status is not met with regular food or tube feeding
  • When enteral peroral nutrition or tube feeding is not possible

Goal

  • Prevent weight loss
  • Ensure the child received adequate nutrition throughout the treatment and follow-up period

 

Refererence

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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