Sometimes, due to the effects of their cancer and its treatment, children may require extra support to get the nutrition they need. Breeana Gardiner, a specialist paediatric dietitian in haematology/oncology at Great Ormond Street Hospital, explains more.
Children with cancer may need additional nutrition support with advice from a dietitian in order to get enough nutrition and help maintain normal growth and development. The dietitian will conduct an assessment which considers weight pattern, cancer type and treatment, symptoms, medications, diet and food/cultural preferences. From this assessment, your dietitian may recommend certain strategies to ensure your child gets enough calories and protein, along with the necessary vitamins and minerals.
Food-based approaches
These are recommended during treatment if your child is having difficulties with their usual eating. They include ‘fortifying’ foods with high energy/ fat and protein components such as nut butter and cream. Your dietitian can also advise you on modifying your child’s diet if they’re experiencing taste changes, nausea or constipation, for example.
Oral nutritional supplements
Usually milk or juice-based drinks, these might be recommended in addition to food-based approaches if your child needs additional nutrition. The type of supplements recommended will depend on your child’s taste preferences and age. These can be taken between or after meals.
Tube feeding
Tube feeding may be advised if your child continues to struggle with eating, is losing weight, or can’t take supplement drinks. It may be recommended early in treatment, where side effects could lead to weight and muscle loss. Parents may feel upset about this, but tube feeding is very common and for some treatments or types of cancer, nearly all children will need it at some point. It can relieve the pressure around mealtimes and can allow meals to remain a positive experience, while additional nutrition can be provided through the tube.
The most common type of tube feeding is a nasogastric tube (NG), a flexible, thin, plastic tube that goes down the nose to the stomach. It can be put in by the nurse or if your child is having a general anaesthetic for a procedure and can take a few days to get used to. A gastrostomy tube (PEG) is a feeding tube surgically placed directly into the stomach. The dietitian will discuss the best type of tube for your child, while play specialists can help prepare them for having the tube.
Your child can be given their usual formula milk, expressed breast milk or a different liquid feed in addition to oral intake through the tube. The feeds are all nutritionally complete with the right calories, protein, vitamin and mineral intake and can be adjusted to your child. Tubes can also be used to give extra water and medication. Families can be taught how to use the tube and feed through it at home safely.
Intravenous nutrition or parenteral nutrition (TPN or PN)
A specialist form of nutrition given via your child’s central line directly into the blood. It might be recommended if it’s not possible to give extra nutrition through a feeding tube or if your child’s gut isn’t working properly and needs rest, usually because of sickness, diarrhoea or mucositis. It’s usually only available in your child’s main treatment hospital and not usually for home feeding. It provides energy, protein, fat, vitamins and minerals and must be given for at least five to seven days. Blood levels need to be closely monitored when a child is receiving PN.
Remember...
Your dietitian and treatment team are there to help and will discuss and guide you through all the decisions regarding nutrition support.
From Contact magazine issue 101 - Winter 2023
