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Children and teenagers with cancer need adequate nutrition for normal growth and development. The better nourished the child, the better they will tolerate treatment, fight infections and develop.
It’s important to consider the whole family when giving nutritional advice; I might be asking parents to administer tube feeds at home, or I may be talking to a teenager struggling with their food intake about how to maximise their calcium intake or adjust vitamin D supplements at a critical time for bone development.
I also talk to families about how to cope with side effects of treatment, food safety, and methods of nutritional support. I advise on oral nutritional support (such as food and drink fortification or supplement drinks) and tube feeding (such as nasogastric, gastrostomy or jejunal feeding), using specialist feeds if necessary.
I prescribe and monitor intravenous nutrition for severe gut toxicity, for example. I also give advice about vitamin and mineral supplements, steroid-induced diabetes, bone health and weight management.
I spend a lot of time with children who have acute lymphoblastic leukaemia. (See the case study below for more).
Children undergoing treatment for this can struggle to eat and drink, so I work with families to maximise calorie intake from the start. I devise a feeding plan with the child and family, and monitor progress to ensure the plan is practical for use at home.
I work closely with Evelyn Ward, Senior Specialist Paediatric Oncology Dietitian, and the multidisciplinary team at the Leeds Children’s Hospital. We are a regional centre for paediatric oncology/haematology, including, stem cell transplantation.
Jack was diagnosed with acute lymphoblastic leukaemia when he was about three and half years old. He was a fussy eater to begin with, and it was difficult to get him to eat anything on treatment. We supported his parents by giving him complete nutrition via a nasogastric tube.
I see the family regularly to make sure he is growing and the tube feed is working for everyone. His parents have always kept a food diary, which has helped to analyse his intake, ensuring he gets all the nutrients he needs for his age. He has now reached the ‘maintenance’ phase of his treatment, when many children start eating again.
Jack managed a few days without his tube and we thought we could persevere with milk, a few foods and a multi-vitamin supplement. Unfortunately he caught a virus and his tube had to be put back in.
He is much better now but still has little interest in food. In time we may have to try holding back on the feed again to see if he’ll eat, and get some support from our colleagues in the psychology team. It’s been hard work for his parents, but at least they know they’ve kept him well-nourished throughout his treatment.
*Names have been changed.
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