If your child requires supplemental feeding, and the bowel and intestines are still functioning well, enteral nutrition may be recommended. Enteral feedings are preferred over IV when possible. Enteral nutrition is feeding via a tube placed through the nose into the stomach or small intestine (NG tube) or via a tube surgically placed directly into the stomach through the abdominal wall (G-tube). Nutritionally complete liquid formulas are fed through the tube. Your oncologist and nutritionist will determine the appropriate formula for your child. Infrequent side effects of enteral nutrition are irritated throat, nausea, diarrhea, or constipation.
Rachel (age 14) was diagnosed in 1997. She used a backpack to carry a G-tube pump and her bag of Ensure with her when she went out. When chemo was over, she worked for about a month with a psychiatrist who used hypnotherapy to get her to start eating normally again. After about three months, she was eating everything she used to. The tube was removed, and the hole closed on its own.
Enteral feedings are usually started in the hospital. If your childs malnutrition is profound, she may initially require continuous feeding at a slow rate. These feedings will be increased as tolerated, with the eventual goal being four to six feedings per day. Blood tests can help your oncologist determine whether your child is malnourished in spite of the obvious weight gain that results from steroid therapy.
Nikhi found it almost impossible to eat. She said that apart from her stomach feeling sick, everything tasted bad, and she didn't want to put that food in her mouth because the taste made her feel worse. As an adult you can say to yourself, this is for my own good, and force yourself to eat, but not kids.
When Nikhi had to get an NG tube after she'd lost a third of her body weight, I felt nearly as bad as when she was first diagnosed. I believed that because she wasn't eating she had given up the will to live. I was a mess! The ward social worker gently pointed out to me that it was not Nikhi's choice about whether to eat or not—it was entirely the fault of the chemo. When she got the nasogastric tube, it was wonderful! She was able to get nutrition without forcing herself to eat when she really couldn't. And sure enough, once we got over the hurdle of that part of the treatment, she slowly regained her appetite again and we were able to wean her off the NG feeds. Four years later, she is still a very fussy eater—but I can live with that!
I feel good nutrition is very important to good health, but the reality of the situation with our child was that he hated anything nutritious when he was on chemotherapy I could doctor it up, add the best toppings, make it look terrific, season it just right, and it would still be rejected. So I decided that since my son wasn't allowed to make any decisions in regard to the pills, treatments, tests, or hospital stays, he wouldn't be forced to eat everything nutritious if he didn't want to. Whether this was a right or wrong decision, I don't know. I just know that I served him a lot of processed foods during those years, and he's a healthy and happy boy ten years later. After he was finished with chemotherapy, however, we did require that he eat healthier foods.
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