Pediatric Nutrition in Practice

Haemato-Oncology 267

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mobilisation, oxidation of energy substrates and
loss of body protein [4].
General risk factors for malnutrition are
shown in table  1. Learned food aversion associ-
ated with nausea-inducing treatment sometimes
leads to anticipatory vomiting. Chemotherapy
may adversely affect food intake and gastrointes-
tinal function by causing oral or oesophageal ul-
ceration, altered taste perception, anorexia, nau-
sea, vomiting, and enteritis with malabsorption
and diarrhoea. Ser v ing food cold or at room tem-
perature and covering drinks (taken through a
straw) can decrease tastes and smells and make it
easier for children to eat. Radiation therapy to the
head and neck can cause mucositis, anorexia,
nausea, vomiting, dysphagia, dry mouth and al-
tered taste, while radiation to the abdomen may
cause enteritis and bowel stricture.
Bone marrow transplantation (BMT) or stem
cell transplantation is indicated in children with
a range of malignant and non-malignant condi-
tions. Chemotherapy and/or radiation therapy

are used to reduce host cells to the point that do-

nor stem cells will engraft (allogeneic BMT), or

to reduce the tumour burden and rescue the pa-

tient with his/her own stem cells (autologous

BMT). Priming chemotherapy causes severe

nausea, vomiting and oral ulceration, and is of-

ten associated with diarrhoea, protein losing en-

teropathy, and depletion of zinc and electrolytes

[5, 6]. Most children undergoing BMT stop eat-

ing either as a result of these side effects or be-

cause eating becomes one of the few areas over

which they can exercise some control. Impair-

ment of gastrointestinal barrier function in-

creases the risk of viral, bacterial and fungal in-

fections. Episodes of sepsis are associated with

protein catabolism and negative nitrogen bal-

ance. Enteral feeds should be prepared in a man-

ner that renders them low in bacterial load (‘clean

feeds’); parenteral nutrition (PN) may be neces-

sary, but enteral tube feeding (ETF), if tolerated,

is associated with better nutritional response

and sense of wellbeing.

Ta b l e 1. Risk factors for nutritional compromise

Decreased food intake

Inadequate amount of food offered

Unappetising food; lack of flexibility in meeting a child’s preferences

Too much food

‘Forced’ feeding

Reduced appetite from illness

Symptoms associated with disease or treatments,

e.g. nausea, vomiting, sore mouth, pain, diarrhoea and breathlessness

Repeated fasting for treatments or procedures

Mucositis, swallowing or chewing difficulties

Difficulty self-feeding

Poor child-carer interaction at meal times

Impaired conscious level

Increased nutritional requirements

Illness/metabolic stress

Wound or fistula losses

Impaired ability to absorb or utilise nutrients

Due to disease or treatment, e.g. chemotherapy causing enteropathy or

pancreatic exocrine impairment

Infection as a consequence of immunosuppression

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 266–270
DOI: 10.1159/000360349