Pediatric Nutrition in Practice

Haemato-Oncology 269

3

monitoring is required [10] ; regimens also require
modification in the light of nutritional response. It
is important to consider and regularly review the
objectives of nutritional support in individual pa-
tients. Monitoring will include assessment of nu-
tritional intake, anthropometry, biochemical and
haematological parameters, general clinical state,
gastrointestinal function and feeding tube/central
venous catheter integrity.

Late Nutritional Complications

Survivors of common paediatric malignancies are
at risk of obesity, which in turn is associated with
cardiovascular and endocrine diseases. Increased
BMI (>25) was found in survivors of acute lym-
phoblastic leukaemia <4 years of age at diagnosis
receiving cranial radiation therapy, and in chil-

dren with brain tumours, especially craniopha-

ryngioma survivors [11]. Late nutritional compli-

cations also include a reduction in lean body mass

in some patients [12]. Reduced bone mineral den-

sity can result from decreased physical activity,

reduced calcium intake and the effects of cortico-

steroid treatment; undermineralisation may per-

sist in a small proportion of patients. Growth and

nutritional status should be monitored during

long-term follow-up.

Conclusions

Always try to:

• identify a child’s favourite foods – these are
  best avoided whilst having chemotherapy so
  that aversion does not develop;


• offer small, frequent meals;

Ta b l e 2. ETF: problems and potential solutions

Symptom Cause Possible solution

Diarrhoea Unsuitable feed for a child with
impaired gut function

Change to hydrolysed formula or modular feed

Excessive infusion rate Slow rate, increase as tolerated

Intolerance of bolus feeds Frequent, smaller feeds, or change to continuous feeds

High feed osmolarity Build up strength of feed slowly and give by continuous

infusion

Microbial contamination of feed Use sterile, commercially produced feeds if possible;

prepare other feeds in a clean environment

Drugs (e.g. antibiotics, laxatives) Review drug prescription

Nausea/
vomiting

Excessive infusion rate Slowly build up feed infusion

Slow gastric emptying Encourage lying on right side; prokinetics

Constipation Maintain regular bowel habit with adequate fluid intake,

fibre-containing feed and/or laxatives

Medicines given at the same time as

feed

Allow time between giving medicines and giving feed,

or stop continuous feeding for a short time

Psychological factors Review feeding behaviour; consider referral to

psychologist

Regurgitation/
aspiration

Gastro-oesophageal reflux Correct positioning; feed thickener; drugs; continuous

feeds; jejunal tube (consider fundoplication)

Dislodged tube Secure tube adequately and regularly review position

Excessive infusion rate Slow infusion rate

Intolerance of bolus feeds Smaller, more frequent feeds, or continuous infusion

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