Weight gain from steroids

Steroids (such as prednisone or dexamethasone) may cause your child to gain excess weight. Steroids can cause an increase in appetite and a build up (retention) of fluid. On steroids, your child:

• May gain weight especially in the face and belly
• Will be hungry and need to eat often
• Should have healthy snacks several times a day
• Should have limited amounts of salty foods, because salt causes fluid retention
• Will usually lose weight after the steroids are stopped

Weight loss

Many children lose weight during chemotherapy or radiation treatments. Your healthcare team will closely watch your child’s weight. If your child cannot eat enough to grow and stay healthy, talk to your healthcare provider about nutritional interventions (see below). For further information about nutrition, see “Why Nutrition Is Important for Your Child.”

Suggestions to help your child maintain or gain weight include:

• Stock up on healthy foods that your child likes.
• Give small snacks or meals every 2 hours during the day.
• Try to add extra calories to foods your child likes, such as adding extra ice cream to a milkshake or spreading peanut butter on toast.
• Limit fluids during meals, as this will make your child feel full more quickly.
• Cook foods with strong flavors that may stimulate the appetite.
• Get your child involved in the cooking!
• Encourage activity before meals to increase appetite.
• Take advantage of the times your child wants to eat.
• Always have food that your child can access easily.

Nutritional Interventions (oral, tube feeding, and TPN methods)

The goals of nutritional intervention for a child with cancer are:

• To prevent or reverse nutritional deficits
• To promote normal growth and development
• To minimize complications and mortality
• To maximize the child's quality of life

Helping a child with medical problems to stay well-nourished can be a challenging andfrustrating process. Fortunately, there are several options.

Oral

The first focus for meeting nutritional needs is by the oral route (eating and drinking). Special diets (high calorie, high protein) and oral nutritional supplements (commercial products, homemade milkshakes) can be helpful.

Despite all efforts to provide nourishing foods, a child with cancer may not be able to maintain their weight or may experience weight loss. This can happen if the child’s appetite remains poor, if eating and drinking are too difficult due to illness or treatments, or if the child’s condition greatly increases his or her requirements for nutrients. Under such circumstances, tube feeding may be recommended.

Tube feeding

Tube feeding involves threading a thin, flexible tube through the nose right into the digestive tract (called a naso-gastric or NG tube). Once the tube is in place, nutritional formulas can be given directly. Tube feedings can be provided in the hospital and at home if needed. Many parents are trained to provide tube feedings at home.

Although it is possible to meet 100% of a child’s requirement for calories, protein, vitamins and minerals with such formulas, a patient with a feeding tube also can usually continue to eat because feeding tubes are small enough not to interrupt the normal swallowing process.

Many physicians recommend tube-feeding at night while your child sleeps and encouraging him or her to eat normally during the day, since eating with friends and family is an important part of a child’s social life.

If needed, medications to combat nausea and vomiting can be given through the tube. In fact, children often feel better once tube feedings begin, because they are receiving the nutrition they need. As a result, they often eat and drink more on their own. Another benefit is that normal intestinal function is maintained, since nutrition is delivered straight to the gastrointestinal tract.

Most young children adapt to tube feeding after a few days. Older children and teenagers have a more difficult time adjusting to the presence of a tube in their nose, perhaps because they are more sensitive to appearance and social issues. It often helps to have a peer who has experienced tube feedings visit with these patients.

If tube feedings will continue when your child is in school, a member of the treatment center can visit the child’s class to explain why tube feedings are necessary. Children should never be threatened with tube feedings as a punishment for not being able to meet their nutritional needs.Older children should participate as much as possible in the decision to begin tube feedings.

While the feeding tube can be inserted every night, most children prefer it simply be left in place. A more permanent type of tube (gastrostomy or G-tube) can be placed directly into the stomach or intestines through the skin by a special procedure before the child leaves the hospital.

IV Feeding: Total Parenteral Nutrition (TPN)

If severe digestive system problems are present, tube feeding may not be the best option to provide your child with the necessary nutrients.

In these cases, nutrition can be given directly into the veins. This type of therapy is called intravenous hyperalimentation (HAL) or total parenteral nutrition (TPN). Parenteral feedings are most often used when a patient has undergone surgery of the digestive system, when the intestines are completely blocked, when severe vomiting or diarrhea occurs, or when complications from the disease or treatment prevents eating or passing a feeding tube into the digestive tract. Parenteral nutrition solutions can usually meet 100%of a child’s nutritional needs for calories, protein, vitamins, minerals, and fluids. This type of nutrition therapy can also be provided at home.