Sometimes, it becomes necessary to feed children intravenously or through a gastric (G-tube) or nasogastric (NG) tube. Although intravenous (IV) feeding and feeding by tube may require additional hospitalization, it helps if parents understand the benefits clearly. If a child with cancer becomes malnourished, events are set in motion that can have grim consequences. As appetite and weight decrease, the child’s ability to tolerate and recover from treatment diminishes. The child becomes progressively weaker and his resistance to infection decreases. Infections and weakness may require interruptions in treatment. To prevent this scenario, most protocols require tube or IV feeding after 10 percent of body weight is lost. The two types of supplemental feeding are described below.

Total parenteral nutrition (TPN)

TPN, also known as hyperalimentation, is a form of IV feeding used to prevent or treat malnutrition in children who cannot eat enough to meet basic nutritional needs. Below are some of the many reasons why your child may require TPN:

• Severe mouth and throat sores that prevent swallowing
• Severe nausea and vomiting
• Severe diarrhea
• Inability to chew or swallow normally
• Loss of more than 10 percent of body weight

TPN ensures that your child receives all the protein, carbohydrates, fats, vitamins, and minerals she needs. TPN is administered through the central venous catheter, but children receiving TPN can also eat solids and drink fluids.

In most cases, TPN is started in the hospital. Each day the concentrations of glucose, protein, and fat will be increased in a step-wise fashion, and doctors will assess your child’s tolerance for the mixture. Generally, TPN is given 8 to 12 hours per day, depending on your child’s unique situation. The infusion may be delivered over the hours that work best for your family. If your child attends school, overnight infusions will probably work best. If your child is at home during the day, infusions during these hours will give the entire family a better night’s sleep.

Be sure to request a small portable infusion pump and backpack from your home care company so your child can go about his daily activities as usual. Your child’s oncologist may need to write a letter to your insurance company to verify your child’s malnutrition so this therapy will be covered.

Enteral nutrition

The doctor may recommend enteral feeding if your child requires supplemental nutrition and her bowel and intestines are still functioning well. Enteral feedings are preferred over IV, whenever possible. Enteral nutrition is feeding via a tube placed through the nose and 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 child’s oncologist and nutritionist will determine the appropriate formula for your child. Infrequent side effects of enteral nutrition are irritated throat, nausea, diarrhea, or constipation.

Enteral feedings are usually started in the hospital. If your child’s malnutrition is profound, he 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 the oncologist determine whether your child is malnourished in spite of the obvious weight gain that results from steroid therapy.