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Getting? enough nutrients is not just about managing weight. It can also help your child have the best possible outcomes. When your child has cancer, they can get the nutrients they need in many ways.

By mouth

If at all possible, your child should get needed nutrients from eating and drinking foods and fluids that are part of a healthy, well-balanced diet. Try to stick to your normal family mealtime habits as much as you can. Regular healthy snacks can be helpful, too.

Some children will have trouble eating enough to stay as a healthy weight. These children may be able to get extra nutrients by eating high-calorie, high-protein meals along with snacks, homemade drinks and shakes. But talk to your dietitian or other member of the cancer care team before making diet changes. Liquid nutrition products you can buy at the grocery store or pharmacy are also options if your child has trouble eating. There are many different types on the market, so discuss them with your dietitian or doctor first. Clinics often have samples your child could try before you buy any.

By feeding tube

If it gets too hard for your child to maintain or gain weight by eating and drinking, or if their calorie and nutrient needs have greatly increased, a feeding tube may be needed.

There are four main types of feeding tubes.

• Nasogastric tubes: These thin, flexible tubes are threaded through the nose and into the stomach. They are meant to be used for a shorter period of time.
• Nasoduodenal tubes: These thin, flexible tubes are threaded through the nose, through the stomach, and into the small intestine.  These tubes can be helpful for a child who is having a lot of nausea and vomiting.
• Gastrostomy tubes (g-tube): These tubes are put through the skin of the belly (abdomen) into the stomach. These can be helpful for children who need a feeding tube for longer periods of time and are easier to hide under clothes when not in use. These are most helpful for children with longer treatment durations who are having (or expected to have) difficulty eating and drinking enough calories and nutrients. 
• Jejunostomy tubes (j-tube): These tubes are put through the skin of the belly (abdomen) right into the intestine. They are most helpful for children with uncontrolled nausea and vomiting and are also easier to hide under clothes.

Once a tube is in place, complete liquid nutrition formulas can be given through it . Most of the time, these feedings can give your child all of the calories, protein, vitamins, and minerals needed. Tube feedings can be given at home. Your child's cancer care team will teach you how to do this.

The type of nutrition formula that each child gets depends on many factors, such as the type of tube being used and the specific needs of the child. There are many options and some formulas are made from whole foods blended to go through the tube.  An option for some families is to blend home foods (called home blenderized feeds).  Your cancer care team will let you know which formula or approach is best. It is important to have a dietitian oversee tube feeds to ensure that the amount of calories and nutrients will meet your child’s needs. 

Some but not all children who have feeding tubes can also eat by mouth. Ask your child’s cancer care team if your child can still eat and drink while their tube is in place. For example, they may be tube fed at night to allow them to eat during the day. Even if your child isn’t eating, it’s important to keep their mouth clean with regular rinsing and brushing.

Most young children can get used to tube feedings within a few days, but older kids and teens may need longer. Involve your child in the decision to use a feeding tube as much as possible. If your child is having trouble getting used to the tube it may help for them to talk with a peer who has had a feeding tube. Parents may also benefit from talking with other parents who have dealt with feeding tubes.

Tube feeding does not come without problems. Talk to your dietitian and cancer care team to fully understand the likely benefits and possible issues for your child.

By vein

Some children will not be able to get enough nutrients either by mouth or a feeding tube. Also, the stomach and intestines in some children are not working properly because of their cancer or treatment. In that situation, the child may need to be given nutrient solutions through a vein. This is called intravenous nutrition or parenteral nutrition (PN). 

PN solutions can usually meet all of a child’s nutritional needs for a while. Like tube feedings, PN can be given at home. Using PN for a short time is a safe way to feed your child until the stomach or intestine is better. Once these issues go away, every effort will be made to switch to tube or mouth feedings because PN is not as good for the body as eating or tube feeding.