Sometimes it becomes necessary to feed children intravenously or through a gastric (G-tube) or nasogastric (NG) tube. Because intravenous (IV) feeding and feeding by tube may require additional hospitalization, it helps to understand the benefits. As appetite and weight decrease, the child’s ability to tolerate and recover from chemotherapy lessens. The child becomes progressively weaker and her resistance to infection decreases. To prevent this scenario, most protocols require tube or IV feeding after 10% 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 their 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% of body weight

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

My daughter needed TPN for two weeks after her stem cell transplant. They told us ahead of time that it would be necessary, and they were right. She got terrible sores throughout her GI tract and couldn’t drink or eat. They just hooked the TPN bag up to her Broviac®. After a couple of weeks, she started gingerly sipping small amounts of water and apple juice. For some reason, I just didn’t worry about her eating. I assumed that when she could eat, she would. She was a robust eater before her illness, so I thought that would help. Before we left for home, she asked for a hospital pizza (yuck!) and ate a few bites. Her eating at home quickly went back to normal, although it took some time to regain the weight she lost.

In most cases, TPN is started in the hospital. Each day the concentrations of glucose, protein, and fat will be increased, 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 situation. The infusion may be delivered over the hours that work best for your family. For example, if your child attends school, overnight infusions will probably work best.

You can request a small portable infusion pump and backpack from a 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 (NG tube) or via a tube surgically placed directly into the stomach through the abdominal wall (G-tube). Nutritionally complete liquid formulas are delivered through the tube. Infrequent side effects of enteral nutrition are irritated throat, nausea, diarrhea, or constipation.

Rachel (age 14) used a backpack to carry a G-tube pump and her bag of Ensure® with her when she went out. When chemo was over, she worked for about a month with a psychiatrist who used hypnotherapy to get her to start eating normally again. After about three months, she was eating everything she used to. The tube was removed, and the hole closed on its own.

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My daughter found it almost impossible to eat. She said that apart from her stomach feeling sick, everything tasted bad, and she didn’t want to put that food in her mouth because the taste made her feel worse. As an adult you can say to yourself, this is for my own good, and force yourself to eat, but not kids. When she had to get a nasogastric (NG) tube after she’d lost a third of her body weight, I felt nearly as bad as when she was first diagnosed. I believed that because she wasn’t eating she had given up the will to live. I was a mess! The ward social worker gently pointed out to me that it was not my daughter’s choice about whether to eat or not—it was entirely the fault of the chemo. When she got the NG tube, it was wonderful! She was able to get nutrition without forcing herself to eat when she really couldn’t. And sure enough, once we got over the hurdle of that part of the treatment, she slowly regained her appetite again and we were able to wean her off the NG feeds. Four years later, she is still a very fussy eater—but I can live with that.

I feel good nutrition is very important to good health, but the reality of the situation with our child was that he hated anything nutritious when he was on chemotherapy. I could doctor it up, add the best toppings, make it look terrific, season it just right, and it would still be rejected. So I decided that since my son wasn’t allowed to make any decisions in regard to the pills, treatments, tests, or hospital stays, he wouldn’t be forced to eat everything nutritious if he didn’t want to. Whether this was a right or wrong decision, I don’t know. I just know that I served him a lot of processed foods during those years, and he’s a healthy and happy boy 10 years later. After he was finished with chemotherapy, however, we did require that he eat healthier foods.