Lori P. Enriquez, RD, CSP, CNSD
Last Modified: January 27, 2002
Dear OncoLink "Ask The Experts,"
I am a pediatric dietitian on an oncology floor. Most of my patients have very poor oral intake. I try supplements, shakes, favorite foods, snacks, etc and sometimes nothing seems to work. Some patients go weeks w/out eating much. Do you have any suggestions on how to increase oral intake?
Lori P. Enriquez, RD, CSP, CNSD, registered dietitian at The Children's Hospital of Philadelphia, responds:
There are tips you can try to help increase appetite, but sometimes it does feel like nothing works. It is extremely important to look at the overall nutritional status of your patient. This includes looking at pre-diagnosis growth parameters, diagnosis growth parameters, current growth parameters, growth velocity, lab values, duration of decreased by mouth intake, gastrointestinal symptoms, taste changes, and actual caloric intake. Looking at the patient's diagnosis and treatment plan helps to determine treatment related side effects and where the patient is in their treatment, are they in the beginning of their treatment, the middle or the end. This will help to make a nutrition plan. We will use tube feedings for patient's who have a prolonged decreased by mouth intake, lack of success with other interventions, and who have a compromised nutritional status. If the patient has uncontrolled nausea or vomiting parenteral nutrition is used as a last resort.
It is important to assess which medications the patient is on to help minimize nausea and vomiting, which may contribute to the poor appetite. If it appears there may need to be some changes or additions, discuss this with the Oncology Team. If the patient appears depressed you can refer to a child life therapist, social worker, and/or a psychologist.
Other tips include using a calorie booster without any taste to foods, like Duocal to add extra calories to foods or fluids currently being consumed. Another tip is trying to make meal time pleasant by allowing are patients to go to the cafeteria for meals instead of eating in their rooms. We also have a program called "Dining with the Chef" where one of the Chefs will visit the patient to discuss making a special meal for the patient. This may boost interest in eating. The question of appetite stimulants comes up often; occasionally the Oncology Team will use an appetite stimulant, which has varying outcomes with appetite.
If you have the a dietitian who works in the outpatient Oncology clinic then you can establish relationships in order to track your high risk patients and try to intervene before the patient becomes malnourished. Remember children age 2 or under are at an additional risk because of the rapid period of growth related to age.