Nutrition and Hydration in Children with Cancer

Abstract

Maintenance of adequate nutritional status and fluid balance is an important component in the care of a child diagnosed with cancer. The physiological effects of the cancer itself, in addition to the numerous side effects of the necessary treatment, frequently interfere with the child's ability to ingest, digest, and absorb food and fluid. Malnutrition has been shown to occur in 8–32% of children diagnosed with cancer (Han-Markey 2000). Cachexia is a severe form of malnutrition that can result from malignant tumors and the side effects of treatment (Chap. 17). Cachexia can be exacerbated by alterations in nutrient metabolism, including increased protein demands leading to depletion of lean muscle mass and impairment of muscle repair, glucose intolerance that mimics insulin resistance, and increased fatty acid oxidation resulting in depletion of fat stores and hyperlipidemia. Children are at a higher risk than adults of developing cachexia, as they have increased nutritional requirements for growth and development and may have limited nutritional reserves. Malnourished children are at risk for serious deficits in growth and development, increased morbidity, poor disease outcomes, decreased immune function, and decreased quality of life. The goals of support and treatment for the pediatric oncology patient include promoting adequate fluid and electrolyte balance, preserving nutritional status or reversing nutritional defi-ciencies, preserving lean body mass, minimizing treatment-related side effects, and maximizing the patient's quality of life.