Problems with Eating and Nausea

“I’m worried that my child is not interested in eating. What can I do to help his appetite and frequent nausea?”

Food is often the daily “centering” activity of our lives as children and adults. It serves many functions for many busy families. We gather over it, talk about it, spend time shopping and cooking, and gain comfort and satisfaction from it. For parents, preparing meals is symbolic of how we care for our family, giving a small but ordinary act of love each day.

When a child has a serious illness, his ability to eat, digest, enjoy, and tolerate food often changes dramatically. Eating and getting proper nutrition is likely to become more frustrating with changes in his condition. Food may no longer be appealing at times or even make him feel uncomfortable. It may be challenging to get your child to eat well while he is adjusting to medication changes, treatments, testing, etc. Your child may generally feel “lousy” and his worries can also affect his appetite. Along with concerns about his illness and how he feels, he may feel anxious about his future. It is no wonder that he is not eating well!

Changes in appetite and eating may not be as bothersome to your child as it is to you. We place a great deal of importance on food and on eating together. If you are worried about whether the disease has progressed or not improving as you hoped, you may start to place increased value on your child’s food intake. We usually associate eating with feeling better, with normalcy, and with our ability to do something for someone we care about.

You may want to consider an initial or follow-up consultation with a nutritionist or dietician. Try incorporating your child’s input about preferences with the consultant’s advice about reasonable improvements that will maintain your child’s strength. You’ll find that there are creative ways to enhance food to get more nutrients from smaller amounts of food.

If food is now making your child feel nauseated, it is important to evaluate his daily intake by using a food diary and consulting with a nutritionist/dietician or your health care team. There may be simple changes that can improve or relieve the nausea. Nausea could also be a result of a side effect of a medication, the disease process, an internal physical change that affects how he eats, or a combination of several things. Once again, try to note any patterns, medications, or specific foods that trigger the nausea and what relieves it. Your child may also be able to offer clues that may elucidate the origins of the nausea. Sharing this information with your health care team will help you work out potential solutions, such as a medication to help relieve the nausea.

Vomiting can also affect your child’s eating and can quickly lead to dehydration, or not enough fluids in his system. Dehydration can cause complications, but there are ways to ensure that your child is sufficiently hydrated. Try offering him small sips of a drink, ice chips, popsicles, or hard candy. Ask your physician how to identify if your child is dehydrated and at what point you should call the health care team to get help. Your medical team may want to order new or different supplements, vitamins, medications, or even IV fluids to ensure optimal intake, especially if there is a significant eating concern.

Some conditions which originate at birth may include eating problems such as difficulty swallowing, gagging, choking on normal amounts of fluid, etc. Some babies nurse or bottle feed easily or with trouble, depending on the underlying condition. Smaller, slower feedings are often easier on your child and less likely to cause problems, but require time and patience. (This might be a good way for friends or family to help out.) Many parents feel some comfort if they are able to offer breast milk to their babies. You can ask your social worker or nurse about breast pumping, especially if your baby is in the hospital.

Some general considerations might be:

•  Try offering smaller, but more frequent meals.
•  Bring snack size portions when you leave the house. Keep a small cooler or lunchbox in your car with water, juice packages, nutritional snacks, and microwaveable things that your child likes to eat.
•  Prepare or buy “lunches to go” for clinic days, long treatments, or days with lots of driving.
•  (Don’t forget that it is important for you to make time for meals and snacks too!)
•  During this phase there may be dietary or nutritional consultation available to provide guidance about ways to add or delete certain foods and make suggestions about how to provide the nutritional needs that your child’s condition and activities demand.
•  Ask if any of your child’s medications might be affecting his appetite, changes in taste, or causing nausea. It is important to know if the medicine(s) might be affecting his taste or hunger sensations, and some medications could even cause him to feel sick to his stomach. Sometimes even the disease process or treatments can affect how things taste.
•  Sometimes a physician might prescribe an anti-nausea medication to help reduce the symptoms and bring relief. Sometimes it takes more than one try for medications to start to help. Always try something new more than once.
•  In general, meals may need to be planned with more flexibility to accommodate when your child feels hungry or less queasy. If in the hospital, ask the nurse if she can hold your child’s meal for a while if your child isn’t feeling well and then reheat it when timing is better.
•  Being in the hospital for long periods of time can be discouraging. Ask the health care team if you can bring in your child’s favorite meals or make something at the hospital for him even if he only eats a small portion. Tastes can be a real source of pleasure for your child.
•  Finding time to make meals can now be very difficult. When friends ask what they can do to help, let them prepare dinners for your family. This is an excellent way that your friends can help while you focus on your child’s treatments and tests. Let them know of any special food needs or restrictions they must follow.
•  Try to be patient, supportive, and flexible during these trying times

If your child’s eating difficulties are anatomical, i.e., your child does not have the ability to eat normally, you and your doctor may need to consider a feeding tube or intravenous therapy. You may also need to consider a feeding tube if your child’s eating problems are considered chronic or long term. There are two types of feeding tubes. A temporary feeding tube can be placed through the nose without surgery. A more long-term option would be a feeding tube that is surgically placed in the abdomen.

Definitions of terms or options that you might hear about:

NG Tube or nasogastric tube: A tube used on a temporary basis that gives liquids and medication. It is placed without surgery, and enters through the nostril, and then goes down the throat into the stomach. Once it is placed, the tube is relatively comfortable but care of the nose and skin from using tape is required.

G Tube or gastrostomy tube: This tube is surgically placed directly through the abdomen into the stomach. It requires daily care and attention to the surrounding skin. The G tube is used for long-term control over nutritional intake as well as to ensure that medications can be tolerated.

TPN or total parenteral nutrition: This serum is a combination of minerals, vitamins, and nutritional ingredients that offers complete nutrition through an IV. TPN may be used when maintaining the proper balance of all aspects of nutrition and blood levels is paramount.