Feeding, cachexia, and malnutrition in children’s palliative care

Feeding a child is considered basic care. As such, when a medical condition impacts a child’s desire or ability to feed and grow, the concerns and negative feelings experienced by the family can be profound. This chapter reviews strategies to promote safe feeding in children, especially those with underlying neurological impairment, in an effort to optimize growth and overall quality of life. The indications and challenges with enterostomy tubes and total parental nutrition (TPN) are also discussed. The concept of ‘feeding for comfort’ at the end of life in children who no longer desire to feed or when feeding causes suffering are explored, as well as the medical and psychosocial interventions to address anorexia and cachexia. Lastly, while the authors wholeheartedly support steps to rectify global malnutrition, a palliative care approach is provided to this problem which continues to result in chronic morbidity and mortality in millions of children annually.