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Pediatric Palliative CareCCEENNLLEE
Anorexia and Cachexia Anorexia – loss of appetite, usually with
decreased intake Cachexia – lack of nutrition and wasting Offer favorite foods but educate families
about disease process Forcing intake orally or artificially may
cause additional suffering
Pediatric Palliative CareCCEENNLLEE
Causes of Anorexia and Cachexia
Pre-maturity
Disease related
Psychological
Treatment related
Pediatric Palliative CareCCEENNLLEE
Assessment of Anorexia and Cachexia
Physical findings
Impact on function and QOL
Calorie counts/daily weights
Laboratory tests
Pediatric Palliative CareCCEENNLLEE
Treatment of Anorexia and Cachexia
Dietary consult/intervention Medications Parenteral/enteral nutrition Education (as artificial nutrition
at EOL may increase suffering)
Pediatric Palliative CareCCEENNLLEE
Time with Grandfather
Pediatric Palliative CareCCEENNLLEE
Constipation
Infrequent passage of stool Frequent symptom in palliative
care Prevention is key Discussion may be difficult with
child/adolescent
Pediatric Palliative CareCCEENNLLEE
Causes of Constipation
Disease related (e.g. obstruction, hypercalcemia, neurolgic, inactivity)
Treatment related (e.g. opioids, other meds)
Pediatric Palliative CareCCEENNLLEE
Assessment of Constipation
Bowel history
Abdominal assessment
Rectal assessment
Medication review
Pediatric Palliative CareCCEENNLLEE
Treatment of Constipation
Medications Dietary/fluids
Popsicles Clear sodas Jello
Other approaches
Pediatric Palliative CareCCEENNLLEE
Assessment of Nausea and Vomiting
Clinical/physical exam
History
Lab values
BARF scale
Minimize suffering
Pediatric Palliative CareCCEENNLLEE
Causes of Nausea and Vomiting
Overview/ definition Gastrointestinal
causes Metabolic causes CNS causes
Pediatric Palliative CareCCEENNLLEE
Pharmacologic Treatment of Nausea and Vomiting
Anticholinergics
Antihistamines
Steroids
Prokinetic agents
Other Hellsten & Medellin, 2010; Karwacki, 2006; Santucci & Mack, 2007
Pediatric Palliative CareCCEENNLLEE
Non-Drug Treatment of Nausea and Vomiting
Distraction
Dietary
Small/slow feeding
Invasive therapies
Pediatric Palliative CareCCEENNLLEE
Oh, My Child
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