13: Peds Flashcards
What are the two most common types of Pediatric cancer?
Brain/CNS
Leukemia
What are nutrition concerns for Acute Lymphoblastic Leukemia (ALL) in Peds?
Malnutrition during therapy can affect disease response, infection risk, toxicities and treatment delays
ALL pts are at risk for obesity during maintenance and continuation phases of treatment but its preventable. They are also at risk for bone mineral density issues from the treatment
What are nutrition concerns for Acute Myeloid Leukemia (AML) in Peds?
Nutritional status at diagnosis can effect outcomes, particularly if unhealthy weight (below 5th% or above 85%)
Prone to anorexia, wt loss, nausea/vomiting, mucositis and malnutrition due to the chemo.
Cardiomyopathy is a common late effect of treatment
What are nutrition concerns for CNS Tumors (Brain) in Peds?
Dysphagia for patients with posterior fossa brain tumors and for those with progressive disease that affects the cerebellum/brainstem areas.
Long term complications are cognitive and motor skill deficits, wt gain, central adiposity, and feeding difficulties. Radiotherapy may adjust ghrelin and leptin cues, causing excessive intake
What are nutrition concerns for Hodgkin Lymphoma in Peds?
3rd most common
significant wt loss may be presenting symptom of HL (and non-HL) however steroids can also cause wt gain
Mediastinal radiation can cause abnormal thyroid, heart, and lung function. Anthracyclines further increase cardiovascular risk.
Survivors are at increased risk for breast, thyroid, and skin cancers
What are nutrition concerns for Non-Hodgkin Lymphoma (NHL) in Peds?
N/V, anorexia, and constipation. Fluid retention and hyperglycemia from steroids.
Survivors are at risk for cardiomyopathy and other cancers. As well as obesity, HTN, impaired mobility and reduced strength.
What are nutrition concerns for Neuroblastoma in Peds?
most common solid tumor–often diagnosed after 1st year of life
Malnutrition appears in 20-50% of cases.
Late effects include underweight, diseased growth and development (after HCT), musculoskeletal complications, neurological complications and endocrine complications
What are nutrition concerns for Rhabdomyosarcoma in Peds?
short-term treatments may cause anorexia, constipation and jaw pain.
Late effects may include SBO, esophageal strictures, renal tubular dysfunction and secondary malignancies. Radiotherapy to Head/neck area may cause dental problems and growth hormone deficiency
What are nutrition concerns for Wilms Tumor in Peds?
Most common kidney cancer in kids
malnutrition at diagnosis may cause anorexia and early satiety from the growing tumor.
whole abd or flank radiation may increase risk for radiation enteritis.
Late effects may include cardiotoxicity and 2nd malignancies. ESRD occurs occasionally in patients with bilateral disease
What are nutrition concerns for Osteosarcoma in Peds?
most common bone tumor, typically occurs in extremities during periods or rapid growth with pain being the most common presenting symptom.
Surgery may involve amputation or limb-salvage surgery.
Malnutrition is exacerbated by treatment with the incidence of underweight status increasing from 7.8% at diagnosis to 36% a year later
What are nutrition concerns for Ewing Sarcoma in Peds?
2nd most common bone
abnormal BMI at diagnosis is associated with poorer response at time of surgical resection.
surgery and radiation may significantly affect functional status, mobility, and growth
What is a long term effect from childhood cancer that could have lasting health concerns?
change in body composition — increased fat mass and decreased lean mass
To review a single point of data to indicate malnutrition, what are the ranges for mild/moderate/severe malnutrition?
-1 to -1.9 for mild — for Wt-for-Ht z score, BMI-for-age z score, mid-upper arm circumference z score
-2 to -2.9 for moderate — for Wt-for-Ht z score, BMI-for-age z score, mid-upper arm circumference z score
-3 or less for severe — for Wt-for-Ht z score, BMI-for-age z score, mid-upper arm circumference z score PLUS length/Ht-for-age z score
To review a 2 or more points of data to indicate malnutrition, what are the ranges for mild/moderate/severe malnutrition?
Wt gain (if under 2)— <75% of expected wt gain for age is mild, <50% is moderate, <25% is severe
Weight loss (2-20 yrs) — 5% of usual weight is mild, 7.5% is moderate, 10% is severe
Deceleration of wt-for-length or BMI z scores —- decline of 1 z score is mild, 2 is moderate, 3 is severe
inadequate intake — 51-75% of estimated needs is mild, 26-50% is moderate, <25% is severe
What is the nutrition tool for Peds?
Nutrition Screening Tool for Childhood Cancer (SCAN)
