Weight loss is a common occurrence both with cancer and its treatment. The overwhelming emotions of fear, stress, and anxiety lessen the desire to eat. On the other hand, children might feel hungry but also may feel full, this can cause them to intake less amount of food. Irrespective of the cause, changes in appetite in children can either cause them to not eat properly or eat too much resulting in sudden weight gain or weight loss. 

If these appetite changes persist, it can cause serious health complications in the child, weight loss can happen due to the body not getting the adequate amount of nutrients which causes excessive fatigue and weakness due to muscle loss (a condition called cachexia). This can slow down the recovery process and also break the treatment process.

If your child does not feel hungry, talk to their healthcare specialist about what can be done. Understanding the cause can make it easier for them to determine a course of treatment. 

Causes for appetite changes:

There are various reasons why a person might experience appetite changes, the following are the most common reason that is experienced, 

• Changes in the metabolic activities in the patient. Metabolism is the activity of the body where the food particles are broken down in order to supply energy for the body. These tend to happen in advanced cancer stages.
• If there is cancer in the abdomen that can cause irritation or swelling whenever food is consumed. 
• If the spleen or the liver is enlarged, it pushes the stomach and makes one feel as if they are full
• A build of protein-filled fluid on the stomach creates a feeling of fullness and it is called Ascites. 
• Taking medications for chemotherapy, immunotherapy and conditions can cause one to not feel hunger
•  Of there is any type of surgery or radiation therapy that is administered to the gastrointestinal organs, such as the stomach or the intestines 

The other side effects that tend to occur due to weight loss are,

• Nausea and vomiting
• Mouth sores and mouth pain
• Pain
• Dry mouth
• Changes in taste and smell
• Difficulty chewing
• Depression
• Difficulty swallowing
• Stress or anxiety
• Infections in the mouth
• Constipation or diarrhea
• Fatigue

How to manage appetite loss:

One of the virtual stages of cancer treatment is to relieve any side effects that occur due to the treatment. This is also known as palliative care or supportive care. Your child will be under the constant guidance and monitoring of their healthcare team and if they experience any symptoms or changes in the symptoms it is better to notify them immediately. It has been proven that starting palliative care early can improve the outcomes of the treatment. 

• The first and foremost consideration should be given to treating appetite loss in patients by addressing the cause. The key treatment for your cancer is to improve your health by improving your intake of food. Healthy eating habits and healthy food can alleviate any side effects that might occur due to cancer treatment such as sores in the mouth, pain, nausea, dry mouth, depression or fatigue can be helped with improved appetite.
• Try practicing simple steps if you feel that your child’s appetite is low, 
• Have a snack whenever you are hungry. Eat about 5-6 meals per day
• Do not limit yourself to how much you eat
• Understand and recognize the times of the day your child feels hungry and fix something at that time and feed them
• Consumption of healthy calorie and protein-rich foods can be of great help. You can give granola bars, cheese, yogurt, pudding, eggs, milkshakes, nuts, dried fruits, or cereals. 
• Always keep their favorite snacks handy and give them what they love the most whenever they ask for
• If you feel that their protein intake is not sufficient, you can increase their protein amounts by adding cheese, butter, sour cream, whipped cream, nuts, nut butter, and gravy
• Go in for more fluids between meals rather than giving them only solid foods throughout the day. They help the child feel more full and in addition to filling your tummy up with calories you can also give your child electrolytes to keep them active and energized
• Rather than opting for soft drinks, go for nutritious and filling drinks such as smoothies or nutritional milkshakes. 
• Rather than feeding your child precooked meals, try your best to home cook for them and prepare foods that they most likely would eat. 
• Tackle your child to a soothing and relaxing environment and ask them to eat there with their family and friends
• Place the food on smaller plates rather than larger plates
• If your child feels nauseous due to the smell of the food, ask them to eat the food in a room that is cold or has an optimal temperature. This will decrease both the odor and the taste of the food. 
• If your child has trouble with tasting or smelling food, and if they feel a metallic taste in their mouth, ask them to put on a candy that is lemon or mint-flavored before eating a meal. 
• Ask their healthcare team to relieve them of any gastrointestinal symptoms that they might have such as nausea, vomiting, and constipation. Also, tell them if your child is experiencing pain and the effective ways of relieving pain.
• Doing light exercises, such as a walk for 20 mins before they start to have their meals would help increase their appetite and stimulate the brain into thinking that the person might be feeling hungry. Doing exercises can also help maintain the muscle mass of the child. 

To further improve the appetite of your child, meet with a registered dietician for advice on or to effectively plan the meal and how to manage the symptoms. The dietician might also offer you insight on whether the child may benefit from nutritional supplements or other digestive enzymes. Ask the doctor in attendance if there is a dietician available on the premises of the treatment center. 

Additionally, the doctor will aid in treating appetite loss and the associated weight loss issue with certain medications, 

• Megestrol acetate (Ovaban, Pallace) are medications that are forms of the progesterone hormone that improves the appetite and weight gain in the child. However, on the downside, the effects of the medication can cause an increased risk of blood clots. 
• Steroid medications increase the appetite as well as their overall well-being. It also helps with the feeling of nausea, weakness, or pain. Steroids are to be used only for a short period of time as long-term usage can cause necessary effects in the child. 
• Metoclopramide (Reglan) is a medication that helps improve the feeling of nausea in the patient and prevent the sensation of feeling full even before eating a proper meal
• Dronabinol (Marinol) is a synthesized medication that is used to stimulate appetite in the child.

In some cases, the patient is fed by using a tube that is temporarily placed through their nose into the stomach. For long-term feeding of the patient, a tube is placed directly into the stomach from the abdominal wall. This method however is not recommended in most cases, especially for patients suffering from more advanced stages of cancer. 

Therefore if your child is experiencing appetite changes, it is wise to let their doctor know before it is too late to provide the necessary treatment methods. 

Cancer cachexia

Cachexia is a term that also means wasting. This condition occurs in patients having advanced stages of cancer and causes a complete loss of appetite due to which their weight goes down drastically causing severe muscle loss. This condition is commonly experienced by almost 80%of cancer patients. Treatment for those having cachexia conditions involves their caretakers recommending them to a registered dietician. These registered dieticians conduct a nutritional assessment of the patient’s body and then offer the appropriate counseling on how to start and if the patient is too weak, their caretakers will be given an idea of how to feed the patient. The dietician will give an account of the high protein foods that can be administered and those that should not. Also, goods should be provided only whenever the patient chooses to eat. Tips on how to offer safe and practical feeding.

Based on recent research, the best way to treat cachexia is to not use medications. The reason behind this conclusion is to stimulate appetite and due to the medication having unnecessary side effects. It is for the best that not using them can improve the conditions of the patients due to the absence of unnecessary side effects that might be caused due to the effects of the medications. Also, patients having cachexia conditions are not recommended for tube feeding as they are most likely to experience complications, and doing so does not have any improvement in the patient’s condition. For very specific conditions, creditors may sometimes recommend short-term treatment with a progesterone hormone through an IV or feeding tube. 

How to care for someone having cancer cachexia:

It can be stressful for the caretaker to watch their loved one experiencing weight loss due to improper intake of food. So to make sure their loved ones eat, various tips are offered for guidance. People having cachexia can find it difficult to consume food, even drinking water can be a task for them. This causes tension between the patients and their caretakers. Consider the following tips on how to effectively take care of cachexia patients, 

• Always remember, that it is not they who choose to not eat and lose weight. Do not push them to eat, telling them to ‘try harder’.
• Do not turn your feeding sessions into a battle. Avoid ‘pushing food’ on them to resolve the issue of them not eating properly. 
• Patients may ask for food, but by the time you prepare and bring it to them, they might not want it, though it is frustrating it is quite common
• Do not consider yourself a failure as a caregiver if you cannot feed your loved one. Some things are just out of control.
• Be creative, look for ways to care for your loved ones outside of giving them food like giving them a massage, reading to them, holding their hands, or playing games. 
• Though a most common practice that people follow when gathering together is preparing and eating food. When you are with your loved one, go for gatherings that do not involve eating food
• Do not exhaust yourself in the process of caring for them. Take some time for yourself too.
• Talk to other caregivers and learn from their experiences on how to effectively manage your duties and your personal life. You can also get an insight into developing creative strategies that best suit the patient.