• Poor appetite and weight loss are common in children with terminal illness, particularly towards the end of life.
• This causes a great deal of anxiety amongst many parents and carers because:
  • They may consider one of their main innate roles as parents is to feed their child
  • They often perceive eating as central to life
  • Acceptance that their child doesn’t want to eat may go hand in hand with acceptance that the terminal phase is approaching

Sometimes the only thing a child can exert control over is their oral intake. Appetite often mirrors anxiety and this may need to be assessed.

Consider reversible causes of appetite impairment:

• Oral candidiasis
• Pain (in mouth: check for ulcers and dental caries)
• Pain (elsewhere)
• Nausea/vomiting (see appropriate section)
• Constipation
• Medication
• Anxiety
• Depression

Management

General measures

• Explanations and discussion with family/carers may be helpful
  Listen to parents concerns and reassure/ discuss as appropriate

Other advice includes:

• Providing small meals on small plates
• Making food less effort to eat: providing mashed meals or wholesome soups; offering ice cream and rice pudding etc.
• Offering favourite meals such as MacDonalds
• Offering supplement high calorie/ high protein drinks (more palatable if served chilled)
• Not making an issue out of meal times
• Low dose steroids are not recommended because of the associated side effects
• NG feeds with supplements under the direction of a dietician and feeding for pure pleasure