When the child is no longer able to swallow, certain decisions need to be made about feeds, fluids and medication.

Note: Starvation causes ketosis which leads to the release of endogenous endorphins, which diminish hunger, cause euphoria and enhance the effects of analgesia medications. Providing dextrose-containing IV fluids may prolong the dying process so is not recommended.

Children often lose their appetite towards the end-of-life, and their metabolic needs decrease. Management options include:

• Do not feed the child if they are not hungry.
• Ideally give fluids orally rather than through an intravenous line.

See Amery pg 339

Leaflet from Footprints 4 Sam on artificial feeding