DIET THERAPY AND CHILDHOOD DISEASES (PART A)

NS 335 Unit 8

Sharon Charles-Brackens, DHSc, MSA, RD

FACTORS THAT DEPEND ON THE NUTRITIONAL CARE OF A SICK CHILD

Disease type, severity, duration Management Strategy Child’s age and growth pattern Nutritional status of child before and during

hospitalization Need for rehabilitation

MAJOR REASONS SICK CHILDREN DO NOT HAVE ADEQUATE INTAKE

Malfunctioning GI system High metabolic demands from stress

and trauma such as fever, infection, burns, or cancer

Excessive vomiting and diarrhea Neurological and psychological

disturbances that interfere with eating, such as the inability to chew or fear of food

Specific nutritionally related diseases such as disorders of the kidney, liver, or pancreas

SPECIAL CONSIDERATIONS FOR THE SICK CHILD

Be familiar with child’s normal ways of eating

Be aware of “familiar foods” child may like

Let child make choices of allowed foods Note these preferences to care team of

not limited with diet Be aware of tone when working with

this age group --- “If you don’t eat your peas, no dessert for you!”

QUESTION……

Which of these factors decrease the probability of adequately feeding a sick child?

A. fear, anxiety, anorexia B. pain, fatigue, lethargy C. vomiting, nausea, medications D. all of the above

INFANT FORMULAS

INFANT FORMULAS IN THE NEWS

http://wwwn.cdc.gov/travel/contentMelamineChina.aspx

INFANT FORMULA BASICS

See Table 23-1 for Different Types and Manufacturers

Table 23-2 has a partial listing of indications for the use of commercial formulas

BREAST VS. BOTTLE Breast Feeding “Perfect food for baby” It is always available Free Contains active infection-fighting white blood cells and

natural chemicals that give increased protection against infections in the first months

Perfect portion of nutrients that baby needs Easily digestible May protect against allergies and asthma in the future, May decrease risk of baby’s risk of obesity in the future Contains fatty acids that promote brain development Can help mothers lose weight more easily.

children.webmd.com

BOTTLE FEEDING BABY

Infant formulas have gotten better at matching the ingredients and their proportions to that of human milk.

While breastfed babies may have relatively fewer infections, the vast majority of infants won’t get a serious infection in the first months whether breast or bottle fed.

Iron fortified formulas are important to select. There is a lot of evidence that iron deficiency in the first years adversely affects brain development.

ANY QUESTIONS???

CYSTIC FIBROSIS (CF)

1 child per 1,500 to 3,500 live births is affected

Two major sites of this disease are the exocrine area of the pancreas and the mucous and sweat glands of the body.

Patients may have: - Pulmonary disorders with recurrent infections and other

trouble leading to COPD- Pancreatic insufficiency resulting in a lack of digestive

enzymes- Excessive loss of electrolytes in sweat, especially chloride- Malnutrition- Failure to Thrive (FTT)- Salt Depletion- Biliary cirrhosis

GENE THERAPY AND CF

CTFR – cystic fibrosis transmembrane regulator

DIET THERAPY GOALS WITH CF1) Improve fat and protein absorption2) Decrease the frequency and bulk of stools3) Increase body weight4) Control or prevent rectum prolapse5) Increase resistance to infection6) Control, prevent, or improve association

emotional problems

PANCREATIC ENZYMES

Improvements in pancreatic enzyme replacements have greatly benefited the CF child. -enteric coated “beads” encased in a capsule.

Enzymes are taken at meal times. Infants are given a predigested

formula (Pregestimil is a brand) Enzyme replacement does not always

work.

GENERAL FEEDING WITH CF

Menu planning Medium-chain triglycerides (MCTs) Protein malabsorption is mild To increase kcal and protein intake, dry

skim milk powder fortified with fat-soluble vitamins can be added to foods prepared for regular meals.

Foods not tolerated (such as raw vegetables and high-fat items) must be identified.

Salty foods such as peanuts, potato chips, and other items will alleviate the problem if the foods are tolerated.

QUESTION…..

Malnutrition in the child with cystic fibrosis is caused primarily by

A. lack of digestive enzymes B. excessive electrolytes in sweat C. lung infections D. vomiting and diarrhea

QUESTION……

Which of the following is a true statement regarding pancreatic enzymes?

A. Infants and small children are given injections of enzymes

B. Enzymes are given al least one hour before mealtimes

C. Prolonged use of enzymes can cause psychological problems

D. Enzymes may cause ulcerations.

ANY QUESTIONS???

CONGENTIAL HEART DISEASE

CONGENITAL HEART DISEASE AND GROWTH RETARDATION

It can cause the child to eat too little. High body metabolic rate due to the

increased nutrient needs of the organs and tissues, elevated body temperature, and thyroid activity.

High loss of body nutrients due to inadequate intestinal absorption, excessive urine output, and the presence of hemorrhages or open wounds.

IS THERE A CURE?

CONSIDERATIONS IN DIETARY CARE

Caloric Need Renal Load Food Intolerance Vitamin and Mineral Need

INFANT DIETARY CARE 8-10% of the daily calories from protein 35-65% from carbohydrate 35-50% from fat

Infants under 4 months should get 1.8-2.0g protein per 100 kcals

4-12 months should receive 1.65-1.75 grams protein per 100 kcals

MORE TO CONSIDER…. Table foods may be introduced when the

child is over 5 ½-6 ½ months old. Sodium intake must be considered. Fluid should be monitored carefully because

children with heart disease can lose much water from fever, high environmental temperature, diarrhea, vomiting, and rapid respiration

QUESTION…..

Which of the following manifestations, in a child with congenital heart disease, affects nutritional status?

A. malabsorption of nutrients B. elevated body temperature C. excessive urinary output D. all of the above

QUESTION…..

Which of these foods are not tolerated well by children with congenital hear disease?

A. fats and sugar in quantity B. proteins C. fluids in quantity D. vitamin supplements

QUESTION…..

Which of these guidelines provides appropriate distribution of nutrients for the child with congenital heart disease?

A. 40% carbohydrates, 20% protein, 30% fat B. 35%-65% carbohydrates, 10% proteins,

30-50% fat C. 30% carbohydrates, 30% protein, 40% fat D. none of the above

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Questions???

QUESTIONS