Transcript Document

Diet Therapy and Childhood Diseases (Part A)
NS 335 Unit 8
Jennifer Wagner, MS, RD, LDN
Nutrition Care of A Sick Child Depends On:
 Disease type, severity, duration
 Management strategy
 Child’s age and growth pattern
 Nutritional status of child before & during
hospitalization
 Need for rehabilitation
Factors Affecting Sick Kids Nutrition 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 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!”
Growth Expectations
 Growth is measured and plotted on standard Center for
Disease Control (CDC) growth charts based on age and
sex.
 Head circumference and weight for height is measured
and plotted until 36 months of age.
 Growth rates may vary considerably for each individual
child.
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Parents growth history and patterns
 Use to assess nutritional status: determine adequacy of
nutrient intake, particularly calories and protein.
 The most important influences on growth potential appear
to be economic, nutritional and environmental
Importance of Nutrition
 Growth can slow or stop if a child is sick several
times a year with inadequate nutrition intake.
 Need to encourage a sick child to eat; nutrition
support may be required
Effects of Undernutrition on Growth
 Depends on severity, timing, & duration of
poor nutrition
 Smaller in size (height and weight)
 Growth is an indicator of nutritional health
(weight & height)
Infant Formulas
Types of Formulas
 Standard cow’s milk-based
 Special formulas:
 Soy protein-based
 Premature
 Protein hydrolysate or hypoallergenic
Breastfeeding
 Always available; free
 Contains active infection-fighting white blood cells and
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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.
Formula Feeding
 Infant formulas have gotten better at matching the
ingredients and 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. Iron
deficiency in the first years adversely affects brain
development.
Any Questions?
Cystic Fibrosis (CF)
 Inherited disease
 Causes thick, sticky mucus to build up in lung & GI tract
 Defective gene causing body to produce abnormally
thick & sticky mucus building up in lungs & pancreas
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Primarily affects pancreas, mucous, and sweat glands
 Result in life-threatening lung infections, digestion, and
malabsorption
Gene Therapy and CF
 CTFR – cystic fibrosis transmembrane regulator
Clinical Concerns
 Patients may have:
Pulmonary disorders with recurrent infections 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): reduced wt gain or height for age
 Salt Depletion
 Biliary cirrhosis
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Newborn and GI Symptoms
 Symptoms in newborns may include:
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Delayed growth
Failure to gain weight normally during childhood
No bowel movements in first 24 to 48 hours of life
Salty-tasting skin
 Symptoms related to bowel function may include:
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Belly pain from severe constipation
Increased gas, bloating, or a belly that appears swollen (distended)
Nausea and loss of appetite
Stools that are pale or clay colored, foul smelling, have mucus, or
that float
Weight loss
Lung Symptoms
 Coughing or increased mucus in the sinuses or lungs
 Fatigue
 Nasal congestion caused by nasal polyps
 Recurrent episodes of pneumonia.
 Sinus pain or pressure caused by infection or polyps
Pancreas
 Pancreas makes enzymes.
 Enzymes body digest and absorb protein and fats.
 Build-up of sticky mucus in the pancreas can lead to
serious problems:
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Stools that contain mucus, are foul smelling, or float
Gas, bloating, or distended belly
Problems getting enough protein, fat, and calories
 These issues cause a hard time maintaining a normal
weight.
 Even if weight is normal may not be getting the correct
nutrition.
 Children with cystic fibrosis may not grow or develop
correctly.
Diet Therapy Goals with CF
1)
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Improve fat and protein absorption
Decrease the frequency and bulk of stools
Increase body weight
Control or prevent rectum prolapse
Increase resistance to infection
Control, prevent, or improve association emotional
problems
Bowel & Nutrition Treatment
 A special diet high in protein and calories for
children and adults
 Pancreatic enzymes to help absorb fats and protein
 Vitamin supplements, especially vitamins A, D, E, K
and calcium usually required
Pancreatic Enzymes
 Enzymes help body absorb fat and protein.
 Will help decrease or get rid of foul-smelling
stools, gas, and bloating.
 Take enzymes with all meals and snacks.
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May need increase or decrease of enzymes, depending on
symptoms.
 Infants are given a predigested formula
(Pregestimil is a brand)
Increased Nutrition
 Occasionally, patients need to take nutrition through
a tube to provide extra calories that help the body
grow and stay strong.
 How do we add calories and protein to kids meals?
General Feeding with CF
 Menu planning
 Medium-chain triglycerides (MCTs)
 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.
Any Questions???
Congenital Heart Defects
American Heart Association Stats
 Up to 1.3 million Americans have some form of
congenital heart defect.
 ~36,000 children are born with a heart defect each
year in U.S.
 At least nine of every 1,000 infants born each year
have a heart defect.
Understanding your risk for congenital heart defects. (March 2011). Retrieved on May 13, ,2011 from
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/UnderstandYourRiskforCon
genitalHeartDefects/Understand-Your-Risk-for-Congenital-Heart-Defects_UCM_001219_Article.jsp
Growth
 Gain weight more slowly
 Cardiac malformations responsible for malnutrition
 Mild undernutrition to severe failure to thrive
 Malnutrition may undermine outcome of surgical
procedures and postop recovery
 Most treatment strategies aim for catch-up growth
Factors Interfering with Growth
 Excessively rapid heart beat
 Increased respiratory rate
 Poor appetite
 Greater caloric needs
 Decreased food intake due to rapid breathing and
fatigue
 Frequent respiratory infections, such as bronchitis or
pneumonia
 Poor absorption of nutrients from the digestive tract
 Decreased oxygen in the blood, called hypoxia
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
Infant Feeding with Congenital Heart Defects
 Be flexible about your feeding method and schedule.
 Do best when fed more often and on a demand schedule.
 Tire quickly during feeding, so frequent feedings work well.
 May need to feed baby every two hours and may need to wake
baby several times during the night to feed until able to
tolerate a larger volume of milk.
 Some infants do best with a combination of breast- and bottle-
feeding.
Medications and Feeding
 Medications may be needed to control congestive heart failure
 Best to give medications to baby before a feeding.
 Give medications directly into baby's mouth using a syringe or
dropper .
 Do not mix medication in bottle because baby
may not finish bottle.
 If baby vomits after the medication, do not give
medication again until next scheduled time.
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 water from fever, high
environmental temperature, diarrhea, vomiting, and
rapid respiration
High Risk Infants
Successful Pregnancy
 Mother’s physical & emotional health
 Infant:
 Full-term=
>37 weeks gestation
 Birth weight > 5.5 pounds
 Sufficient lung development (occurs ~37 weeks)
is critical to survival
 The longer the gestation, the less the health risk
Infant Birthweight
 Low-birth-weight (LBW):
 Less
than 5.5 pounds at birth; LBW associated with
preterm birth
 Preterm= born before 37 weeks
 Increased medical costs
 Small for gestational age (SGA):
 Full-term
or preterm babies
 Insufficient growth; low birth weight for the expected
weight for their length of gestation
 More likely to have medical complications
Infant Linear Growth
Preterm goals:
 1-1.75 cm/week until 3 mos. adjusted age
 0.5 cm/week from 3-6 mos. adjusted age
 0.3 cm/week from 6-12 mos. adjusted age
Term goals:
 0.66-0.75 cm/week for first 6 months
 0.5 cm/week from 6-12 months
Head Circumference
Preterm goals:
 0.5-1 cm/week until 3 mos. adjusted age
 0.25 cm/week from 3-6 mos. adjusted age
Term goals:
 0.33 cm/week
Calorie & Protein Goals
Category Age (yrs)
 Preterm
------ Infants
0-0.5
0.5-1
 Children 1-3
4-6
7-10
 Males
11-14
15-18
 Females 11-14
15-18
kcal/kg
≥120-130
108
98
102
90
70
55
45
47
40
g Pro/kg
3.5-4.4
2.2
1.6
1.2
1.2
1.0
1.0
0.9
1.0
0.8
Catch-Up Growth
(Ideal Body Weight for Ht x RDA for Wt Age)
Current Weight
Wrap-UP
 Important to remember that feeding
preterm infants can be an emotional
issue for families.
 Families may feel responsible for
inadequate dietary intake and growth.
 Every attempt should be made to undertake this
procedure with a family-centered, non-judgmental
approach.