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Nutrition in Children with HIV Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme.

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Presentation on theme: "Nutrition in Children with HIV Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme."— Presentation transcript:

1 Nutrition in Children with HIV Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

2 HIV and Malnutrition Children with HIV are more likely to become malnourished than other children ©TALC

3 Why?  Recurrent illnesses  Diarrhoea (prevents body from absorbing nutrients)  Loss of appetite  Mouth Infections  Poor access to nutritious foods  ? Ability of carer to prepare nutritious foods  Loss of household income due to death of parent ©TALC

4 HIV and Nutrition Increased nutritional needs reduced intake and increased loss of nutrients Increased vulnerability to infections, poor health, earlier and faster progression to AIDS Poor ability to fight HIV and other infections Poor Nutrition HIV National Department of Health, South Africa, 2001

5 Malnutrition and Diarrhoea  Malnutrition can make diarrhoea more severe  If a child is malnourished, he cannot digest food properly and the stomach wall is weakened  Food is therefore not absorbed properly and lost as diarrhoea ©TALC

6 Psychological Changes ©TALC

7 This Child is Not Fat!  Note!!  Kwashiokor  Appears fat due to oedema  The child is actually wasted  Moon face and muscle wasting in shoulder muscles Thin hair, falls out easily ©TALC

8 Severe Kwashiorkor Child 1:  Flaking paint rash  Skin very thin and weak Child 2:  Flaking paint rash  Sores on face  Sunken eyes & loss of skin  Oedema has cleared with dehydration Child 3:  Skin sores following diarrhoea ©TALC

9 Road To Health Chart ©TALC

10 MUAC  Mid Upper Arm Circumference  Arm circumference is the same between 1 and 5 years  Useful measure of malnutrition  More than 13.5 cm = well nourished  Picture 2 = child is malnourished ©TALC

11 Nutritional Support for Children with HIV Essential throughout the course of illness Should start as early as possible  To prevent them getting infections  To help them recover from infections  To promote the child’s growth  To improve quality of life

12 Food Hygiene A child with HIV will get sick very easily if food is not prepared in a hygienic way. Always counsel carer about:  Hand Washing  Clean surfaces and utensils  Cook food thoroughly  Avoid contact between raw foodstuffs and cooked foods  Serve food immediately after preparation  Only store cooked foods in fridge or cool place  Store in fridge for one or two days only)

13 Food Hygiene  If food is reheated, do so at a high temperature  Wash fruits and vegetables before serving  Use safe water that is boiled or filtered  Clean cups and bowls  Never use bottles for feeding babies  Protect foods from insects, rodents, and other animals  Store non-perishable foodstuffs in a safe place

14 No food available If there is no food available in the house  Refer to the Social Worker  Ensure local schemes and grants are accessed and received by carer  When food supplements are given, ensure carer knows how to use them properly

15 Good Foods for the Immune System Important Vitamins and Minerals Best Food SourcesFunctions Vitamin AAll yellow, orange and green fruit and vegetables, especially melon, mangoes and paw paw; milk, garlic, egg yolk, liver To make white blood cells; for vision, healthy skin, teeth and bone development; protection against infection; antioxidant Vitamin CSweet peppers, raw leafy green vegetables, all fruits, especially guava, baobab pulp, grapefruit and tomatoes Builds healthy bones, teeth and gums; helps fight infection; antioxidants; Vitamin C helps the body to take up iron in the blood Vitamin ECold-pressed vegetable oils, nuts and seeds, whole grains, eggs, legumes, dark green vegetables, wheat germ Increases disease resistance; protects fats and vitamins A and C from oxidation; prevents ageing; treats scar tissue; antioxidant SeleniumBrown rice, nuts, seafood, liver, egg yolk, onions, garlic, meat, whole grains, milk Prevents oxidation and breakdown of fat and other body cells; antioxidant ZincProtects the immune system; needed for digestion and enzymes; prevents HIV locking on to CD4 cells, promotes wound healing; Vit A metabolism leafy, green vegetables, oily fish, nuts, meat, whole grains, egg yolk, garlic, chicken) (Adapted from Francis, 2003)

16 Breastfeeding and HIV  HIV may be passed from an HIV positive mother to her child during breastfeeding  So, if the baby has not already been infected during pregnancy or during delivery, he/she may be infected during breastfeeding  HIV positive mothers therefore need counselling about feeding options for their babies ©TALC

17 Counsel the Mother Breast feeding  Increases the risk of passing HIV to her baby  Provides the baby with nutrients and protection against other infections  Provides comfort and close bonding between mother and child  Free and readily available! Formula Feeding  HIV cannot be passed by exclusive formula feeding  Does not provide the same nutrition or protection against infections  Increases the risk of other infections from dirty water, unhygienic preparation of formula milk

18 Counsel the Mother  Mothers must be counselled so that they can make their own decision  There is some evidence that Mixed Feeding increases the risk of HIV infection  Mixed Feeding = breast feeding AND formula feeding

19 Counsel the Mother Mothers with HIV should be advised to either: Exclusively breast feed up to 6 months of age  DO not give other foods or fluids  Rapid change from breast milk to none at 4 -6 months OR Exclusively formula feed  No breast milk at all  Give formula feed or modified cow’s milk

20 Counsel the Mother For a child who is being breastfed:  If at 4-6 months, it is confirmed that the child has HIV, the mother may continue to breastfeed  There is no danger of her passing HIV to her child through breastfeeding as the child is already infected

21 Counsel the Mother We also know that the risk of passing HIV to the child through breastfeeding may be increased by:  Sore, cracked nipples  Mastitis  Thrush  Breast abscesses  Oral thrush in the baby  High levels of virus in the mother  New infection in the mother A breastfeeding mother needs counselling on preventing/treating all of the above

22 Some General Principles A child with HIV needs:  More food than other children, particularly when he is ill  A variety of different foods (once foods introduced)  Family foods – more nutritious, healthier and cheaper  To drink more when they do not feel like eating  2- 3 glasses of fresh milk over 1 year of age  At least 3 glasses of clean water every day  Margarine and oil added when cooking food

23 Some General Principles  At least one portion of fish/chicken/meat/dry beans/eggs/peanut per day  Sweets, chocolates and crisps should not replace food  Dry beans have the same nutritional value as meat and can be eaten as often as possible  Bread, pap, samp, rice, mealies as much as the child wants, provided they are mixed with meat/beans/fish/ chicken/sour milk/peanut butter  Plant a vegetable garden  Eat at least 1 fruit or vegetable (not potato) every day  Make food look and taste good

24 Up to 6 Months of Age  Breastfeed as often as the child wants, day and night  Feed at least 8 times in 24 hours  Do not give other foods or fluids ©TALC (IMCI, 2002)

25 6 to 12 Months (HIV Confirmed)  Continue to breastfeed as often as the child wants  Give 3 servings of nutritious complementary foods  ALWAYS mix margarine, fat, oil, peanut butter or ground nuts with porridge Also add:  Chicken, egg, beans, fish or full cream milk Or  Mashed fruit and vegetables, at least once each day (IMCI, 2002)

26 6 – 12 Months  If baby is not breastfed, give 3 cups (3x200ml) of full cream milk as well  If baby gets no milk, give 6 complementary feeds per day (IMCI, 2002)

27 1 – 2 Years  Continue to breastfeed as often as the child wants  Breast milk is still an important food at this age and helps prevent infections  Give at least 5 adequate nutritious feeds  Increase the variety and quantity with family foods:  Mix margarine, fat, oil, peanut butter or ground nuts with porridge  Give egg, meat, fish or beans daily  Give fruit or vegetables twice every day  Give milk every day, especially if no longer breastfeeding  Feed actively with her own serving (IMCI, 2002)

28 2 Years and Older  Give the child his own serving of family foods 3 times a day  In addition, give 2 nutritious snacks such as bread with peanut butter, full cream milk or fresh fruit between meals  Continue active feeding (IMCI, 2002)

29 During Illness Remember to encourage feeding during illness and to advise an extra meal a day for one week after an illness ©TALC

30 Poor Appetite A child with HIV commonly has a poor appetite  Plan small frequent meals  Give milk rather than other fluids except where there is diarrhoea with some dehydration  Give foods with a high energy input  Give snacks between meals  Check for oral thrush and mouth ulcers ©TALC

31 Nausea and Vomiting  The child must eat!  Give food that he likes  Small regular meals and rest after eating  Drink fluids between meals and not with meals  Cold foods may be better than warm cooked foods  Eat bread, porridge and rice without gravies

32 Nausea and Vomiting  Drink extra fluids  ORS  Eat before taking medicines  Dry toast, rusks and dry crackers may help to relieve nausea  Avoid fatty, sweet food  Avoid tea and coffee, milk and milk products, spicy food

33 Mouth Sores  Give paracetamol an hour before feeds  Do not give acidic (sour) cold drinks like orange juice  Sour milk and porridge are allowed  Soft and mashed food is easier to eat (eggs, mashed potatoes, pumpkin, avocado  Avoid spicy, salty and rough foods  Chop foods finely and give cold drinks or crushed ice, if available ©TALC

34 Diarrhoea  Drink enough fluids and ORS every time the child has to go to the toilet  The child must eat!  Bread, rice, pap and porridge good  DO not give the child the skin and pips of fruit or vegetables (eg peas and beans)  DO not give food left over from previous day

35 Encephalopathy Monitor the child’s feeding skills May have to change texture and consistency of food Modify eating techniques and utensils Refer to speech therapy for assistance with feeding

36 Poor Weight Gain  Counsel the mother about feeding practices used  Advise mother about foods to give as per recommendations already outlined  Give the child an extra meal each day  Offer snacks that he likes  Ensure child is weighed again in 14 days ©TALC

37 Protein-Energy Malnutrition Scheme  Administered by local authorities  Part of Integrated Nutrition Programme  Provides food supplements to those children underweight (below 3 rd percentile on the Road to Health Chart)  All children are eligible to benefit from the PEM scheme  Should not be administered in isolation  Also refer to existing community support agencies

38 Remember! If a child is sick, he not only needs more food but also more fluids  If child is breastfed, breast feed more frequently and for longer at each feed  Increase other fluids ef give soft porridge, amasi, SSS or clean water  If the child has diarrhoea, giving extra fluids can be life-saving

39 Breast Feeding Problems Common reasons why mothers add other feeds or stop breastfeeding:  Problems with Positioning and Attachment  “Not Enough Milk”  Sore or Cracked Nipples  The Baby Feeds often or cries a lot Usually, mother has enough milk but lacks confidence that it is enough Observe feeding practice and advise on attachment and Positioning Offer support and encouragement

40 Safe Preparation of Formula Milk  Always use a marked cup or glass and spoon to measure water and the scoop to measure the formula powder  Wash your hands before preparing a feed  Bring the water to the boil and then let it cool. Keep it covered while it cools  Follow the instructions on the tin, ensuring the scoops of powder are LEVEL and the powder and water are MIXED WELL  Feed the baby using a cup  Wash the utensils

41 How to Feed a Baby with a Cup  Hold the baby sitting upright or semi-upright on your lap  Hold a small cup of milk to the baby’s lips - tip the cup so the milk just touches the baby’s lips - the cup rests gently on the baby’s lower lip and the edges of - the cup touch the outer part of the baby’s upper lip - the baby becomes alert and opens his mouth and eyes  Do not pour the milk in to the baby’s mouth. Just hold the cup t his lips and let him take it himself  When the baby has had enough he closes his mouth and will not take any more

42 Counsel the Mother  If the mother or main carer is sick or malnourished, she will be unable to care for the child  Counsel the mother to keep up her own strength and health  Advise her about her own nutrition and the importance of a well balanced diet to keep herself healthy ©TALC

43 So How Can You Help? You have a vital role to play in identifying potential problems and preventing malnutrition…….  Check the Road to Health Card  Explain the importance of weight checks to the carer  Advice the carer about the foods required by the child  Counsel the mother about food preparation and availability  Refer any concerns!

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