1. Diet Therapy and Childhood Diseases (Part A) NS 335 Unit 8 Erin Hetrick, MS, RD, LDN

2. 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

3. 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

4. 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!”

5. Infant Formulas

6. Infant formula in the News http://wwwn.cdc.gov/travel/contentMelamineChina.aspx

7. 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

8. 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

9. 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.

10. Any Questions???

11. 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

12. Gene Therapy and CF CTFR – cystic fibrosis transmembrane regulator

13. Diet Therapy Goals with CF 1)Improve fat and protein absorption 2)Decrease the frequency and bulk of stools 3)Increase body weight 4)Control or prevent rectum prolapse 5)Increase resistance to infection 6)Control, prevent, or improve association emotional problems

14. 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.

15. 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.

16. Any Questions???

17. Congential Heart Disease

18. 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.

19. Is there a cure?

20. Considerations in Dietary Care Caloric Need Renal Load Food Intolerance Vitamin and Mineral Need

21. 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

22. 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