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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 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.
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
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.
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.
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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