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Diet Therapy and Childhood
Diseases (Part A)
NS 335 Unit 8
Erin Hetrick, MS, RD, LDN
Factors that depend on the
nutritional care of a sick child
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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
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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!”
Infant Formulas
Infant formula 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
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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:
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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
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Biliary cirrhosis
Gene Therapy and CF
• CTFR – cystic fibrosis transmembrane
regulator
Diet Therapy Goals with CF
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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
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
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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.
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
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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