Download infant formulas

DIET THERAPY AND CHILDHOOD DISEASES
(PART A)
NS 335 Unit 8
Sharon Charles-Brackens,
DHSc, MSA, RD
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 FORMULAS
INFANT FORMULAS 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:

- 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
GENE THERAPY AND CF

CTFR – cystic fibrosis transmembrane regulator
DIET THERAPY GOALS WITH CF
1)
2)
3)
4)
5)
6)
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
 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.
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
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
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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
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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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Questions???
QUESTIONS