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MNT for children

MNT for children. GI disorders. Differential nutrient absorption Site of pathology Congenital problems. Diarrhea. Children (esp. infants) are sensitive to dehydration, because of high water content Acute diarrhea Re-hydration Then back to regular diet Full strength formula Fiber helps

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MNT for children

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  1. MNT for children

  2. GI disorders • Differential nutrient absorption • Site of pathology • Congenital problems

  3. Diarrhea • Children (esp. infants) are sensitive to dehydration, because of high water content • Acute diarrhea • Re-hydration • Then back to regular diet • Full strength formula • Fiber helps • Lactose free formula?

  4. Chronic diarrhea of infancy • After acute diarrhea • Decreased absorptive capacity • Usual treatment • BRAT: not adequate • Treatment recommendations • Replace fluids: avoid hyperosmolar juices • Semi elemental feeds, low lactose • Yogurt?

  5. Celiac Disease • Gluten induced enteropathy • Antibody screening allows identification of more patients • Same gene as IDDM, several other auto-immune conditions • Low bone density • Wheat, rye, oats?, barley, malt, gluten. • Long term inadequate diet

  6. Short bowel syndrome • Loss of 50% or more of small intestine • Depends on site of resection and degree of injury • Ileum • Absorption of B12 and bile salts • Ileocecal valve • High water content in stool (also with loss of minerals)

  7. Short bowel • Urine specific gravity to check hydration • Enteral nutrition to promote intestinal adaptation • Adaptation may take more than 1 year • Oral feeing assistance • Long term nutritional concerns • Illness precipitates crisis

  8. Diabetes • Insulin dependent • Family centered • Focus on normal development and typical use of food • Problems with growth and developmental stages • Problem with change of routine • Team management • Behavioral intervention

  9. Diabetes • Long term outpatient management • Include child • Include favorite foods, even if “junk” • Counsel older child separately from parents • Include “holiday” food activities in treatment plan • Sliding scale insulin for illness and ‘fun’ • Watch juice?

  10. Diabetes and development • Infancy until 2 • Frequent revision of meal plans • Monitor growth • Toddlers • Variable intake • Insulin after food • School age • Adjust diet and insulin to school, not the other way around

  11. Diabetes and development • Adolescents • Rebellion and denial, greater independence • Growth • Follow carefully • Using insulin to diet • Large changes in weight • High HgA1-C, and keto acidosis • Depression

  12. Nutrition Support • Calorie requirements • EAR • WHO • Catch up? • EAR for protein: male female • 1-3 gm/kg/day 0.88 0.88 • 4-13 0.76 0.76 • 14-18 0.73 0.73

  13. Indications for nutrition support • Anthropometric • Fall 2 weight or height for age channels • > 5% weight loss • < 5th percentile weight for age or weight for height • < 90% ideal weight for height • Skin folds

  14. Indications for nutrition support • Behavioral • Excessive feeding time • Physical inability to keep liquids in mouth • Oral aversion • Mechanical problem with mastication, swallowing or peristalisis • Video swallow

  15. Indications for nutrition support • Biochemistry • Serum albumin <3.2 • Refeeding syndrome • Severe fluid shifts • Hypokalemia, hypophosphatemia • Tube feeding syndrome • Hypertonic dehydration secondary to highly osmotic feeds

  16. Optimal feeding method • Intervene early • Ethical issues regarding disease • Provide support of managing complications and improving quality of diet • Hard to force a child to eat when they don’t want to • See algorithm

  17. Enteral feeding • Ng vs GT? • What shows • Discomfort • Pulling the tube • Ng • Short term • Small size: 6-8 french

  18. Enteral feeding • GT • PEG tube • Catheter: pull the tube • Cellulitis and infections • Leaking • Bolus or pump or both • Who pays for what

  19. Enteral Feeding • Rate vs concentration • ½ continuous at night and rest bolus during day • Mechanical complications • Plugged tubes • Adequate flushes • Appropriate equipment • Replacement of tubes • Lack of community support

  20. Dietary requirements • Fluid needs • 1-10 kg 100 ml/kg • 11-20 kg 1000 ml + 50 ml for each kg >10kg • 20-30 kg 1500 ml + 20 ml for each kg >20kg • > 30kg 35 ml/kg/day • Volume for feeding is NOT free fluid • Calories : WHO equations

  21. Dietary requirements • Protein • ? EAR? • Child AA solutions • Fat: 30-40% total calories • CHO • Children 5-8 mg/kg/min • Electrolytes and vitamins age adjusted

  22. Special considerations • Time off for activity • May need to administer insulin to control blood sugar • Peripheral TPN

  23. Special considerations • Fit between product and nutritional needs • Infant formula: maybe age 2 • 20 kcal/oz • Child formula • 30 kcal/oz adequate at 1000 kcal • Maybe iodine? • Adult formula • 30 kcal/oz adequate at 1200-1800 kcal

  24. Enteral products for children • Blenderized feedings • Child products • Pediasure, with and without fiber • Kindercal • Resource Just for Kids • Neocate One + • Vivonex Pediatric • Peptamen Junior

  25. End game • Need to consider how social needs of eating will be met • Long term use of enteral or parenteral feeds may interfere with oral feeding • Needs supportive care from dysphagia specialist

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