Nutrition and the Pediatric Patient Dawn O Eckhoff

Nutrition and the Pediatric Patient Dawn O. Eckhoff, Ph. D, APRN, CPNP-PC

What are we going to cover? • • Nutritional Requirements and Dietary Intakes Nutritional Assessment Optimal Nutrition Strategies Age-Specific Considerations Disorders Adverse Reactions Controversies

Nutritional Requirements and Dietary Intakes • Energy: basal metabolism, Growth, Activity; stored or daily calories • Water loss: illness, activity, heat, dry air • Electrolytes: • Na: 1000 mg/day to 1500 mg/day • K: fruits, veggies, meat • Cl: no normal amount noted • Macronutrients: • Protein: 5 -30% daily calories; premature infants need more protein • Carbohydrates: >50% energy requirements • Fats: provide energy and absorption of fat-soluble vitamins

Nutritional Requirements and Dietary Intakes • Micronutrients • Fat-Soluble Vitamins: stored in body tissues for long time • Water-Soluble Vitamins: stored in small amounts • Minerals and Elements • 3 major minerals • Ca: bone density • Mg • P • Supplements • Vitamin D: 400 -600 IU daily • Need nutrient rich diet

• History • • Nutritional Assessment Pregnancy nutrition Food and fluid intake-child and family Eating patterns/behaviors Reactions/attitudes Management of foods Health status and food Family history: HTN, DM, hyperlipidemia, obesity, heart disease, allergies, eating disorders • PE • Labs: Hgb, Hct, Iron studies, electrolytes, D, bone radiographs

Optimal Nutrition Strategies • Healthy Eating Habits • • • Positive Examples/Role Models Portions: 1 TBS per year of age Limits Routine mealtimes Appropriate supervision Adequate exercise, sleep, rest Offer foods when hungry Small taste Have them help • Nutrition Education • My. Plate, My. Plate for Kids, Super. Tracker

Age-Specific Considerations • Newborns - Infant • • Rapid growth = high calories Need fat intake Whole cow’s milk until 24 months Vitamin D until 1 year old Vitamin C after age 4 to 6 months Iron: fortified cereals Fluoride: starting at 6 months old where water is not fluorinated • GERD – resolved by 24 months • Solids at 6 months of age • Self-regulation

Age-Specific Considerations • Early Childhood • Decreased energy needs • Vitamin D supplement • Learn to eat by observing

Age-Specific Considerations • Middle Childhood • • • Increase protein with growth Encourage good eating habits and mealtime routines Vitamin D Multivitamin for poor diets Vegans need B 12

Age-Specific Considerations • Adolescents • Rapid growth needs increase calories • Increase protein for muscle mass • Increase need for thiamin, riboflavin, niacin, folate, iron, zinc, calcium • Irregular eating habits or limited diets may need supplements • Vitamin D for all • B 12 for vegans • Eating habits influenced by independence and social activities

Physical Activity • 60 minutes every day, moderate to vigorous activity • 3 days a week; muscle and bone strengthening • 3 days a week; vigorous activity

Vegetarian and Vegan Diets • • Vegan: only plant-based foods Lactovegetarians: add milk and dairy Lacto-ovovegetarians: add eggs Macrobiotic diets: add whole grains, white meats or white fish (minimally) • Pescatarians: only meat is fish • Flexitarians: mostly plant-based with occasional fish, chicken, seafood

Management of Diets • Labs: B 12, Zinc, Fe and D • Make sure of high fiber

Disorders Need Increased Caloric Intake: CP, ADHD, chronic lung issues, AIDS, chronic renal insufficiency, inadequate resources, oral motor issues, low birth weight or premies, steroid treatment, malabsorption issues (CF) Need Decreased Caloric Intake: Prader-Willi, Down syndrome, Myelomeningocele, Hypothyroidism Restricted or Supplemental Diets: Metabolic disorders, inflammatory bowel, short bowel syndrome, celiac disease, cancer, infectious disease Physical Alterations: Cleft lip or palate, Esophageal atresia, CP, GERD, pyloric stenosis, environmental trauma, prepare for surgery

Disorders Eating Disorders: Discuss in Chapter 15 Childhood Obesity/Overweight • Ages 2 – 18 years with BMI >95% (obese) • Ages 2 – 18 years with BMI >85% <95% (overweight) • Younger than 2 with height-weight ratio >95% overweight • Risk factors: • Hyperinsulinemia = prevention of satiety • Increased stress • Decreased physical activity • Diet high in fructose and decreased fiber • Screen Time = snack food and sugar sweetened beverage ads • Psychosocial and Environmental Factors • Food used to regulate emotions and cope with stress • Sugar-sweetened beverages

Management: • Lifestyle Changes • • Eating habits Physical activity Goals Support • Medications • Orlistat • Metformin Disorders • Bariatric Surgery • Adolescents • Distinct criteria • Community Changes • Access to healthy foods • Healthy food choices • Breastfeeding • Community areas to exercise

Adverse Reactions Food allergy: hypersensitivity to food or food additive Food intolerance: nonimmunologic inability to process food Contributing Factors: • Heredity • Infant diet: include allergenic foods • Compromised GI tract • Type of food

Adverse Reactions Management: • Elimination diet • Oral immunotherapy • Food Challenge • Medication • Education

Controversies Sugar Consumption: • 4 to 8 year olds: 3 tsp • 9 to adult: 5 to 8 tsp Gluten-Free Diets: • Celiac disease • Often highly processed and not enriched with Fe or folate