Info Xmo
Figure 34-1. Lubchenco intrauterine growth curve. Reproduced with permission from Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26-42 weeks. Pediatrics 1966 37 403-8. Figure 34-1. Lubchenco intrauterine growth curve. Reproduced with permission from Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26-42 weeks....
Galactosemia
Galactosemia is an inherited disorder of galactose metabolism resulting from a defect in one of the enzymes required to convert galactose to glucose. The most common defect is in the galactose-1-phosphate uridyltrans-ferase GALT enzyme. Symptoms of vomiting, diarrhea, failure to thrive, jaundice, hepatomegaly, cataracts, and Escherichia col i sepsis are usually seen within the first 2 weeks of life. Galactosemia is treated by restricting dietary galactose. Because lactose is hydrolyzed into...
Down Syndrome
Down syndrome is the most common chromosomal anomaly associated with mental retardation.7 The chromosomal anomaly involves an extra chromosome 21 trisomy 21 . The incidence is reported to be I case per 800 to 1000 live births, with increasing incidence with increased maternal age.K Approximately 40f of children with Down syndrome are born with congenital heart defects, and 15 are born with gastrointestinal malformations.8 Children with Down syndrome are also at risk for other medical...
1. Trier Js. Celiac Sprue. N Eng J Med 1991
IM intramuscular USRDA United States Recommended Dietary Allowance. IM intramuscular USRDA United States Recommended Dietary Allowance. should he made oil an individual basis, however. Minor Food sensitivities and intolerances may occur during a flare but generally do not persist and are not sufficiently important to warrant elimination from the child's diet.-0 Nutritional support and monitoring are essential in the pediatric patient with IBD to minimize malnutrition and growth failure. The use...
Scad
Very long chain acyl-CoA dehydrogenase long chain hydroxyacyl-CoA dehydrogenase Hypoketotic hypoglycemia, hyperammonemia Short chain acyl-CoA dehydrogenase short chain hydroxyacyl-CoA dehydrogenase Ketotic hypoglycemia, hyperammonemia, metabolic acidosis Cardiomyopathy, failure to thrive, hypotonia, hepatomegaly, lethargy, coma Metabolic decompensation with fasting lethargy, vomiting, coma , hepatomegaly Poor feeding, vomiting, failure to thrive developmental delay Fasting avoidance None long...
Info Ceh
For ordering information Astra 1-800-225-4803 Baxter Clintec 1888-229-0001 American Pharmaceutical Partners, Inc. APP 1800-386-1300 For ordering information Astra 1-800-225-4803 Baxter Clintec 1888-229-0001 American Pharmaceutical Partners, Inc. APP 1800-386-1300 Nonetheless, judicious use of iron dextran is warranted in those patients with iron deficiency as noted by biochemical assessment of iron status and for whom the enteral route is contraindicated. The total amount of iron Fe Table...
WaterSoluble Vitamins Ascorbic Acid C
Forms collagen Joint tenderness, cross-linkage of scurvy capillary proline hydroxylase, hemorrhaging , thus strengthening impaired wound tissue and improving healing, acute wound healing and periodontal resistance to infection gingivitis, petechiae, aids absorption of iron purpura, anemia Biotin Component of several Anorexia, nausea, carboxylating enzymes vomiting glossitis plays an important role depression dry, in the metabolism of scaly, dermatitis fat and carbohydrate thin hair...
Nutritious Snacks
Filling and satisfying snacks should include all three macronutrients carbohydrates, protein, and fat. Carbohydrates provide bulk and some energy value, while proteins and fat provide satiety value. Snacks are important for children as they tide them over from one meal to the next, help- Table 8-1. Nutritious Choices within Food Groups Hard-cooked egg Breads and Cereals Whole-grain breads Whole-grain cereals Whole-grain, low-fat crackers Tortillas corn or flour English muffin Rice cakes or...
Cystic Fibrosis
Cystic fibrosis CP is an autosomal recessively inherited genetic disorder. It is caused by mutations in the gene that encodes for the CF transmembrane conductance regulator protein CI'TR . The CFTR protein is responsible for chloride ion exchange a defect in this protein results in the production of abnormally thick mucus throughout the body. This mucus can clog tubules and airways eg, bronchioles and pancreatic ducts as well as function as a medium for bacierial growth. Major clinical...
Nutritional Assessment
Malnutrition is a common clinical manifestation in CF. with about 20c r of children in the 1998 national CF patient registry below the fifth percentile for height or weight for age.2 Several factors are involved in the development of malnutrition in the patient with CF Table 21-1 . Improved nutritional status may slow the progression of pulmonary disease and improve long-term survival.'4 The nutritional assessment of the patient with CF involves a thorough review of medical history, nutrient...
Info Xnx
Organic acidemia OA-1 Mead J OA-2 Mead J Carbohydrate restriction Protein restriction 052 Milupa Propimex 1 Ross Propimex 2 Ross XMTVI Analog SHS XMTVI Maxamaid SHS XMTVI Maxamum SHS Cyclinex 1 Ross Cyclinex 2 Ross UCD-1 Mead J UCD-2 Mead J UCD1 Milupa UCD2 Milupa PFD-1 Mead J PFD-2 Mead J ProPhree Ross
Metabolic Complications of Short Bowel Syndrome
In patients with steatorrhea, long chain fatty acids LCFA combine with magnesium and calcium, contributing to a deficiency of these minerals. Calcium becomes unavailable for the formation of calcium oxalate, and bile salts in the colon are thought to increase mucosal permeability to oxalate. These two factors combine to increase enteric oxalate absorption, which in turn increases the risk of oxalate renal stones.5 There is an increased incidence of gallstones among patients with a jejunostomy...
Info Kwo
PN parenteral nutrition CVC central venous catheter IL Intralipid CA calcium P phosphorus N normal solution . PN parenteral nutrition CVC central venous catheter IL Intralipid CA calcium P phosphorus N normal solution . weaned from PN include age, tolerance to PO advancement, length of time NPO, psychologic factors, and previous medical interventions eg, prolonged intubation or nasogastric tube placement . For example, a well-nourished, school-aged child who is taking at least 50 percent of...
Info Lvv
Adapted from Jensen D.Wallace S. Kelsay P. LATCH a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs 1994 23 27-32 Adapted from Jensen D.Wallace S. Kelsay P. LATCH a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs 1994 23 27-32 Why express breastmilk Separation ot mother and infant due to maternal or infant illness, prematurity, return to work Infant unable to feed by mouth eg, neurologic problems, ventilator dependency,...
Info Mzd
Solution recommended by the World Health Organization Fructo-oligosaccharides and dextrose are carbohydrate source Whole cooked rice is carbohydrate source Rice-syrup solids are carbohydrate source Marketed under several different generic titles 'CeraLyte is also available in CeraLyte 50 and CeraLyte 90. Chapter 26 Gastrointestinal Disease 403 Table 26-10. Oral Therapy for Acute Diarrhea7 Degree of Replacement of Ongoing Dehydration Rehydration Therapy Stool and Vomit Losses Diet 60-80 mLVkg of...
Males
Figure 4. Head circumference of males wilh Down syndrome 0 to 36 months . Figure 4. Head circumference of males wilh Down syndrome 0 to 36 months . Figure 5. Physical growth of males with Down syndrome 1 to 36 months . Figure 5. Physical growth of males with Down syndrome 1 to 36 months . Figure 6. Physical growth ot males with Down syndrome 2 to 18 years . Figure 6. Physical growth ot males with Down syndrome 2 to 18 years .
Metabolism
The body's response to trauma was first described by Cuthbertson as consisting of two phases, an initial ebb phase and a subsequent flow phase The ebb phase is associated with a decrease in metabolic rate and is equivalent in modern terminology to shock. The duration of the ebb phase reflects the magnitude of the injury and the time needed to restore circulating volume. The flow phase, which was further subdivided by Moore into two components. refers to the period of hypermetabolism catabo-lism...
Nancy S Spinozzi RD 1
Chronic renal failure CRF occurs when renal function has deteriorated so that glomerular filtration rate GFR is reduced and progression to endstage renal disease ESRD is inevitable. Endstage renal disease usually denotes the point at which conservative management of the patient is no longer effective and renal replacement strategies dialysis and transplantation are necessary. The major cause of ESRD in children is chronic glomerulonephritis primarily in older patients, 15 to 19 years of age...
Sample Diet Calculation Traditional CreamBased Diet
April is a 6-year-old girl. She weighs 21 kg SO to 75 percentile weight for age and is 1 10 em tall 10 to 25 percentile height for age . Her weight for height is 90 to 95 percentile. She is on the following medications Tegretol 700 mg day and Celontin 600 mg day. 1. Energy needs. Caloric needs for patients on the ketogenic diet are lower than the Recommended Daily Allowance RDA . Table 30-4 . If the child is overweight, energy needs are based on ideal weight for height. For example April is...
Nutrition Assessment
Nutrition assessment and therapy in premature infants must begin immediately afterbirth. Initial nutritional assessment includes accurate determination of gestational age and degree of prematurity as well as accurate measurement of birth weight, length, and head circumference Table 34-3 . Although a variety of intrauterine and postnatal growth curves are available,1 no single reference set has been used exclusively. Most widely used are the growth curves of Lubehenco Figure 34-1 and Babson...
Breastfeeding Promotion
The World Health Organization WHO and United Nations International Children's Emergency Fund UNICEF published a joint statement in 1989 entitled Protecting, Promoting and Supporting Breastfeeding The Special Role oj Maternity Services, with a view to increasing global awareness of the impact of health care services Table 6-3. LATCH Assessment Guidelines for Lactation Systematic assessment of the breastfeeding dyad Identifies areas requiring intervention and or education Serves as a...
Info Tvx
Reproduced with permission Irom Davis A, Baker S. The use of modular nutrients in pediatrics. JPEN 1996 20 228-36. Reproduced with permission Irom Davis A, Baker S. The use of modular nutrients in pediatrics. JPEN 1996 20 228-36. Table 16-15. Potential Renal Solute Load of Infant Table 16-15. Potential Renal Solute Load of Infant
Info Oaw
931 mL 18 5 h 50 mL h plus ramp up - 25 mL'ti 30 mm -plus ramp off 25 mUh x 30 min 12 mLVh 30 min Total 931 12 5 12 5 6 962 mL For 16h infusion 960 mL x 0.95' 912 mL 912 mL 13.5 h 68 mL'h plus ramp up 34 mL h x 30 min -plus ramp Dff 34 ml h x 30 min 17 mL'h x 30 min Figure 17-3. Cycling parenteral nutrition. Table 17-17. Suggested Monitoring Schedule for Inpatients Receiving Parenteral Nutrition Parameter Daily Weekly' Periodically' More often as necessitated by clinical course. CO2 bicarbonate...
Gastrointestinal Diseases
Gastroesophageal reflux GER is the effortless movement of gastrie contents into the esophagus. While GER is considered a normal physiologic process rather than a disease. it can produce clinical symptoms ranging from mild heartburn to esophagitis. respiratory disease, and even apnea. Gastroesophageal retlux disease GERDl refers to these symptoms. Pediatric patients with GERD may present with chest pain, dyspepsia, vomiting, burping, dysphagia. postprandial fullness, chronic hoarseness and...
Kathleen M Gura PharmD BCNSP
Possible Gastrointestinal Side Effects Anticoagulants Coumarins Vitamin K antagonist Coumadin warfarin with vitamin K may decrease anticoagulant effects high doses of vitamins A, E, or C may alter prothrombin time fried or boiled onions may T drug effect by T fibrinolytic activity Antihistamine drugs Cyproheptadine Appetite stimulant Periactin increased weight Anti-infective drugs Antibiotics General Decreased synthesis of vitamin K by gut microflora some are folate and B12 antagonists...
Food Allergies
Food allergy can be defined as an immunologie reaction resulting from the ingestion of a food or a food additive as opposed to the more general term food intolerance, which includes any abnormal response to a food or food additive.1 It has been estimated that 6 to of all children are affected by food allergies.Allergies may occur after a small amount of the allergen is ingested and are unrelated to any physiologic effect of the food, food additive, or cross-contaminant.2 The most common...
Table 345 continued
Infants receiving breastmilk with HMF or premature formula do not usually require multivitamin supplementation Preterm infants receiving breastmilk exclusively, recommend multivitamin supplementation Recommended dose 6-12 lU kg d May require supplementation if receiving elemental iron greater than 4 mg kg d, to decrease risk of hemolytic anemia Preterm infants are born with low stores and are subject to many blood draws Recommend initiating iron supplement at 4-6 weeks of age Infant should be...
Special Aspects of Nutritional Management
As evidenced by the frequent finding of growth failure, children with cardiac disease require additional calories beyond the Recommended Dietary Allowance RDA to establish growth. Energy needs vary throughout this population. For children having corrective surgeries, increased energy needs are usually present only before surgery whereas those undergoing palliative surgeries will have prolonged increased requirements. Energy needs may be roughly estimated by adding the RDA for age to 30 to 60...
Info Ygc
The ratio of protein to nonprotein calories prov ided in PN is also a useful measure of macronutrient balance. When expressed as the ratio of nonprotein energy kcal to nitrogen g , metabolism is generally optimal when this ratio is between 150 1 and 250 1. Burn patients and others with very high protein requirements may be optimally fed with a ratio of 100 1. The ratio is calculated as follows Carbohydrate calories fat calories protein intake g f gt .25 Intravenous lipids are necessary for the...
References Tvb
I. Gillette PC. The cardiovascular system. In Behrman RK. Kliegaman RM. editors. Nelson essentials of pediatries. 2nd ed. Philadelphia W.B Saunders Company 1994 2 Forehielli Ml MeColl R. Walker WA. I.oCL. Children with congenital heart disease a nutrition challenge. Nutr Rev 1994 52 I 34K-5.V 3. Gaedcke Norris MK. Hill CS. Nutritional issues in infants and children with congenital heart disease. Cril Care Nursing Clin North Am I994 6 l l53-63. 4. Schwarz SM. Gewitz MH. See CC. et al. Enteral...
Nutrition Risk Factors in Congenital Heart Disease
The most profound nutrition issue in patients with CHD is growth failure. Malnutrition among these patients is thought to be multifactorial common etiologies are outlined in Table 20-2.2 5 Table 20-1. Common Congenital Heart Disease Lesions Ventricular septal defect VSD Patent ductus arteriosus PDA Common A-V canal CAVC Pulmonary stenosis arteries TGA Tetralogy of Fallot TOF Tricuspid atresia Truncus arteriosis Total anomalous pulmonary vein return TAPVR Pulmonary atresia Ebstein's anomaly...
Ann Munier MS RD and Frances Rohr MS RD
Inborn errors of metabolism are inherited disorders caused by a defect in enzymes required to metabolize protein, carbohydrate. or fat. The inheritance of most metabolic disorders is autosomal recessive and the incidence uncommon. Many of the disorders result in severe clinical manifestations that often appear soon after birth. Rapid diagnosis and treatment are essential to prevent neurologic damage, mental retardation, and possible death. Because these disorders are rare and require careful...
Servings
Figure 9-1. The Food Guide Pyramid from US Department of Agriculture, vide guidelines for parents and educators on how to use the pyramid to educate the young child about food and eating healthy. Shown below is a table from the booklet Table 9-11 that shows how to use the pyramid to plan a healthy day of meals and snacks. The booklet is available to the public and can be obtained by downloading it from the USDA's home page at URL http www.usda.gov cnpp index.htm or by calling the Government...
Info Fmc
Before adding to the diet, verify with manufacturers that ingredients do not include gluten. Reproduced with permission from Gluten Intolerance Group. 15110 10th Ave. SW, Ste. A, Seattle WA 98166 1987 content in the diet Table 26-8 . it is important to provide adequate fluids to ensure the liber's effectiveness. Not all fiber is equivalent in modifying stool si e and consistency. Wheat bran is Ihe most effective in increasing weight of the stool, followed by fruits, vegetables, oats, corn....
Sweeteners
Historically, sucrose has beert restricted in the diets of people with diabetes, based on the belief that sucrose is more rapidly digested and absorbed than starches. Research comparing the glycemic effect of high-sucrose and low-sucrose meals, however, has shown a consistently similar blood glucose effect for the two test meals. It is the total amount of carbohydrate eaten, rather than the tvpe of carbohydrate, that has the greatest effect on blood glucose control. It is now accepted that...
Introduction Of Solids
Progression of the infant diet from breustniilk or formula to solid foods is dependent on multiple factors, including the development of oral motor skills. Table 7-1 outlines the normal development of sucking, swallowing, biting, and chewing skills and how they impact on the infant's ability to consume liquids and solids. Texture, consistency, type, and amount of food should complement the infant's feeding skills and development of the gastrointestinal tract. The infant feeding guide Table 7-2...
Cycling Parenteral Nutrition Infusions
The provision of one day's worth of PN over fewer than 24 hours has been termed cycling. Advantages of cycling include allowing the patient to be disconnected from intravenous tubing and pumps, avoiding chronic hyperinsulinemia. and perhaps an improved visceral protein status.1 Cyclic PN may also help reduce the chances of developing PN-associated liver disease. The suitable candidate for cycling PN are those patients for whom long-term gt 1 month of PN is anticipated and whose endocrine,...
Lori J Bechard M Ed RD CNSD
C'anccr in children comprises a group of diseases ol abnormal cell growth. The most common type of pediatric cancer is acute lymphocytic leukemia AI.L .1 accounting for 2.V of cancer in children under 15 years of age. followed by central nervous system tumors, which account for 21 'A of pediatric cancers. Due to advances in medical treatment, approximately 65 of children with cancer will survive disease-free for more than 5 years. Treatment for refractory or high-risk cancers may include bone...
Table 354 Specific Nutritional Products for Renal Patients
Ross Products Ross Products Nestle Clinical Nutrition Infant formula reduced in electrolytes and PO4 Tube feeding which contains no electrolytes Hndstage renal disease patients should begin with a parenteral solution without added K . Mg . and PO4 titrated according to serum levels. Because of intake of PO4 and other cations, malnourished renal patients should be closely monitored for the refeeding syndrome see Chapter 17 . Since micronutrients eg, vitamin A, selenium are excreted primarily...
Linda Gallagher Olsen MEd RD Major Manufacturers of Enteral Nutrition Products
Applied Nutrition 273 Franklin Road Randolph. NJ 07869 1-800-605-0410 www.medicallood.com Mead Johnson Nutritionals 2400 West Floyd Expressway Evansvillc. IN 47721 1-800-457-3550 www.meadjohnson.com Nestle Clinical Nutrition Three Parkway North Suite 500. P.O. Box 760 Deerfield. IL 60015-0760 1-800-422-2752 Novartis Nutrition Corporation 5320 West 23rd Street Minneapolis. MN 55416 1-800-999-9978 www.novartis.com Ross Laboratories 625 Cleveland Ave. Columbus. OH 43215 1 -800-544-7495...
References Eno
1. Pollack fi. Pediatric abdominal surgical emergencies. Pediatr Ann 1 96 25 448-57. 2. Herndon D, Rutan R. Rutan T. Management of the pediatric patient with burns. J Burn Care Rehabil 1993 14 3-8. .V Cunningham J. Body composition and nutrition support in pediatries what to defend and how soon to begin. Nutr Clin Praet 1995 10 177-82. 4. Sehears Ci. Deutschman C. Common nutritional issues in pediatric and adult critical care medicine. Crit Care Clin 1997 13 669-90. 5. Deutschman C. Nutrition...
Presence or Absence of the Ileocecal Valve
The ileocecal valve ICV serves to regulate the flow of enteric contents from the small bowel into the colon. The absence of an ICV shortens gastrointestinal transit and increases fluid and nutrient losses. In addition, colonic bacteria may contaminate the small intestine, causing an inflammatory response that damages small bowel mucosa, resulting in an exacerbation of the malabsorptive state 1 Bile salts and Bi may be deconjugated by the bacteria, further contributing to fat and vitamin Bi...
Age In Years Yzm
Figure 12. Standardized head circumference curves 95th, 50th, and 5th percentiles for 29 Prader-Willi syndrome females compared to normal controls. TURNER GIRLS 2 TO 19 YEARS PHYSICAL GROWTH Figure 13. Turner girls 2 to 19 years physical growth. Normal girls top three lines percentiles derived from National Center for Health Statistics. Untreated Turner patients growth rates derived from Lyon AJ, Preece MA, Grant DB. Growth curve for girls with Turner syndrome. Arch Dis Child 1985 60 932-5....
Autism
Autism is a developmental disorder characterized by a severe impairment of language, cognitive skills, and social development.10 Ritualistic and obsessive compulsive behavior is frequently seen.1 Approximately 70r r of children with autism have some level of mental retardation.11 The etiology of autism is unclear but the disorder is believ ed to have a neurobiology- basis with multiple possible causes, including structural abnormalities of the brain, viruses, genetic disorders. chromosomal...
Nutrition Therapy Goals for Type 2 Diabetes
The management goal is to achieve and maintain optimal blood glucose and lipid control by making nutrition and lifestyle changes. Recommendations are to space meals and snacks throughout the day. make healthy food choices. moderate total fat, saturated fat. and calorie intake, and increase physical activity. Insulin sensitivity improves with even a modest amount of weight loss. It is recommended that a moderate calorie restriction. 250 to 500 calories less than average daily intake, be...
Ketogenic Diet Therapy
Although several factors are considered necessary for its efficacy, the diet's exact mechanism of action has not yet been determined. It is known that a high level of ketosis must be reached. Traditionally, ketosis has been monitored by measuring urinary acetoaeetate. Measurement of blood ketones eg, p-hydroxybutyrate may give a more accurate picture of ketosis level although this is not feasible for routine outpatient care. Strict adherence to the diet is essential since only a small variation...
Special Considerations
No concentrated sweets diets are not recommended as a meal planning option due to the similar effect of all carbohydrate-containing foods on blood glucose level. Infection, illness, and surgery all make glucose control difficult due to multiple factors, including increased counter-regulatory hormones, anorexia, and altered meals and snacks. In general, sick children should be given their usual insulin dose. Insulin should never be skipped, and extra insulin is often required. Blood glucose...
Weaning from Parenteral Nutrition
The transition from PN to oral intake PO can be highly variable. Factors affecting how quickly a patient can be Table 17-20. Nursing Care in Parenteral Nutrition Administration 1. Change PN administration sets every 96 hours every 24 hours if lipid is used , using strict aseptic technique. Solution is to be changed every 24 hours. a All connections in the PN system must be luer-locked or secured with adhesive tape. b Prep every connector and entry site with alcohol. c Stopcocks are not to be...
Nutritional Assessment In Sick Or Hospitalized Children
Hospitalized children who are acutely and or chronically ill are at increased risk for malnutrition Table 15-1 ,' and malnourished hospitalized patients suffer disproportionately from both infectious and noninfectious complications.2 Nutritional assessment prov ides the foundation for rational and effective nutritional support see Chapter 1 , but, unfortunately, this process is especially difficult in hospitalized patients. Table 15-2 lists standard methods of nutritional assessment and...
Info Ges
Meticulous CVC care treat bacterial Gl gastrointestinal CVC control venous catheter. Gl gastrointestinal CVC control venous catheter. iiiiiit and tend to he high in sodium content. Parenteral solutions with at least 80 to 100 niEq L of sodium are often required to maintain sodium balance. Meticulous attention needs to be paid to the fluid and electrolyte status of SBS patients. This includes daily weights, careful measurement of urine, stool, and ostomy losses, and laboratory monitoring of...