References

In United States Renal Data System. USRDS 1997 Annual Data Report. Bethesda (MD) National Institutes of Health. National Institutes of Diabetes and Digestive and Kidney Diseases 1997. p. I 13-28. 2. Spinoz i NS. Nelson P. Nutrition support in the newborn intensive care unit. J Ren Nutr 1996 6 188-97. 3. Brewer ED. Supplemental enteral tube feeding in infants undergoing dialysis indications and outcome. Semin Dial 1994 7 429-34. 4. Salusky IB. Goodman WG. The...

Teeth And Gum Care

Nutrition plays a vital role in oral health. It not only affects the integrity of oral-cavity development and maintenance but also provides protection from dental plaque and bacteria. The formation of healthy teeth, beginning at about 4 months in utero and continuing until 15 to 16 years of age, requires an adequate dietary intake of calcium, phosphorus, and vitamin D, as per the Recommended Dietary Allowance (RDA). Fluoride plays a key role in ensuring strong enamel composition as well as...

Treatment

The goal of treatment for obesity is weight reduction and maintenance of a lower body weight to minimize health risks and improve quality of life. Treatment should be multidisciplinary and include counseling on diet, exercise, and behavior modification. Nutrition education should focus on healthy food choices and include adequate protein, fat (< 30r r of total kilocalories. with an emphasis on monounsaturated fatty acids), and enough carbohydrates for energy and to spare protein for growth...

Info

HE reticuloendothelial FFA free fatty acids BMR basal metabolic rate USRDA United States Recommended Dietary Allowance. HE reticuloendothelial FFA free fatty acids BMR basal metabolic rate USRDA United States Recommended Dietary Allowance. that 3 to 5f r of energy intake be fat. Lipids commonly account for up to 4(Wc of total calories in parenteral nutrition. Above a minimal carbohydrate load, lipids supplied as the primary energy source are at least as. if not more, nitrogen-sparing than...

Sports Nutrition

The number of American children and adolescents participating in organized sports is on the rise, with roughly half (49.5 ) participating in organized sport teams nationwide.1 Young athletes arc bombarded with mixed messages from the media, coaches, and even professional athletes. These messages often focus on fads and false claims concerning nutrition, and unrealistic body images. Sports nutrition begins with a base of sound nutrition. Eating well includes a balanced diet, which provides...

Additional Resources Books

The epilepsy diet treatment an introduction to the ketogenic diet. New York Demos Vermande Publication 1996. Brake D. Brake C. The ketogenic cookbook. Oilman (CT) Pennycorner Press 1997. The ketogenic diet computer program Available from the Epilepsy Asociation of Maryland 300 East Joppa Road. Suite 1103. Towson (MD) 1-410-828-7700 Introduction to the ketogenic diet a treatment for pediatric epilepsy The Charlie Foundation. 501 10th Street. Santa Monica. CA 90402...

Adjusted Body Weight

Among individuals of normal weight, basal metabolic rate can be calculated from standard equations or tables, using body weight, height, age. and gender. When applied to obese individuals, however, these equations are invalid since they assume a relatively fixed ratio of lean body mass (eg. metubolically active mass) to fat mass. Since this ratio is significantly altered in those individuals 125'i heavier than ideal body weight, an adjusted body weight is preferred for calculating their basal...

Age

Factorial estimates of energy requirements. SDA specific dynamic action or thermic effect of food BMR basal metabolic rate. Adapted from Tsang RC, Nichols BL, editors. Nutrition during infancy. C.V. Mosby Co. 1988. p. 6. Chapter 15 Assessment in Sick or Hospitalized Children 181 Indirect calorimetry can also help determine whether a patient is being overfed. The ratio of VCO2 to VO is termed the respiratory quotient (RQ) and is used to estimate substrate oxidation. For example, in...

Of Agricultures Food Guide Pyramid

The US Department of Agriculture (USDA) developed the Food Guide Pyramid (Figure 9-1) and released it in 1992 with the view that most Americans have diets that are too high in fat. In addition to the pyramid, the Dietary Guidelines for Americans include the following Balance the food you eat with physical activity. Maintain or improve your weight. Choose a diet low in fat. saturated fat. and cholesterol. Choose a diet moderate in sugars. Choose a diet moderate in salt and sodium. If you drink...

Ger

Neurologic damage Clogging of tube Improper or infrequent irrigation of tube Administration of medications via feeding tube Formula too viscous for diameter of feeding tube Improper size or placement of tube Nasopharyngeal discomfort, nasal or esophageal erosions. Pressure on the nares or esophagus. Infuse formula past pylorus Consider continuous infusion Elevate head of bed 30 to 45 degrees Flush tubing with water every 8 hours and after all medicines Crush medications well or use liquid form....

Dietary Reference Intakes Linda Gallagher Olsen MEd RD

Dietary reference intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to provide quantitative estimates of nutrient intakes for use in a variety of settings. The DRIs are the result of a vast expansion in our understanding of the roles of nutrients and other food components that impact long-term health, going beyond deficiency states they expand and replace the series of Recommended Dietary Allowances that have been published since 1941 by the Food and Nutrition...

Glycogen Storage Disease

Glycogen storage diseases GSD are disorders in which glycogen cannot be metabolized to glucose because of an abnormality in the enzymes involved in glycogenolysis. The major sites of glycogen deposition are liver and muscle tissue. Clinical manifestations include hypoglycemia, hepatomegaly, poor growth, muscle weakness, cramping, and fatigue. The most common types of GSD that respond to nutritional therapy are GSD type I and GSD type III. The goal of dietary treatment is to prevent...

Table 11 An Approach to the Identification of Nutritional Problems

If problems are indicated, additional midlevel or in-depth parameters should be evaluated Midlevel, add As indicated by routine screening or in populations at risk for chronic nutrition problems and children with special health care needs In-depth, add As indicated in acute and chronic PCM and to monitor chronically ill patients Typical dietary pattern food pyramid food frequency , vitamin and mineral supplement, family eating habits, subsidy support 24-hour...

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...

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...

Nancy S Spinozzi RD

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 Cream Based Diet

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...

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...

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...

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

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...

Is Dextromaltose Gluten Free

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...

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...

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...

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...

Jill Kostka Fulhan MPH RD

It is now widely recognized that breastmilk is the optimal choice of feeding for both full-term and premature newborn infants. The nutritional, immunologic, physiologic. health, psychologic, and socioeconomic benefits to baby and mother are many Table 6-1 . prompting a recent increase in the number of mothers initiating breastfeeding postpartum. Despite an increase to nearly 60 7 lt of mothers breastfeeding their newborns in 1995. however, only 21.6r continued to breastfeed infants aged 5 to 6...

Urea Cycle Disorders

Urea cycle disorders result from a defect in one of the enzymes involved in the conversion of ammonia to urea in the liver. Hyperammonemia is common to all the disorders. The en .yme defects include l carbamyl phosphate sy nthetase CPS deficiency. 2 ornithine transcarbamylase OTC deficiency. 3 citrullinemia argininosuccinic acid synthetase deficiency . 4 argininosuccinic aciduria argininosuccinic acid lyase deficiency , and 5 arginine-mia arginase deficiency . Infants present with...

Cerebral Palsy And Developmental Disabilities

Developmental disabilities DD is a term used to describe a collection of disorders that cause an impairment in normal development and body function.' There are a wide range of disabilities, with varying degrees of impact on growth and nutritional status. It is estimated that the incidence of developmental disability in the pediatric population is approximately 37r. Approximately 90 of children with developmental disabilities have nutritional concerns.- Some of these are outlined in Table 22-1....

Roseann Cutroni MS RD

Hyperlipidemia enhances lipid accumulation on arterial w alls and is one of several risk factors associated with cardiovascular disease CVD . Other risk factors include hypertension, cigarette smoking, family history, obesity, diabetes, and a sedentary lifestyle. Although detection and treatment efforts have decreased the mortality of CVD, it continues to be the leading cause of death in the United States. Fifty-eight million Americans have some form of cardiovascular disease the United States...

Special Aspects of Nutritional Assessment in Down Syndrome

The patient's medical and feeding history should be obtained to identify issues which may have an impact on growth and feeding Tables 22-7. 22-8. and 22-9 . Down syndrome growth charts should be used to plot growth see Appendix E . Weight for length height should Table 22-7. Medical Diagnoses Associated with Down Syndrome Intestinal malformations eg, duodenal atresia. Hirschsprung's disease Increased incidence of infections ear. respiratory Endocrine diabetes, hypothyroidism Orthopedic...

Susan E Frates MS RD and Heidi Schauster MS RD

Eating disorders are characterized by a disturbed relationship between nutritional intake and body image, often leading to subsequent medical problems. While eating disorders are found predominantly in the adolescent and young adult populations, they are increasingly being recognized in children and preadolescents. Eating disorders are the third most common chronic illness in adolescents following obesity and asthma.1 Anorexia nervosa is estimated to occur in lt 3 of adolescent women and...

Food Assistance And Nutrition Education Programs

Knowledge of age-appropriate feeding practices and good nutrition concepts cannot be implemented unless a caregiver has access to food or to financial resources to buy food. A number or programs have been created over the years to assist families in obtaining foods, many developed by the US Department of Agriculture USDA . Table 14-1 describes USDA-directed programs for children. In addition, many state and local agencies, neighborhood health centers, and local schools and universities offer...

Table 1 List of Some Special Growth Charts

Growth Chart Turner Syndrome

J Pediatr 1978 93 435. Stature, growth velocity, head circumference, upper and lower segments Kline AD, et al. Am J Med Gent 1993 47 1042. Length- and weight-for-age birth to 36 months, height- and weight-for-age 2 to 18 years, and head circumference-for-age birth to 18 years Krick J, et al. J Am Diet Assoc 1996 96 680 Stature and weight-for-age and weight-for-stature age birth to 10 years Cronk CE, et al. Pediatrics 1978 61 564 and Pediatrics 1988 81 102. Length-for-age and...

Healthy Eating for Children

Children require adequate amounts of a balanced variety of foods. These include fruits, vegetables, whole and enriched grains and cereals, milk and other dairy products, and meat, fish, poultry, and other protein products.' Fruits and vegetables are the primary sources of vitamins A and C and contain other nutrients such as B vitamins, trace minerals, and fiber.' Breads and cereals are excellent sources of B vitamins and. if enriched, iron. Whole-grain breads and cereals are also good sources...

Kristy M Hendricks Rd Ms ScD

Nutritional assessment is the tool by which the nutritionist evaluates the patient for maintenance of normal growth and health, risk factors contributing to disease, and early detection and treatment of nutritional deficiencies and excesses. Comparison of an individual with an established norm provides a basis for objective recommendations and evaluation of nutrition therapy.12 Although much information has been published on the use on increasingly sophisticated techniques, clinical judgment...

So 55 60 65 70 75 80 85 90 95 100 105 110 Length In Cm

Female Height Weight Curve

Top. head circumference by age percentiles for boys birth to 36 months . Bottom, weight by length percentiles for boys birth to 36 months . BM1 correlates well with adiposity in adults and because of its relativ e ease and accuracy of basic measures, is recommended for use in screening for obesity in adults. In the pediatric population use of BMI is still being evaluated. It is recommended that percentiles be used rather than an absolute number because this value changes throughout...