Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
or associated with uncontrollable vomiting, shock, or severe lethargy. The contents
of the intravenous solution and the rate of administration are calculated based on
percentage dehydration, rate of ongoing losses, and serum electrolyte values.
Chronic Diarrhea
Diarrhea is considered to be chronic if one episode lasts longer than three weeks or if
there are multiple episodes with only a few weeks or months between.
Causes
Some of the same factors that cause acute diarrhea may also result in chronic
diarrhea. In addition, there are other etiologies of chronic diarrhea. Some of the
more common ones include:
• Carbohydrate intolerance (e.g., lactose, fructose)
• Other food/formula intolerances, improper formula preparation, tube-feeding
complications
• Chronic nonspecific diarrhea (This is a term used for diarrhea of at least 3 weeks
duration, greater than 3 loose stools per day, no evidence of malabsorption or
enteric infection.)
• Cystic fibrosis (see Chapter 17)
• Celiac disease (Glutensensitive enteropathy)
• Short bowel syndrome (see Chapter 20)
• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
• HIV/AIDS and other immune deficiencies
• Constipation/obstipation with encopresis
• Pseudomembranous colitis (Most often related to antibiotic use)
• Micronutrient deficiency (e.g., zinc deficiency can be both a cause and a
complication of chronic diarrhea (8)
Nutritional Complications
Compromise of nutritional status is much more likely to occur with chronic diarrhea
than with acute diarrhea. Malnutrition can result both from chronic loss of nutrients
and fluid through the gastrointestinal tract and from overzealous attempts at dietary
eliminations to determine the cause of chronic diarrhea (8). In turn, this malnutrition
can lead to additional diarrhea secondary to alteration of mucosal absorptive ability
and decreased enzyme activity (8). Children who have chronic diarrhea may have
decreased appetites and therefore decreased intakes of nutrients.
Nutrition Interventions for Children With Special Health Care Needs 85