Nutrition Interventions for Children with Special Health Care Needs

Chapter 18
Section 3 - Condition-Specific Nutrition Interventions
Nutrition Interventions for Congenital
heart Disease
M. Annie Goodwin, RD, CD, and Nancy James, RD, CSP, CD
Updated by Nancy James, RD, CSP, CD and Laili Abd Latif, MS, RD, CD
Congenital heart disease (CHD) refers to cardiovascular defects that are present
and usually evident at birth. Most commonly, these defects include ventricular or
atrioventricular septal defects, Transposition of the Great Arteries, Tetralogy of Fallot,
Coarctation of the Aorta or a single ventricle. With improved detection, diagnosis,
medical management, and surgical techniques, the number of children surviving with
congenital heart disease is increasing (1). Presently, surgical repair in this population
is often delayed in order to permit increased weight gain (2). Surgery is performed
when a patient reaches an ideal weight and age, or when failure to thrive precludes
further waiting (2). See Table 18-1 for a list of congenital cardiac anomalies.
Children with CHD often demonstrate slow growth, which becomes apparent early in
life. Depending on cardiac status, many factors may cause poor growth:
• Chronic deficit of oxygen in cyanotic patients
• Decreased food intake due to poor appetite, fatigue, or oral aversions
• Decreased gastrointestinal absorption
• Increased energy needs due to increased cardiac workload
• Increased susceptibility to infection with frequent illnesses
• Decreased gastric/intestinal motility and associated reflux disease.
• Increased resting metabolic rate
• Poor cardiac output resulting in decreased splanchnic blood flow which may lead
to early satiety, nausea and vomiting
Congestive heart failure (CHF) may be a result of CHD due to the heart having to
work harder than usual. CHF is a serious condition in which the overworked heart
becomes strained and does not pump blood efficiently. As the heart works harder, the
metabolic rate rises, and energy requirements increase. Further contributing to the
increased energy requirement is a decrease in the rate of gastrointestinal absorption
resulting from reduced cardiac output (3,4,5).
In CHF, the heart’s inefficient pumping causes fluid to back up into the lungs, the
liver, and other organs. Therefore, children with CHF often require fluid restriction
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