Nutrition Interventions for Children with Special Health Care Needs

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Chapter 19 - Nutrition Interventions for Chronic Renal Failure Normal growth and development depends on many factors, the main one being adequate nutrition support. Nutrition management of children with CKD involves meeting nutrient needs while avoiding excesses of substances that accumulate because of renal insufficiency. A child with CKD needs to receive adequate energy for weight gain and at least the DRI for protein. Protein restriction below the Dietary Reference Intake (DRI) has not been found to be beneficial for children with CKD (7). Sodium may be restricted if hypertension is a problem. Sodium, potassium, and phosphorus are restricted if blood levels are high and increased if levels are low. There is not one specific diet that meets the needs of all children with CKD. CKD is staged by a combination of age, height, and creatinine level. The glomerular filtration rate (GFR) is estimated by the Schwartz formula for children 2 years of age and older. Confirm CKD stage with nephrologist(8). GFR (ml/min/1.73m²) = (0.413 x height (cm)/creatinine (mg/dL)) Table 19-1 Stages of Chronic Kidney Disease Stage Description Glomerular Filtration Rate (Gfr) At increased risk >90 with CKD risk factors 1 Kidney damage with normal or increased GFR Action Screening. CKD risk reduction >90 Diagnose & treat. Treat comorbid conditions. Slow progression. Cardiovascular disease risk reduction 2 Mild decrease in GFR 60-89 Estimate progression 3 Moderate decrease in GFR 30-59 Evaluate and treat complications 4 Severe decrease in GFR 15-29 Preparation for kidney replacement therapy 5 Kidney failure
Section 3 - Condition-Specific Nutrition Interventions Even with adequate nutrition, a child with CKD will not grow unless metabolic acidosis is corrected and bone disease is treated. Metabolic acidosis (diagnosed by a low serum bicarbonate level) is a major factor in failure to thrive and contributes to bone demineralization; it is generally corrected by giving sodium bicarbonate. The biggest factor in bone demineralization is 1,25(OH)2 vitamin D deficiency. Vitamin D is activated in the kidney. As kidney function decreases with CKD, activation of 25 (OH) vitamin D to1,25 (OH)2 vitamin D is decreased. This results in decreased intestinal absorption of calcium and subsequent hypocalcemia. Hypocalcemia stimulates the production of parathyroid hormone (PTH), which results in release of calcium from the bone. Deficiency of 25(OH) D is also common in children with CKD and should be corrected prior to treatment with activated Vitamin D. In the early stages of CKD, correction of 25(OH) Vitamin D levels may result in a normal PTH level. Another factor in bone disease is retention of phosphorus in the blood. This also stimulates production of parathyroid hormone, further increasing mineral loss from the bone. Bone disease is prevented and treated by giving vitamin D2 or 3 if 25 (OH) Vitamin D level is low, as well as 1,25 (OH)2 vitamin D (calcitriol, paricalcitol) based on PTH levels. It is also necessary to limit phosphorus in the diet and give phosphate binders with meals. Calcium carbonate, calcium acetate and sevelamer are the most commonly used phosphate binders. The calcium based binders also serve to supplement calcium. With vigilant attention to treatment, bone development can be fairly normal (1). Anemia is a major problem for all patients with significant CKD. The main cause of anemia is decreased production of the hormone erythropoietin by the kidneys. Erythropoietin stimulates the bone marrow to produce red blood cells. Anemia is treated by giving erythropoiesis-stimulating agents (ESA’s), such as epoetin alpha or darbepoetin, subcutaneously or parenterally up to 2 to 3 times per week. In order for ESA’s to work to produce red blood cells, adequate amounts of iron must be given. Iron stores are quickly depleted when ESA’s are started, and hematocrit is rapidly increased (5). It is often necessary to give IV iron to patients on ESA’s to keep up with the demand for production of red blood cells (1). Despite early medical intervention and adequate nutrition support, children with CKD often continue to exhibit slow growth and rarely achieve catch-up linear growth without the use of recombinant growth hormone therapy (1,4,5,9). Long-term growth hormone treatment of growth retarded children with CKD results in significant improvement in linear growth with few side effects. Many children with CKD treated with growth hormone from a young age are able to reach their genetic potential. Nutrition Interventions for Children With Special Health Care Needs 217
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Nutrition Interventions for Childre
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Kay Kopp, OTR/L Occupational Therap
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Appendices Appendix A Sample Screen
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ii Nutrition Interventions for Chil
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Population “Children with special
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vi Nutrition Interventions for Chil
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Chapter 1 - Nutrition Screening and
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Chapter 2 - Anthropometricss needs,
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Chapter 2 - Anthropometricss Statur
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Chapter 2 - Anthropometricss Techni
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Chapter 2 - Anthropometricss paraly
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Chapter 2 - Anthropometricss time a
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Chapter 2 - Anthropometricss measur
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Chapter 2 - Anthropometricss Mild m
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Chapter 2 - Anthropometricss 9. Re-
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Chapter 2 - Anthropometricss 5. Per
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Chapter 2 - Anthropometrics Table 2
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Chapter 2 - Anthropometricss Refere
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Chapter 2 - Anthropometricss 26. Kr
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Chapter 3 - Physical Activity for C
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Chapter 4 - Breastfeeding recommend
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Chapter 4 - Breastfeeding Table 4-1
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Chapter 4 - Breastfeeding Assessmen
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Chapter 4 - Breastfeeding 58 Nutrit
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Chapter 5 - Medication-Nutrient Int
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Chapter 6 - Nutrition Interventions
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Chapter 8 - Oral-Motor Feeding Prob
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Chapter 9 - Behavior Issues Related
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Chapter 10 - Enteral Feeding Other
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Refere
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Chapter 11 - Community Monitoring o
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Chapter 12 - Accommodating Special
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Chapter 13 - Nutrition Intervention
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Page 182 and 183: Chapter 15 - Nutrition Intervention
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Appendix A Please list any other nu
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Appendix A Baby formula What kind o
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Appendix B Manufacturer Description
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Appendix C 282 Nutrition Interventi
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Appendix D 284 Nutrition Interventi
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Appendix E 292 Nutrition Interventi
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Appendix E Table 3: Parent-Specific
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Appendix F Percentiles of Upper Arm
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Appendix F 302 Nutrition Interventi
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Appendix G 304 Nutrition Interventi
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Appendix H 312 Nutrition Interventi
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Appendix I 320 Nutrition Interventi
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Appendix J 328 Nutrition Interventi
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Appendix K 336 Nutrition Interventi
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Appendix K 338 Nutrition Interventi
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Appendix L 340 Nutrition Interventi
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Appendix M 342 Nutrition Interventi
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Appendix M 344 Nutrition Interventi
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Appendix N Gastrostomy Tube Feeding
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Appendix N activities. When feeding
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Appendix N Feeding Sets/Extensions
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Appendix N Fluid and Electrolytes W
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Appendix N osmolality of full-stren
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Appendix N Modular Products Modular
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Appendix N his family, and the home
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Appendix N • The feeding tube may
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Appendix N equipment. The Special S
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Appendix N Table N-2: Common Compli
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Appendix N Complication Possible Ca
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Appendix N 368 Nutrition Interventi
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Appendix O Some conditions increase
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Appendix O Table O-3: Recommended P
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Appendix O 374 Nutrition Interventi
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Appendix P Diet Prescription for Me
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Appendix Q Goals Considerations for
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Appendix R Condition Description Nu
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Appendix R Condition Description Nu
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Appendix R References 1. Ekvall SW
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Appendix S Table S-1: Infant Formul
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Appendix S Comments Osmolality (mOs
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Appendix S Table S-2: Pediatric For
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Appendix S Table S-3: Modular Produ
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Appendix S Comments Energy (kcal) P
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Appendix S Contact Information Abbo
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Appendix T Powdered Formulas Accura
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Appendix T Table T-1: Liquid Concen
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Appendix T 402 Nutrition Interventi
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Appendix U Nutrition Strategies for
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Appendix U ADA Pocket Guide to Nutr
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Glossary Autism Spectrum Disorders
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Glossary Early intervention service
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Glossary Length (recumbent length)
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Glossary Stadiometer moveable headb
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Index specialist 98 target 108 Bink
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Index elemental formula 348 elimina
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Index I ICF. See International Clas
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Index risk indicators 4 screening 1
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Index suppositories 72, 77 Surmonti
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Nutrition Interventions for Children with Special Health Care Needs

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