Nutrition Interventions for Children with Special Health Care Needs

Appendix N
Fluid and Electrolytes
Water must be provided in sufficient quantities to replace fluid losses and allow for
normal metabolism. Fluid requirements depend on the following variables: urine
output, sweating, vomiting, fever, stool pattern, environment, renal disease, cardiac
anomalies, tracheostomies and medications. Constant drooling also contributes to
fluid losses. Water requirements can be estimated using Table N-1 as long as the
above variables are considered. Indications that fluid intake is not adequate include
constipation, decreased urine output, strong smelling or dark urine, crying without
tears, dry lips and skin, sunken eyes, weight loss. Symptoms of fluid overload
include rapid weight gain, puffy appearance, and rapid or uncomfortable breathing.
Patients who rely on tube feedings as their sole source of nutrients are at risk for
electrolyte imbalances, which may result in serious medical complications, e.g.,
hyponatremia, hypernatremia, hypokalemia, hyperkalemia, dehydration, and
cardiac arrhythmias. Sodium, potassium, and chloride status should be evaluated
regularly (4,5). The DRIs/RDAs provide guidelines for a safe and adequate intake of
electrolytes.
Vitamins and Minerals
To determine vitamin and mineral needs, the DRIs/RDAs for age can be used as
a base, unless the child’s growth is markedly delayed. For the child with growth
delay, the DRIs/RDAs for height age can be used. Children with inadequate energy
intakes, decreased absorption, and increased energy needs should be evaluated for
supplemental vitamins and minerals.
Vitamin and mineral requirements can be altered by medications (See Chapter 5).
Other variables to consider are disease, previous medical and dietary history and
biochemical parameters.
Minerals that require special attention are calcium, phosphorus and iron; these
are usually not adequate in commercial tube feeding formulas at the energy levels
required by many children. Supplemental vitamins and minerals can be given with
feedings in the form of a liquid multivitamin with iron or a crushed chewable multiple
vitamin/mineral tablet appropriate for age. Children on long-term enteral support
are at risk for trace mineral deficiencies. The risk of developing nutrient deficiencies
increases with frequent vomiting or gastrointestinal disturbances. Children on longterm
tube feedings need to be evaluated for fluoride intake and may need to be
supplemented. This will require a prescription from the child’s physician or dentist.
352 Nutrition Interventions for Children With Special Health Care Needs