Nutrition Interventions for Children with Special Health Care Needs

Appendix O
Some conditions increase fluids needs:
• Fever (any degree of fever above normal (37.0-37.4 C) needs immediate medical
attention. Fevers are often indicators of line sepsis.)
• Hypermetabolism
• Diarrhea (high ostomy outputs)
Some conditions decrease fluid needs:
• Heart disease
• Renal failure with low urine output
Energy
Parenteral energy needs vary depending upon the activity and stress of the individual
child. Because PN requires less energy for digestion and absorption, energy needs
may be up to 15 % lower in stable (renourished and not stressed), parentally
fed children than for those who are fed enterally. Conversely, an individual’s
energy needs may be higher than the DRIs during periods of catch-up growth,
hypermetabolism, and illness (2,3).
The dietitian must monitor the child’s rate of weight gain to ensure appropriate
growth. Only by tracking monthly plots on the child’s growth chart can the dietitian
determine whether to increase energy to maintain the growth pattern or decrease
calories to prevent excessive weight gain.
Other Nutrients
Amino acids (AA) provide 4 kcal/g and should provide 6-16% of total energy
depending upon the child’s energy needs and disease state. For infants and children,
AA are typically started at 1.5 g/kg/day and increased by 0.5 g/kg/d increments until
the final protein goal is reached (2).
Intravenous (IV) lipids provide a concentrated, isotonic source of energy by which fat is
used to supply approximately 30-40% of the child’s total calories. The minimum amount
of lipid required to prevent essential fatty acid deficiency is 4 – 8% of total calories, while
the maximum amount of lipid that may be administered is 60% of total calories. Such
IV lipids are available as 20% or 10% emulsions. 20% emulsions provide 2 kcal/ml and
is the exclusive solution used in pediatric PN. 10% emulsions are no longer used in the
pediatric population due to increased phospholipid content and inferior clearance.
Carbohydrate (dextrose) is typically the major source of non-protein energy and
provides 3.4 kcal/g. In general dextrose should provide 40-50% of total energy (3).
370 Nutrition Interventions for Children With Special Health Care Needs