Nutrition Interventions for Children with Special Health Care Needs

Carnitine
Section 2 - Problem-Based Nutrition Interventions
Numerous studies have shown that plasma carnitine levels are significantly lower
among patients taking valproic acid than among controls (10). Carnitine deficiency
in epilepsy results from a variety of etiologic factors including underlying metabolic
disease, inadequate nutrient intake, and specific medication effects (6, 7). The
relationship between carnitine deficiency and valproic acid-induced hepatotoxicity
is unclear. Carnitine treatment does not always prevent the emergence of serious
hepatotoxicity, but it does alleviate valproic acid-induced hyperammonemia (4,11).
Medications for Treatment of Attention Deficit and
Attention Deficit Hyperactivity Disorders
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD)
is commonly treated with stimulant medications such as methylphenidate (Ritalin,
Ritalin SR, Metadate CD, Metadate ER, Concerta), dextroamphetamine (Dexedrine)
and amphetamine mixture (Adderall). Automexetine (Strattera) is a non-stimulant
drug used to treat ADD/ADHD. Studies have shown that all of these medications
are associated with depressed appetite in children, often resulting in a slower rate
of weight gain and growth. Other studies have shown that effects of stimulant
medications on appetite or growth are temporary and dose related; after one to
two years of treatment, a tolerance is developed, and growth and appetite are no
longer depressed. A 1996 study found small but significant differences in height
between children with ADHD and controls (12). These height differences were
evident in young children, but not older adolescents and were unrelated to the use of
psychotropic medications (13,14).
Diuretics
Diuretics are frequently prescribed for children with cardiac defects or chronic
lung disease. Many diuretics such as furosemide (Lasix) increase the excretion of
potassium, calcium, sodium, zinc, chloride, and magnesium; other diuretics such as
spironolactone (Aldactone) spare potassium, but increase the excretion of calcium
and magnesium (2). The diets of patients on diuretics must provide adequate
replacement of the minerals that are excreted. Diuretics can also contribute to
anorexia and gastrointestinal distress (15).
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