Nutrition Interventions for Children with Special Health Care Needs

Chapter 5 - Medication-Nutrient Interactions
Corticosteroids
Glucocorticoids are used as replacement therapy in adrenal cortical deficiency states
and for anti-inflammatory and immunosuppressive effects in the treatment of many
disorders, including asthma. Side effects of glucocorticoids include decreased bone
mineral density, and decreased absorption of calcium and phosphorus; poor linear
growth; increased appetite often leading to excessive weight gain; sodium and water
retention occasionally leading to hypertension; muscle catabolism; increased glucose
leading to insulin resistance; and increased lipolysis (16,17). Inhaled corticosteroids
are now more commonly used than systemic corticosteroids. Their side effects are
minimal compared to oral corticosteroids, but they can have similar effects when
used long term.
Antidepressants
Tricyclic antidepressants (TCAs) are used to treat mental depression, as an aid in the
temporary treatment of nocturnal enuresis in children over the age of six years, and
as a treatment for ADHD for some young adults and children over six years of age.
Although the exact mechanism of action in the treatment of depression is unclear,
TCAs have been thought to increase the synaptic concentration of norepinephrine
and/or serotonin in the central nervous system. Nutrition-related side effects of TCAs
can include an increased appetite and weight gain, dry mouth, nausea and vomiting,
constipation, and diarrhea.
The relatively new antidepressant medications, selective serotonin reuptake
inhibitors (SSRIs) may cause dry mouth and GI disturbances such as nausea and
vomiting, dyspepsia, diarrhea or constipation (18,19).
Antibiotics
Antibiotics are used to treat infections. They are sometimes used long-term on a
prophylactic basis. Side effects that may interfere with an adequate nutrient intake
include mouth and tongue sores, diarrhea, nausea, and vomiting (1). With long-term
use, gut flora can be altered, decreasing vitamin K production (20). Monitoring of
nutritional effects is indicated.
Anti-Inflammatory Medications
Anti-inflammatory medications (e.g. sulfasalazine for ulcerative colitis and Crohn’s
disease) can cause nutrition-related side effects including anorexia, nausea,
vomiting, taste changes, diarrhea, gastric distress, and abdominal discomfort (20).
62 Nutrition Interventions for Children With Special Health Care Needs