Nutrition Interventions for Children with Special Health Care Needs

High Fiber Diet for Children
Section 2 - Problem-Based Nutrition Interventions
There have been concerns that a high fiber diet may have adverse effects on total
energy intake and nutrient absorption in children. However, current research is
inadequate to support a recommendation for fiber supplementation in children, and
instead the recommendation is a balanced diet including whole grains, fruits and
vegetables (1,3). The American Dietetic Association released a position statement
in 2008 on dietary fiber, citing: “Appropriate kinds and amounts of dietary fiber for
children, the critically ill, and the very old are unknown”. Reference Intakes are set at
14 grams of fiber per 1000 calories (7). Unfortunately, these recommendations may
not be applicable to children with special health care needs consuming individualized
diets, such as a low energy diet or tube feeding. Other recommendations have been
followed with successful outcomes in bowel management for healthy children and
children with special needs.
The American Academy of Pediatrics recommends 0.5 g fiber/kg for a general healthy
intake, with an upper limit of 35 g/day (8). Another method for estimating fiber
requirements is “age plus 5 g,” as established by the American Health Foundation for
children over age 2 years (e.g. a child who is 3 years old: 3 plus 5 g = 8 g fiber/day)
(9,10). It is important to realize that children with chronic constipation may require
fiber in amounts greater than the usual recommendations, along with increased
fluid, to maintain normal elimination. However, it is recommended that levels above
“age plus 10 g” be avoided (9). Children who are not able to consume adequate
amounts of fiber from food often benefit from the use of supplemental fiber products.
Examples of these include Unifiber ® , Benefiber ® , and Metamucil ® . (See Appendix S.)
Mineral Oil
Another controversy in the treatment of constipation involves the use of mineral oil.
Mineral oil serves to soften the stool and provide lubrication for easier elimination.
However, there have been concerns that it may bind fat-soluble vitamins and thus
cause nutrient deficiency. This controversy began with a study done in 1939 that
showed a decrease in serum carotene after six months of high-dose mineral oil use.
However, the participants in this study never developed serum levels in a deficient
range (11). Two recent studies have demonstrated no adverse effects of mineral oil
use on fat-soluble vitamin status (2,11).
Mineral oil is not appropriate for infants less that 1 year of age secondary to
concerns for gastroesophageal reflux and immature swallowing skills that may lead
to aspiration (1,3). The risk for lipoid pneumonia also exists for children with history
Nutrition Interventions for Children With Special Health Care Needs 73