Nutritional Guidance for Children with Health Challenges
This presentation by Maria Raspolic, MS, RD discusses common nutritional issues in children with health challenges, providing recommendations to address these issues and exploring the use of the ketogenic diet for seizure management. Topics cover poor growth, dehydration, constipation, inadequate nutrient intakes, and strategies for improving nutrition through high-quality foods, liquid supplements, and supplemental tube feeding. The importance of fluid intake, thickened liquids, and monitoring health indicators is emphasized for optimal health outcomes.
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Presentation Transcript
Maria Raspolic MS, RD Santa Clara Valley Medical Center
Objectives: Review most common nutritional issues in AHC Provide recommendations to minimize above issues Review ketogenic diet as treatment for seizures
Poor growth Dehydration Constipation Decreased bone mineral density
Inadequate nutrient intakes Decreased muscle tone Oral motor dysfunction Limited growth potential Frequent illness, fatigue, infections
1. Provide food of high nutritional quality Breakfast yogurt, Carnation Instant Breakfast, meat Breakfast: oatmeal, eggs, cream of wheat, Lunch/Dinner tofu, almond/nut butter, avocados, fatty fish, meat, sweet potatoes, fried rice/mex rice Lunch/Dinner: refried beans/cheese, lentils, Snacks Snacks: milk shakes/smoothies, cheese stick
2. Liquid supplements Concentrate infant formula to 24-30 kca/oz Pediasure, Boost Kids Essential, Nutren Jr Ensure, Nutren, Boost Carnation Instant Breakfast 1.5 and 2 cal/cc formulas
3. Supplemental tube feeding Child not able to gain weight adequately Excessive time needed to feed Difficult decision for parents Goal: improved quality of life Dramatic improvement in nutritional status
Inadequate fluid intakes Excessive fluid loss Need for thickened liquids Result in constipation, decreased appetite Kidney stones, UTI, thickening of secretions Monitor number of diapers, UA
100 cc/kg of body wt for the first 10 kg 50 cc/kg for the second 10 kg 20 cc/kg for the additional kgs 44 lbs :2.2 = 22 kg 1000 + 500 + 40 = 1540 cc 1540: 30 = 51 oz
Provide hi nutritional value liquids: Milk, soy, rice, almond, coconut Smoothies, milkshakes ? juice
Multifactorial cause Poor intakes of fluids and solids Low muscle tone/ GI motility Low activity levels Low fiber diet
Contributes to poor appetite Abdominal distention/discomfort Irritability Adequate fluid intakes and fiber Hi fiber foods: cereal (5 gr/serving), legumes Sweet potatoes, fruits/vegetables Prune or pear juice
If additional help needed: Milk of magnesia Lactulose Miralax Benefiber
Limited ambulation Inadequate intakes of Ca, Phos, Vit D Anticonvulsant therapy Limited sun exposure If untreated may lead to osteoporosis, bone deformities and fractures
1-3 years: 500mg 4-8 years 800 mg 9-18 years 1300 mg
Calcium Sources in Food Food Source Food Source Serving Size 3 ounces 1 tablespoon Serving Size Amount of Calcium per Serving 210 milligrams (mg) 170 mg 60 mg Amount of Calcium per Serving almonds blackstrap molasses broccoli (cooked) canned salmon (with bones) canned sardines (with bones) collards cottage cheese hard cheese (cheddar, swiss) kale (cooked) milk mozzarella cheese rhubarb (cooked) ricotta cheese spinach (cooked) yogurt Food sources/ table 1 cup 3 ounces 180 mg 3 ounces 325 mg 1 cup 1 cup 265 mg 155 mg 1 ounce 225 mg 1 cup 1 cup 1 ounce 1 cup 1 2 cup 1 cup 8 ounces 95 mg 300 mg 200 mg 345 mg 335 mg 245 mg 425 mg
Calcium Carbonate Viactiv, Tumbs, Caltrate Calcium Citrate Citracal Oyster Shell, Bone Meal
Sunshine Vitamin Sunblock use prevents Vit D production Anticonvulsant meds (Phenobarb, Dilantin) Decreased absorption of Calcium Limited food sources: fish liver oil, fatty fish, egg yolk, mushrooms, milk (fortified)
Recommend to check blood levels yearly Goal: 30-60 mmol/dl Supplement 1000 IU/day Vit D3 (cholecalciferol) in the skin by sun expo Vit D2 (ergocalciferol) synthesized by plants 50 000 IU/ week 15 min sun exposure prevent Vit D deficiency
Borusiak et al, 2012 128 children receiving one AED 24 % hypocalcemia 25% hypophosphatemia 13% low vit D Phenobarb, Depakote, Trileptal, Dilantin
Common in children with AHC Complete MVI recommended Chewable tablet preferred Liquid/soft gummy vits less minerals Bugs Bunny, Flinstone s, Scooby Doo, NanoVites
How does it work? Brain needs glucose from food 24 hours supply Breakdown of fat produces ketones ??? Prevention of seizures
2-3 months trial 30% of the children seizure free 30% significant reduction in seizures, reduction in medication or no medication Reminder do not respond or find it to hard to continue
Dehydration-check urine daily with keto stick Constipation-MOM, Miralax Kidney Stones- UA, trace amount of blood Nutrient deficiency- complete MVI, ck blood Decreased growth- adjust protein, kcal Hi Cholesterol- replace butter with olive oil, levels ZN, Se, Vit D supplement with carnitine
Gradual decrease in CHO over one week 2-3 day hospital admission Fasting only in the AM At lunch time full keto meal Allow fluids to meet hydration need Spec. gravity and ketones check with every void
Teach families how to calculate and prepare meals Keto meal planer Complexity of meals controlled by parents Ready to feed Ketogenic formula; Ketocal RCF for tube feeding
Reduction of the ratio over couple of months Most parents find diet easier than anticipated Ketogenic diet is the most effective available treatment for intractable epilepsy today Atkins diet
