Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Assessing Nutritional Status - Medical Issues

What medical conditions/issues should I be aware of when assessing nutritional status?
Include the impact of a child’s medical conditions in the nutritional assessment. Some conditions (e.g., pulmonary problems) can increase energy needs. Other conditions (e.g., renal disorders) may change requirements of specific nutrients. Appetite may be decreased by symptoms associated with certain conditions. Medications can alter a child’s nutritional status as well. Some medications may change nutrient needs or may interfere with absorption and/or metabolism, while other medications can affect appetite.

What are some common drug-nutrient interactions to be aware of?

ANTICONVULSANTS: e.g., phenobarbitol, phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), valproic acid (Depakene)

• Assess intake of vitamin D, folic acid, B vitamins, vitamin C, calcium, vitamin K
• Assess status (if indicated) of vitamin D and bone mineralization
• Assess side effects, including nausea, vomiting, diarrhea, lethargy
• Ensure adequate micronutrient intake via foods, supplements
• Supplement folate (if indicated) only when drug levels and seizure activity are closely monitored

STIMULANTS: e.g., methylphenidate (Ritalin), dextroamphetamine (Dexedrine), pemoline (Cylert)

• Assess intake of energy, protein, and micronutrients
• Assess growth (height and weight)
• Assess side effects, including decreased appetite
• If medication is interfering with an adequate intake, offer meals and snacks before medication and when drug action is minimal
• Offer nutrient-dense foods

DIURETICS: e.g., furosemide (Lasix), spironolactone (Aldactone), triamterene (Dyrenium), thiazides (Diuril, Hydrodiuril, Naqua, Hygroton, Hydromox, Diamox)

• Assess intake of potassium, magnesium, calcium, and energy
• Assess status of potassium, magnesium, and calcium excretion
• Assess side effects, including nausea, diarrhea, and vomiting
• Ensure adequate macro- and micro-nutrient intake

ANTIBIOTICS: e.g,. chloramphenicol, tetracycline

• Assess intake of energy, protein, and minerals
• Assess side effects, including altered GI flora, nausea, vomiting, impaired absorption

CORTICOSTEROIDS:

• Assess intake of calcium, phosphorus, simple carbohydrates, and energy
• Assess growth, bone growth, blood glucose levels, weight gain
• Assess side effects, including increased appetite
• Ensure adequate intake of calcium and vitamin D
• Encourage physical activity to prevent excessive weight gain

SULFONAMIDES: e.g., sulfamethoxazole, Bactrim, Gantanol

• Assess intake of vitamin C, protein, folate, and iron
• Assess iron status

TRANQUILIZERS

• Assess intake of energy
• Assess rate of weight gain
• Assess side effects, including increased appetite
• Prevent excessive weight gain

REFERENCES

Nardella M, et al. Nutrition Interventions for Children with Special Health Care Needs. Washington State Department of Health. 2002.

Trahms CM and Pipes PL. Nutrition in Infancy and Childhood, 6th edition. WCB-McGraw Hill. 1997

Nevin Follino N. Pediatric Manual of Clinical Dietetics, 2nd edition. American Dietetic Association. 2003.