Nutrition Focus

32(2) Nutrition and Oral Health for Children

Posted on March 1, 2017 by nutrfoc

Dental caries is the most common chronic disease of childhood. It is more prevalent than asthma, which is the second most common chronic disease. It is estimated that 17.5% of 5-19 year olds have untreated dental caries.

Problems with oral health affect all children. However, the importance of oral health for children with special health care needs is particularly relevant. Special health care needs can increase a child’s risk for oral health problems and can make the overall effects of poor oral health more severe.

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Posted in Nutrition-related Issues | Tagged assessment, CSHCN, development, feeding, fluid, fluoride, infants, intervention, medication interactions, oral health, premature infants, team members | Comments Off

32(1) Nutrition Assessment and Management of the Child with Cancer

Posted on January 1, 2017 by nutrfoc

Despite recent advances in research and treatment, cancer is still the leading cause of death by disease for all children past infancy in the United States. As recent as 2014, researchers estimated 10,450 new cancer cases and 1,350 cancer deaths among children from birth to 14 years, and an additional 5,330 new cases and 610 deaths were expected in adolescents between 15-19 years old.

Progress in survival rates is nevertheless being made nationwide. An estimated 379,112 survivors of childhood cancer were in remission in the United States as of January 1, 2010. The five-year relative survival rate for all children diagnosed with cancer under age 20 years, increased from 58% in the late 1970’s (1975-1979), to over 83% between 2007-2013.2 This dramatic increase in childhood cancer survival is due to multiple factors, including improved treatment protocols; the opportunity for children and adolescents to participate in sophisticated clinical trials, such as those from Children’s Oncology Group (COG), and the increasing acceptance of interdisciplinary supportive care teams that specialize in treating and caring for children undergoing treatment.

More recently, since Nutrition Focus published “Nutrition Assessment and Management of the Child with Cancer” in 2009,4 researchers and treating providers have developed, and are now administering, new treatment options for certain relapsed pediatric cancers. These “novel” treatments, including biologic and immune-based therapies, harvest the patient’s own T-Cells, genetically modify them and reintroduce the cells into the body. This complex process is intended to boost the immune system to eradicate malignant tissues and lessen side effects caused by some cancer treatments. A recent published phase 1 trial of 45 children and young adults with relapsed or refractory CD 19* B-lineage acute lymphoblastic leukemia (ALL), with a dismal prognosis, were treated with CD19 CAR-T cells. The trial outcome showed patients can achieve remission of disease, without need for prolonged chemotherapy or allogeneic hematopoietic cell transplantation (HCT).

As further progress is made towards curing childhood malignancies, researchers will continue to focus on improving outcomes for all pediatric cancers by incorporating more precision treatment strategies based on specific tumor targets and approaches to new therapies. The challenge for oncology dietitians will be to continue to define and address the nutritional status of this patient population, to focus on reliable standards of care to prevent malnutrition and to support the child though their treatment process. This issue of Nutrition Focus addresses nutrition assessment and management of children with cancer. Nutritional effects of cancer therapy and nutrition support practices are also addressed.

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Posted in Specific Conditions | Tagged assessment, cancer, chemotherapy, development, education, enteral nutrition, feeding, GI, growth, intervention, medication interactions, medications, nutrition management, oncology, radiation, tube feeding | Comments Off

31(6) Children and Weight: Providing Help, Preventing Harm Part 2 – Nutrition Intervention

Posted on November 1, 2016 by nutrfoc

Parents and caregivers receive many different messages about children, weight, and food, and it can be confusing for parents to navigate what is sound advice versus what is dangerous. How can health care providers help families and children without doing harm? These topics are discussed in this issue and the previous issue of the Nutrition Focus Newsletter:

Part 1 – Children and Weight: Providing Help, Preventing Harm – Nutrition Assessment
Part 2 – Children and Weight: Providing Help, Preventing Harm – Nutrition Intervention

This issue of Nutrition Focus examines intervention strategies,
with a focus on supporting a positive dynamic between
parent(s) and child(ren) around food.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged energy, family centered care, growth, growth charts, intervention, nutrition management, obesity, overweight, physical activity, team members | Comments Off

31(5) Children and Weight: Providing Help, Preventing Harm Part 1 – Nutrition Assessment

Posted on September 1, 2016 by nutrfoc

Parents and caregivers receive so many different messages about children, weight, and food, and it can be difficult and confusing to navigate for families and health care providers alike. What is sound advice? What is dangerous? How can health care providers help families and their children to develop and sustain positive feeding and eating relationships? These topics are discussed in the next two issues of the Nutrition Focus Newsletter:

Part 1 – Children and Weight: Providing Help, Preventing Harm – Nutrition Assessment
Part 2 – Children and Weight: Providing Help, Preventing Harm – Nutrition Intervention

This issue of Nutrition Focus highlights the essential components of a comprehensive nutrition assessment with consideration of feeding and eating dynamics between parent and child. This newsletter will:

Review various growth patterns in children
Discuss causes of growth problems in children
Review the division of responsibility in feeding

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Posted in Uncategorized | Tagged assessment, behavior, CSHCN, energy, family centered care, growth, growth charts, obesity, overweight, resources, team members | Comments Off

31(4) A Look at Blended Tube Meals: Part 2 – The How-To’s

Posted on July 1, 2016 by nutrfoc

This issue of Nutrition Focus is the second in a two-part series about blended tube meals (BTMs). Part 1 updated a 2004 issue discussing homemade blended tube feedings. Interest has grown in the use of blended food in a tube feeding. Families are requesting advice and guidance from health care providers.

Part 1 of this topic suggested the name, blended tube meals, to acknowledge the use of blended food (blended at home or commercially), fed via the tube as a meal whether for an adult or child. Part 1 also reviewed the continuum of food choices for a tube feeding, why BTMs are popular, who is a candidate, the RDN’s role, and recent research on this topic. An extensive list of resources and references was included. The list of resources are also included in this issue, as well as the pertinent references.

In Part 2, the “how-to’s” of the actual process for BTMs is discussed including delivery method, food safety, and inclusion of all nutrients and appropriate fluids. Examples of foods that work from each food group are given. Two family stories illustrate the decision to move to BTM and the outcomes for their children.

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Posted in Nutrition-related Issues | Tagged assessment, blenderized, calories, CSHCN, enteral nutrition, family centered care, growth, intervention, team members, tube feeding | Comments Off

31(3) A Look at Blended Tube Meals: Part 1 – An Update

Posted on May 1, 2016 by nutrfoc

In 2004, Nutrition Focus ran an article entitled “Homemade Blended Tube Feeding,” by Ellen Duperret, RD, Jude Trautlein, RD, and Marsha Dunn Klein, OTR/L, MEd. The purpose of this article is to revisit this evolving conversation and share expanding professional and parent experiences. The current authors are experienced in the provision of these meals with children, so this article focuses on pediatric use. We recognize that many registered dietitian nutritionists (RDNs) working with adults are also recommending blended meals by tube.

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Posted in Nutrition-related Issues | Tagged assessment, CSHCN, education, energy, enteral nutrition, family centered care, feeding, growth, intervention, team members, tube feeding | Comments Off

31(2) Increasing Energy Concentration in Infant Feedings

Posted on March 1, 2016 by nutrfoc

Energy is required by each individual’s body to sustain functions including respiration, circulation, physical work, metabolism, and protein synthesis. In children, energy is also needed for overall growth. Energy needs depend on intake and expenditure. Energy requirements and expenditure are affected by age, gender, body composition, and physical activity levels. Health conditions can also affect energy requirements; this is often seen in children with special health care needs.

Infancy is a period of rapid growth that requires support with proportionately higher calorie (energy) intake than at any other life stage. At one month of age an infant’s energy cost for growth is 35% of their energy requirements. By 12 months of age the cost of growth drops to 3% of energy requirements and remains low until the adolescent growth spurt and an average increase to 4%.

While most infants are able to support their growth by drinking breast milk or standard infant formula, some require extra support due to individual feeding issues and/or special health care needs. This edition of Nutrition Focus will review indications for use of calorically dense breast milk and/or infant formula and discuss how to formulate a fortification recipe that is appropriate and safe for use in young infants.

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Posted in General Topics Related to CSHCN | Tagged assessment, calories, CSHCN, dri, energy, fluid, growth, nutrition management, team members | Comments Off

30(6) Food Allergies

Posted on November 1, 2015 by nutrfoc

Food allergies in children present many challenges:

ensuring appropriate nutrient intake for growth and development while avoiding offending foods and ingredients
maintaining positive social interactions
maintaining quality of life

This issue of Nutrition Focus examines food allergies – including diagnosis, symptoms, and management

30(5) Pediatric Malnutrition – A Look at the New Guidelines

Posted on September 1, 2015 by nutrfoc

INTRODUCTION
Globally, pediatric malnutrition contributes to about half of child deaths. Historically, pediatric malnutrition has been associated with starvation only and was considered primarily to be a problem of the developing world. Identification of malnutrition has focused on the effects of malnutrition (e.g., protein-energy malnutrition, kwashiorkor, and marasmus), but failed to investigate the etiology of malnutrition. Lack of a standardized definition has hampered early identification of malnutrition, understanding of the prevalence of malnutrition, and its effect on clinical outcomes.

Recently, more attention has been paid to the non-starvation causes of malnutrition, including acute and chronic illness. Studies estimate between 6 and 51% of hospitalized children are under nourished, although the prevalence of disease related malnutrition has been difficult to determine due to a lack of a precise and consistent definition. Malnutrition in hospitalized children leads to worse outcomes including lean body mass depletion, muscle weakness and loss, cognitive and developmental delays, immune dysfunction, delayed wound healing, infections, more ventilator days, and increased length of both ICU and total hospital stay.

Although recent research has focused primarily on pediatric malnutrition in a hospital setting, malnutrition can also be identified in the community setting. Children with chronic illness and special health care needs have many risk factors for developing malnutrition and should be routinely screened in the primary care and outpatient clinic setting. Screening for malnutrition requires a team approach to address nutritional deficits that can predispose the patient to acute illness or exacerbate the underlying disease or condition.

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Posted in Nutrition-related Issues | Tagged assessment, CSHCN, education, failure to thrive, growth, intervention, malnutrition, team members | Comments Off

Nutrition Focus

32(1) Nutrition Assessment and Management of the Child with Cancer

31(5) Children and Weight: Providing Help, Preventing Harm Part 1 – Nutrition Assessment

30(6) Food Allergies

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