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212 7.3 Nutrition for Children with Chronic Diseases and Syndromes
the need for catch-up growth or energy helplines to answer carers’ queries and offer
restrictions to address obesity support to cope with any problems.
●● fluid requirements Parenteral feeding for critically ill
children with very poor gut function
●● nutrient and fibre requirements.
This is an expensive treatment and usually only used
Requirements are usually based on a child’s weight in hospital. The child is fed directly into a vein with a
so, as the child grows, requirements and the feeding combination of sterile solutions prepared by a
regime need to be regularly reassessed and pharmacy. The solutions must be calculated carefully
recalculated. and prescribed for each child. Together these solutions
provide fat, carbohydrate, protein, vitamins and
Considerations when initiating tube minerals. Occasionally a child can be fed at home by
feeding this method but parents require considerable support
and training to do this safely and effectively.
If a child has not been eating for some time a feed
may need to be started slowly and increased over Common Medical Conditions
several days according to how the child tolerates Requiring Dietary Modifications
an increased flow rate or increased energy density.
Stomach pain, vomiting and diarrhoea are all Autistic spectrum disorders,
indications that the child is not tolerating the including attention deficit
feed. However, these symptoms need to be hyperactivity disorder (ADHD)
interpreted according to the clinical condition of and Asperger’s syndrome
the child.
Some children with these disorders only eat a
The gradual introduction of feed over several narrow range of foods. This selective eating may be
days will also protect against the risk of ‘refeeding related to either over- or under-sensory perception
syndrome’ in those children who have had very with tastes, smells, texture and temperature of foods
little nutrition for some time. as well as the visual appearance of food. Diaries of
foods normally eaten can be assessed by a paediatric
Support for home tube feeding dietitian for nutritional adequacy and a supplement
recommended for any deficiencies.
When infants and children are tube fed at home
parents and carers need to be trained in: Parents often wish to try a variety of dietary
modifications for which there is varying anecdotal
●● operating the pump using appropriate flow rates evidence of symptom improvement in some children.
or bolus volumes A dietitian can support parents to do this safely so
that there is no nutritional risk to the children. Such
●● frequency and method of changing the plastic dietary interventions requested include:
tubes (giving sets and reservoirs)
●● supplements of zinc, iron, magnesium, omega 3
●● appropriate flushing of tubes before and after fatty acids (eicosapentaenoic acid (EPA) in
feeding episodes particular), vitamin A, methyl sulphonyl
methane/magnesium sulphate, folinic acid,
●● cleaning the gastrostomy site betaine and/or methylcobalamine
●● clearing blocked tubes. ●● excluding phenolic compounds, salicylates,
aspartame, monosodium glutamate (MSG),
Companies making the feeds all have home artificial colours or benzoates
delivery services to deliver both the sterile plastic
tubes (giving sets and reservoirs) and the feeds
either to a local pharmacy or directly to the home.
They can usually arrange deliveries to holiday
accommodation as well. They also have 24-hour
