Nutritional Management Of Children Research Articles

Evolution of nutritional management in children with cystic fibrosis - a narrative review.

Nutrition has played a central role in the management and outcomes of people with cystic fibrosis (pwCF) since the 1970s. Advances in therapies and practices in recent decades have led to a significant change in the patient landscape with dramatic improvements in life expectancy, as well as quality of life, bringing with it new issues. Historically, cystic fibrosis was a condition associated with childhood and malnutrition; however, changes in patient demographics, nutritional assessment and fundamental nutritional management have evolved, and it has become an increasingly prevalent adult disease with new nutritional challenges, including obesity. This paper aims to describe these changes and the impact and challenges they bring for those working in this field. Nutritional professionals will need to evolve, adapt and remain agile to the wider range of situations and support required for a new generation of pwCF. Specialised nutrition support will continue to be required, and it will be additionally important to improve and optimise quality of life and long-term health.

Current practices and challenges of registered dietitians in the nutritional management of children with cerebral palsy in South Africa

Background: Feeding difficulties and subsequent malnutrition are common in children with cerebral palsy (CP). Objectives: A study was undertaken to determine the current practices and challenges of South African registered dietitians (SA RD) regarding the nutritional management of children with CP, to compare these practices with international guidelines and to compare the practices of private- and public-sector dietitians. Design: This was a cross-sectional descriptive study with an analytical component. Subjects and outcome measures: The SA RDs completed an online questionnaire, which was developed according to the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines. Participant answers were scored to assess their management of children with CP. Results: Of the 87 SA RDs who participated, 78 had work experience in CP (40 public and 38 private sector). Over two-thirds (n = 62/87, 71.2%) received training on the management of CP at university, albeit inadequate (n = 42/62, 67.7%). Common challenges that affect RDs’ management are poor caregiver compliance (n = 72; 92.2%) and poor networking between healthcare professionals (HCPs) (n = 60; 77.0%). The SA RD (n = 78) management of children with CP was significantly different from the ESPGHAN guidelines (p < 0.001). When comparing the total practice score, no significant difference was found between private- and public-sector RDs. The SA RDs did not achieve many of the recommended practices, particularly those pertaining to anthropometry. Conclusions: Improved training of SA RDs in the assessment and management of children with CP, and addressing barriers such as poor caregiver compliance, would enhance SA RDs’ competence to improve the nutritional management of children with CP.

The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy.

Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.

Telemedicine in nutritional management of children with severe neurological impairment: implication for quality of life.

Children with severe neurological impairment (SNI) frequently present feeding problems requiring a close monitoring of their nutritional status. In addition to constant clinical monitoring of body composition and nutritional indexes in these patients, frequent reports of dietary intake and weight gain variations are useful to ensure proper nutritional management. Furthermore, non-oral feeding is often needed to avoid malnutrition or aspiration pneumonia, constantly necessitating medical assistance. Despite their necessity for frequent hospital accesses, these patients' disabilities represent an important obstacle to accessing care, generating anxiety and concern in children and their families. Telemedicine has proven to be a promising instrument for improving pediatric patients' healthcare in several fields. By breaking down geographical and temporal barriers, telehealth may represent a valuable tool to implement in clinical practice, in order to improve patients' outcomes and quality of life. The aim of this narrative review is to provide an overview of the main nutritional issues in children with SNI, the potential implications of telemedicine in their management and the available evidence regarding the effects and benefits of telehealth.

Nutritional Management in Children and Adolescents with Severe Neurological Impairment-Who Cares? A Web-Based Survey Among Pediatric Specialists in Germany.

Nutritional management of children and adolescents with severe neurological impairment (SNI) is challenging. A web-based survey was distributed to identify the present situation and the knowledge of the involved medical professionals in Germany. The survey was created with LimeSurvey, and access data were distributed by several medical societies. Eighty-three questions covered four topics: "general information," "gastro- and jejunostomy procedure," "handling of gastrostomies and feeding tubes," and "nutritional management and follow-up of children and adolescents with SNI." A descriptive analysis was performed with Microsoft Excel. A total of 156 participated (65 completed and 91 partially), 27% being pediatric gastroenterologists, 23% pediatric neurologists, and 10% pediatric surgeons. The most common indications for gastrostomy and tube feeding were oropharyngeal dysfunction and failure to thrive. Many patients were still underweight after some months of enteral feeding. The procedure of gastrostomy and handling recommendations varied broadly. Frequently, standard operating procedures (SOPs) and written local guidelines did not exist, and there was a considerable request for training. Only 53% of participants were aware of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition position paper published in 2017, even fewer (38%) followed the guidelines. The recommended measures to assess a nutritional status were often not respected. Nutritional management of children and adolescents with SNI in Germany is still strongly deficient. Despite the international guideline of 2017, few colleagues are aware of and adhere to the recommendations. This could be improved by interdisciplinary teaching and evaluation of the reasons for noncompliance. The procedure of gastrostomy and the patients' follow-up vary widely. Therefore, modified SOPs should be developed.

Evaluation of Parents’ Knowledge about Nutritional Management of children with Phenylketonuria

Abstract&#x0D; Objective(s): to Evaluation of Parents’ Knowledge about Nutritional Management of kids with Phenylketonuria; to Identify the association between parents’ Knowledge about nutritional management then their demographic variables of fathers, mothers (parents age, residence then socioeconomic position).&#x0D; Methodology: A non-experimental project; was accompanied on parents of phenylketonuria kid in Baghdad town since the period 3 June to 5 October 2022. A Non-probability sample (convenience) of 35 PKU children and their parents (father and mother) was selected Purposively from the hospitals that are select for the study. A survey is built for the purpose of the education throughout a review of applicable literature. It composed of two parts: The first part Demographic Characteristics: parents' Demographic features and Socioeconomic Status; And the second part is Parents’ Knowledge about Nutritional Management of children with Phenylketonuria. The internal consistency between items was strongminded by using alpha Cronbach`s coefficient. The consistency analysis shows very good evaluation for knowledge scale. Data was collected from one hospital in Baghdad city beside al-Rusafa\ Ibn Al-Baladi Hospital for maternity and Children, after the approval of the director of the hospital and the acceptance of parents to involve themselves and their children in the study. data are examined using Statistical Data Analysis: Frequencies, percentage, mean scores, standard deviation, mean, whole scores then ranges-test and one - way analysis of variance.&#x0D; Results: Outcomes presented that (62.9%) of the parents showing moderates knowledge of Parents about and nutrition knowledge of children with phenylketonuria during pre-test time, while they show very good close of knowledge through the post-examination time 1 and post-examination time 2.&#x0D; Conclusions: Overall evaluation of Parents’ knowledge about Nutritional Management for Children with Phenylketonuria showing moderate knowledge about nutritional management during pre-test time, their knowledge level is increased to very good through the post-examination time 1 and 2, and a study confirms that older parents are better knowledge.&#x0D; Recommendations: The study recommends that Parents of phenylketonuria children should be very well-oriented and greatly aware about the importance of Nutritional Management. Additional research studies container remains carried out with respect to big sample scope and wide variety variables, particularly, nationwide studies.&#x0D; Key Words: Evaluation, Parents’ Knowledge, Nutritional Management, Phenylketonuria.

Nutritional management of children with acute kidney injury-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce.

The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.

Online Nutritional Management in Children with Congenital Heart Disease in the Context of COVID-19: A Prospective Study

Online Nutritional Management in Children with Congenital Heart Disease in the Context of COVID-19: A Prospective Study

ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

<scp>ISPAD</scp> Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

Evaluation of the use of non-invasive hemoglobin measurement in early childhood.

Iron deficiency anemia in children affects psychomotor development. We compared the accuracy and trend of a non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration (SpHb) by rainbow pulse CO-oximetry technology to the invasive blood Hb concentration measured by an automated clinical analyzer (Hb-Lab). We measured the SpHb and Hb-Lab in 109 patients aged 1-5 years. Regression analysis was used to evaluate differences between the two methods. The bias, accuracy, precision, and limits of agreement of SpHb compared with Hb-Lab were calculated using the Bland-Altman method. Of the 109 enrolled subjects, 102 pairs of the SpHb and Hb-Lab datasets were collected. The average value of measured Hb was 12.9 ± 1.03 (standard deviation [SD]) g/dL for Hb-Lab. A significant correlation was observed between SpHb and Hb-Lab measurements (SpHb = 7.002 + 0.4722 Hb-Lab, correlation coefficient r = 0.548, 95% confidence interval = 0.329-0.615). Bland-Altman analysis showed good visual agreement, with a mean bias between SpHb and Hb-Lab of 0.188 ± 0.919 g/dL (mean ± SD). We concluded that non-invasive Hb measurement is useful for Hb estimation in children and provides new insights as a screening tool for anemia. Our results indicated a good correlation between non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration using a finger probe sensor by rainbow pulse CO-oximetry technology and invasive blood Hb concentration. Although previous studies have indicated that in patients with a worse condition, the bias between the two methods was large, this study, which was conducted on children with stable disease, showed a relatively small bias. Further studies using this non-invasive device might help to understand the current status of anemia in Japan and promote iron intake and nutritional management in children.

Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis

The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2–5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.

Nutritional management in children with disease-related malnutrition : what’s the guideline?

Background: Disease-related malnutrition (DRM) is one of the most common problems in pediatric patients. Both cancer and congenital heart diseases (CHD) are commonly associated with DRM. Altered nutrition utilization, reduced intake, malabsorption, and hypermetabolism are the main pathophysiology in DRM.&#x0D; Method: A systematic literature searching was performed through Pubmed and Google Scholar websites. Thirty-six articles were included into the study.&#x0D; Results: Malnutrition screening should be performed as soon as possible since early feeding can benefit the patients. One of the most commonly used tools is Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), which was proven to be valid, reproducible, and applicable in pediatric patients with malnutrition. Following screening and assessment, nutrition support can ensue, preferably in the form of enteral nutrition, unless contraindicated. Nutrient-dense formula, also known as protein and energy-enriched formula, aims to aid infants to reach nutrition target rapidly and stimulate anabolism. This formula has been studied in various population, mostly infants with CHD and studies showed favorable outcomes with its administration, namely faster improvement, reduced diuretics use and oxygen supplementation, decreased length of hospital stay, and less antibiotic use. Nutrient-dense formula is also safe and well-tolerated.&#x0D; Conclusion: Proper screening and management should be performed with multidisciplinary approach to achieve the best outcome in children with DRM.

Nutritional Management of Children With Neurological Impairment in China: Current Status and Future Directions.

A web-based questionnaire was distributed between November 2020 and January 2021 among Chinese healthcare professionals involved in the clinical management of children with NI. Fifteen questions covering the most relevant aspects of nutritional management and gastrointestinal issues of children with NI were surveyed. A descriptive analysis of responses was performed. A total of 577 healthcare professionals from over 28 provinces in China answered the questionnaire. Anthropometrics were the most used parameters (n = 539) to assess nutritional status. Most respondents (n = 455) indicated weight faltering and/or failure to thrive as definition of undernutrition. Direct observation of meals was considered the recommended method for diagnosing oropharyngeal dysfunction by 542 professionals. Fundoplication was indicated at the time of gastrostomy placement in patients with uncontrolled gastroesophageal reflux disease by 437 respondents. The clinical practice of Chinese healthcare professionals does not completely match the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, probably due to the medical system and the economic, social, and cultural differences. Further studies are needed to improve clinical practice and knowledge. Multidisciplinary approach is crucial to optimize the overall medical care and quality of life for children with NI.

Potassium and fiber: a controversial couple in the nutritional management of children with chronic kidney disease.

Fruit and vegetable intake is commonly discouraged in children with chronic kidney disease (CKD) to avoid hyperkalemia. However, direct evidence in support of this widespread practice is lacking. Furthermore, the resultant restricted fiber exposure may deprive CKD patients from potential health benefits associated with the latter. Therefore, we investigated associations between dietary potassium intake, fiber intake, and serum potassium levels in pediatric CKD. This study is a longitudinal analysis of a 2-year, prospective, multi-institutional study, following children with CKD at 3-month intervals. At each visit, dietary potassium and fiber intake were assessed, using 24-h recalls and 3-day food records. On the same occasion, serum potassium concentrations were determined. Associations between dietary potassium intake, dietary fiber intake, and serum potassium concentrations were determined using linear mixed models. Fifty-two CKD patients (7 transplant recipients, none on dialysis) aged 9 [4;14] years with an estimated glomerular filtration rate (eGFR) of 49 [25;68] mL/min/1.73 m2 were included. For every g/day decrease in dietary potassium intake, the estimated mean daily fiber intake was 5.1g lower (95% confidence interval (CI), 4.3-5.9g/day; p < 0.001). Neither dietary potassium intake (p = 0.40) nor dietary fiber intake (p = 0.43) was associated with circulating potassium in a model adjusted for time point, eGFR, treatment with a renin-angiotensin-aldosterone system blocker, serum bicarbonate concentration, and body surface area. Dietary potassium and fiber intake are closely related but were not associated with circulating potassium levels in pediatric CKD. A higher-resolution version of the graphical abstract is available as Supplementary information.

ISPAD Clinical practice consensus guidelines 2018. Chapter 10: Nutritional management in children and adolescents with diabete

ISPAD Clinical practice consensus guidelines 2018. Chapter 10: Nutritional management in children and adolescents with diabete

Nutritional Management In Children With Congenital Heart Diseases In Zagazig University Children Hospital

ABSTRACT: BACKGROUND: Malnutrition and growth failure is highly prevalent among infants with congenital heart disease. The aim is assessment of nutritional status of children with congenital heart diseases and evaluate impact of nutritional counseling and support for those children.SUBJECTS AND METHODS: This study included 42 children of CHD with undernutrition 19 had cyanotic CHD, 13 had heart failure and 16 had pulmonary hypertension. They were subjected to Medical History, clinical Examination, Cardiological Assessment including Cardiac symptoms, echocardiographic assessment, Nutritional assessment through (nutritional history, calculation of subjective global assay, Full Anthropometric Measures including weight, height, mid arm circumference, triceps skin fold measurement, head circumference) and Nutritional plan was applied to those patients. Follow up visits was done every 2 weeks and patients were reassessed after 2 months.RESULTS: (54.8%) of our cases were of moderate degree of malnutrition while (45.2%) of cases were of severe degree. There was significant improvement in all anthropometric measurements post to nutritional support and there was significant increase in weight all over the study follow up intervals. There was no improvement in length. CONCLUSION: Malnutrition is common in pediatric patients with CHD. It lead to serious complication. Proper nutritional assessment and intervention help improving general condition of them.

Nutritional management in children with congenital heart diseases in Assiut University Children Hospital

Nutritional management in children with congenital heart diseases in Assiut University Children Hospital

Nutritional Management of the Pediatric CKD Patient

Children with chronic kidney disease (CKD) have unique nutritional needs related to decreased kidney function. This review discusses outcomes related to nutritional status in children with CKD. It reviews recommendations specific to children with CKD including nutritional assessment, energy needs, and macro- and micronutrient requirements. In addition, other considerations including supplemental feeding and potential barriers are briefly summarized. While malnutrition has been long associated with CKD, obesity is increasingly being recognized in CKD and may contribute to progression of disease. The practice of dietary potassium restriction is being questioned. Education regarding phosphorus management should include inorganic sources from food additives and preservatives in addition to the usual organic sources of phosphorus. There are emerging options for formula alternatives including blenderized diets that meet the dietary restrictions of this population. Recognizing and addressing food insecurity and providing guidance on cooking techniques may enhance adherence. The nutritional management of children with CKD is complex. An individualized approach by a multi-disciplinary team can help educate and promote success in these lifelong dietary modifications.

Nutritional Management in Child Diarrhea: An Evaluation of Awareness in General Population from Dobrogea Region

Abstract Diet has a major role in the treatment of acute diarrhea in children, along with a minimal drug therapy, but not necessarily using antimicrobials. Children can successfully pas a diarrheal episode with diet and symptomatic treatment. It is important to know how to properly choose foods to introduce in ill children diet. There is a lack of statistical data in our region regarding dietary treatment in child diarrhea. This study was realized by completing a questionnaire regrading nutritional management in children with diarrhea. 110 persons from Dobrogea region completed this questionnaire. We analyzes demographic and clinical issues, people preferences in choosing different foods appropriate to this pathology and minimal knowledge about medication. Our results evidenced that general population knowledges regarding nutritional management of acute diarrheal disease in children and infants are appreciable. Foods like rice, toast, applesauce/baked apple, mint/figs/bilberry leaves teas, vegetables soup, bananas were found among people preferences, proving appropriate information. Antimicrobial drugs misusage is not reported, 83 out of 110 people avoiding them.

Dietetics Practices for Nutritional Management of Children with Cerebral Palsy: A Cross-sectional Study in Saudi Arabia among the Practicing Dietitians

Dietetics Practices for Nutritional Management of Children with Cerebral Palsy: A Cross-sectional Study in Saudi Arabia among the Practicing Dietitians