Nursing Management in Nutrition for Children While Hospitalized

Feeding in General:- * Infants up to school age children have a large demand for calories as evidenced by the rapidly increasing height and weight * Protein and caloric requirements are higher than at almost any period of postnatal development * As growth rate slows down, especially with a decrease in metabolism; there is a reduction in caloric and protein requirements Feeding During Hospitalization:- (pg 650) Loss of appetite is a symptom common to most childhood illnesses (luckily acute illnesses are usually short so nutritional state is seldom compromised) * Refusing to eat may be one way for child to exert power and control NI

Don’t urge food on sick child that may precipitate Nausea and Vomiting( children usually can determine their need for food) * Young children loss of appetite may be related to depression due to separation from parents (and parents’ concern with eating only intensifies the situation) NI: Encourage parents to relax any pressure during acute illness * Children sometimes desire foods and liquids that contain nonnutritional calories NI: Some well-tolerated foods can be given even though they are not nutritious but will provide necessary fluid and calories such as: gelatin, carbonated drinks, ice pops, crackers etc * Dehydration is always a hazard when children have fever or anorexia accompanied by vomiting and diarrhea.

NI: Fluids should not be forced and child should not be awaken to take fluids (same as urging child to take unwanted foods instead gentle persuasion with preferred beverages) NI: Encourage parents or other family members to be present at mealtimes NI: Don’t overwhelm children with food or they will push it away NI: Supervise young children during meals because they tend to play with it rather than eat it NI: Involve children if possible in food selection and preparation NI: Start with small portions at a time and then end with dessert or they will eat dessert first NI: Make food attractive and different eg Use cookie cutter for sandwich NI: Praise children for what they do eat

NI: Don’t punish children for what they don’t eat or by removing their dessert * When child is better, appetite begins to improve NI: Take advantage of hungry period by serving high quality foods and snacks or encourage nutritious fluids if child still refuses to eat * Children prefer to eat food that they are familiar with NI: Have parents bring in food items from home especially if cultural eating habits differ from hospital Post Surgery: * Children placed on special diets such as clear liquids should be assessed of their intake and readiness to be advanced to more complex foods * Accurate amounts consumed should be charted regardless of type of diet and comments such as “ate well” or “ ate poorly” are inadequate.

However a good example of an adequate comment is “Child eats well when with other children but plays with food if left alone in room” Nutritional Assessment: – (knowledge of child’s dietary intake is essential. ) * Dietary history: However it is one of the most difficult factors to assess as individuals recollection of amounts eaten are often unreliable. Therefore a food intake history of children and adolescents is prone to reporting of errors due to underreporting. Nevertheless it is still important to conduct a dietary evaluation. The younger the child, the more specific and detailed the history should be. A Dietary Reference Intakes (DRIs): are a set of 4 nutrient based reference values that provide quantitative estimates of nutrient intake.

They are: * Estimated Average Requirement(EAR)- nutrient intake to meet req of 50% healthy people * Recommended Dietary Allowance (RDA)- avg daily DI to meet req of nearly all(97-98%) * Adequate Intake (AI)- recommended intake level based on est of nutrient intake * Tolerable Upper Intake Level (UL)-highest avg DI level that will pose no risk of adverse health * Anthropometry: measurement of height, weight, head circumference, proportions, skinfold thickness and arm circumference in young children. * Biochemical Tests: assesses nutritional status and common lab procedures to measure nutrition are Hgb, Hct, Transferrin, Albumin, Creatinine, Nitrogen.

Evaluation of Nutritional Assessment: from data assess whether child is malnourished, at risk for becoming malnourished, well nourished with adequate reserves or overweight or obese. Although sick children’s appretites may be poor and not characteristic of their home eating habits, the hospital stay provides numerous opportunities for nurses to asses family’s knowledge of good nutrition and to implement teaching as needed to improve nutritional intake. Healthy Diet (MyPlate):- according to MyPlate it suggests to make half of your plate fruits and vegetables and the other half grains and proteins. Avoid oversized portions, make half your grains whole grains and drink fat-free or low-fat(1%) milk.