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Child Health Nursing Partnering with Children & Families. Kristine Ruggiero CPNP, MSN, RN. Chapter 9 Nutrition pp 318-344. © 2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458. Child Health Nursing: Partnering with Children & Families

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Child health nursing partnering with children families

Child HealthNursingPartnering withChildren & Families

Kristine Ruggiero CPNP, MSN, RN

Chapter 9

Nutrition pp 318-344

© 2006 Pearson Education, Inc.

Pearson Prentice Hall

Upper Saddle River, NJ 07458

Child Health Nursing: Partnering with Children & Families

By Jane W. Ball and Ruth C. Bindler


Nutrition
Nutrition

  • Overview:

    • Nutritional Needs

      • Infancy

      • Todlerhood

      • Preschool

      • School age

      • Adolescence

      • Nutritional challenges

    • Nutritional assessment

      • Physical and behavioral measurement

    • Common nutritional concerns

      • Overweight and obese

      • Collaborative care

      • Dietary deficiencies (iron, ca, vit d, folic acid, protein-energy)

    • Feeding and eating disorders

      • Pica

      • Ftt


Nutritional concepts
Nutritional concepts

  • Nutrition:

    • Taking in food and assimilating it metabolically for use by the body.

  • Macronutrients:

    • Major building blocks

    • Carbohydrates, proteins and fats

  • Micronutrients:

    • Substances needed in small quantities for health body functioning.


Carbohydrates
Carbohydrates

  • Energy source: composed of carbon, hydrogen, and oxygen.

  • Saccharides (sugar molecules)

  • 50% of daily calories

  • Fiber= indigestible carbohydrate components, ensures healthy movement of fecal matter thru bowel


FIGURE 9–16While a child’s nutritional status influences health, it is also important to consider conditions that may affect the child’s nutrition and include this knowledge in your assessment.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Proteins
Proteins

  • Amino acid compounds

  • 9 essential and 12 nonessential amino acids

  • Catabolism and anabolism

  • Nitrogen balance

  • Deficiency disorders


Fats

  • Energy source

  • Cellular processes and blood clotting

  • Fatty acids

    • Saturated

    • Unsaturated

      • Monounsaturated

      • Polyunsaturated


Glycemic index
Glycemic Index

  • The blood glucose response to 50g of carbohydrate from any specific food as compared to the glucose level after ingestion of white bread

  • Low glycemic index has been found to have beneficial effects such as reducing serum lipids, insulin levels and improving serum glucose control


How are nutritional needs of the infant different from the adult
How are nutritional needs of the infant different from the adult?

  • Increased energy expenditure

  • Rate of growth: doubles by 6 months, triples by 1 year

  • Organ size and immaturity

  • Physiological changes


Nutritional needs preterm and sga infants
Nutritional Needs: Preterm and SGA Infants adult?

  • Preterm (<37 weeks) and SGA (<2700 g) infants

  • Medical problems

  • Immature body systems

  • High calorie/kg intake to provide energy for necessary weight gain; may need up to 140 kcal/kg/day


Nursing strategies for preterm and sga infants
Nursing strategies for Preterm and SGA infants adult?

  • Specialized feeding methods

    • Parenteral nutrition

    • Gavage/ tube feedings

    • Transition to oral feedings

  • Assist families w/ teaching feeding methods

  • Assessment of growth and development


FIGURE 9–3 adult?This premature baby cannot yet coordinate suck and swallow. Gavage feeding is being used until the baby can effectively acquire nutrients.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Nutritional needs term newborn
Nutritional Needs: Term Newborn adult?

  • Infants need minimum of 120 cal/kg/day to maintain weight and growth

  • 20 cal/oz is the usual calories found in formula

  • Feedings/day q3-4 hrs= 6-8 feedings/ day


Question
Question… adult?

  • How much formula would an infant who weighs 4.3 kg need at each feeding if they feed every 4 hours?


Answer let s break it down
Answer… adult?Let’s break it down

  • 1. Infant weight in kg is multiplied by 120 calories/ number of feedings per day

    • Baby weight= 4.3 kg

  • 2. Calories needed/day= 4.3 x 120

    • Calories needed/day= 516 calories/ day

  • 3. calories needed per feeding= 516/6

    • Calories needed per feeding= 86

  • 4. ounces per feeding= calories needed per feed/number of calories per ounce of formula

    • 86/20= 4.3 ounces/ feeding


Breast and formula feedings
Breast and Formula Feedings adult?

  • Breast milk: advantages include:

    • Excellent nutrition

    • Promotion of GI function

    • Fostering immune defense

    • lower incidence of OM’s, Type 2 Diabetes, and obesity

    • Psychological benefits

    • Economic advantage


Breast feeding
Breast Feeding adult?

  • Nursing role:

    • Includes education, and encouragement to foster breastfeeding

    • Help mothers to have positive experience w/ Breastfeeding

      • Encouragement

      • Lactation consultant/ group support


Contraindications to breastfeeding
Contraindications to breastfeeding adult?

  • Chemotherapy

  • Active untreated maternal TB

  • Maternal HIV/AIDS

  • Maternal primary herpes in the breast

  • Certain medications (chloramphenicol)

  • Use of alcohol and recreational drug abuse


FIGURE 9–4 adult?Breastfeeding offers many physical and emotional benefits for the infant. This new mother is learning to breastfeed her baby. How can nurses encourage mothers to have positive breastfeeding experiences?

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Formula feeding infants newborn 6 months
Formula Feeding Infants adult?(newborn- 6 months)

  • Types of formulas

    • Ready to feed, powder, and concentrate (p 323, Table 9-7)

  • Specialized formulas for specific needs (PKU, allergies)

  • Nursing strategies

    • Education

    • Partent-infant relationship

    • Prevention of early childhood caries


Introducing solid foods
Introducing solid foods adult?

  • When is an infant ready to begin solid foods?

    • 4-6 months of age

    • Introduction of foods b/f or after this period increases risk of food allergies

  • Readiness for solid foods

    • Extrusion reflex, swallowing

    • Sitting skills

    • Interest


FIGURE 9–5 adult?The baby who has developed the ability to grasp with thumb and forefinger should receive some foods that can be held in the hand.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Infants age 6 12 months developmental readiness
Infants age 6-12 months adult?Developmental Readiness

  • Initial introduction of foods

    • Appropriate first foods: rice cereal

  • Weaning occurs at 12 months

  • Longer bottle feeding increases

    • Dental caries

    • Otitis media

    • allergies


General nutrient requirements of an infant
General nutrient requirements of an infant adult?

  • Introduction of whole milk at 1 year, and low-fat milk at 2 years

  • Fluoride supplements at 6 months if not in water

  • Iron enriched cereals should be started first

  • New foods added gradually

  • Introduce veggies b/f fruits

  • No honey b/f 1 year…infant botulism


FIGURE 9–6 adult?Early childhood caries. This child has had major tooth decay related to sleeping as an infant and toddler while sucking bottles of juice and milk. Courtesy of Dr. Lezley Mcllveen, Department of Dentistry, Children’s National Medical Center, Washington, DC.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Feeding 9 12 months
Feeding 9-12 months adult?

  • Finger foods

  • Peeled fruit

  • Cheese and soft cooked vegetables

  • Delay introduction of peanuts/ peanut butter until 1 year of age (unless h/o allergies in family, then 3 years of age)

  • No yolks until 8-10 months of age, or whole eggs until 1 year of age

  • Carbs and fats needed for energy and growth

  • Introduction of a cup (b/t 8-9 months)


Nutritional needs of the toddler
Nutritional needs of the toddler adult?

  • Remember developmental level

    • Goal is to gain control of bodily functions

  • Physiologic anorexia

  • Nutritional needs

    • Restrict fat to less than 30% of calories

      • Low fat milk (2%)

    • Adequate protein


FIGURE 9–7 adult?Toddlers should sit at a table or in a high chair to eat, to minimize chance of choking and to foster positive eating patterns.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Nutritional needs of the preschooler
Nutritional needs of the preschooler adult?

  • Food jags (eating only a few foods for a few days of weeks)

  • Socialization (associative play)

  • Help with food preparations

  • Dental care

  • Meal and snack patterns

  • Nutritional requirements


FIGURE 9–8 adult? Preschoolers learn food habits by eating with others. Engaging them in food preparation enhances knowledge of food and promotes intake at meals.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Nutritional needs of the school age child
Nutritional needs of the school-age child adult?

  • Appropriate food choices

  • School involvement

  • Growth spurts

  • Dental care


Nutritional needs of the adolescent
Nutritional needs of the adolescent adult?

  • Growth rate

  • Calorie needs

  • Mineral and vitamin needs

  • Food choices


Nutritional assessment
Nutritional assessment adult?

  • Family history

  • Developmental history

  • Medical history

  • Physical examination of growth parameters

    • Height

    • Weight

    • Head circumference


Assessment of growth
Assessment of Growth adult?

  • Measure using appropriate tools

    • Growth charts

      • Gender specific

      • Pre-term or specific medical conditions


FIGURE 9–10 adult?The nurse accurately measures the child and then places height and weight on appropriate growth grids for the child’s age and gender.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


FIGURE 9–11 adult?Growth chart with first few entries in same channel and then a change indicated. The growth for the child indicated on this chart remained steady and in the same channel (75th percentile) for some months. Then the weight measurement decreased to another channel. What kind of dietary assessment will you complete with the parents? What could be the possible causes?

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Nutritional assessment includes physical assessment and lab findings
Nutritional assessment includes physical assessment and lab findings

  • H&H

  • Blood Chemistry

  • Lipid Profile

  • Renal and Liver function tests


Nutrition assessment
Nutrition Assessment findings

  • Dietary intake

  • 24 hour food recall

  • 3 day food history

  • Genogram to recognize nutrtional risk (heart disease and hypertension)


Overweight and obesity
Overweight and Obesity findings

  • Public health epidemic in US

  • Increasing incidence

  • Factors influencing obesity include:

    • Genetics

    • Psychological

    • Environmental (excessive TV, lack of exercise, % of calories from fat)


Obesity by the numbers
Obesity by the numbers findings

  • Childhood obesity has reached epidemic levels in developed countries.

  • Twenty five percent of children in the US are overweight and 11% are obese. About 70% of obese adolescents grow up to become obese adults

  • US children at risk for being overweight= 25%

  • Overweight + obese children in US= 15%

  • Increase in obesity since 1960= 300%


Overweight and family history
Overweight and Family History findings

  • When a child has one obese parent, chances of the child being overweight are increased by 220%. In families where both parents are overweight, the incidence of obesity in children increases by 320%.

  • Finally, the child who has obese parents, and is overweight as an adolescent has an 80% risk of being an obese adult


Definitions of obesity and overweight
Definitions of Obesity and Overweight findings

  • The Center for Disease Control and Prevention defined overweight as at or above the 95th percentile of BMI for age and "at risk for overweight" as between 85th to 95th percentile of BMI for age.


Treatment of obesity
Treatment of obesity findings

  • Medical treatment and referrals

  • Nutrition and behavioral counseling

  • Treat family

    • Focus on family environment

  • Nonjudgmental support

    • Focus on concern for health, not appearance


Treatment of obesity1
Treatment of obesity findings

  • Discourage food as a reward

  • Encourage healthy eating patterns

    • Family meals around table

  • Plan for small changes one at a time

  • Decrease sedentary behavior

    • Decrease tv time to 2 hrs/day


Specific dietary deficiencies
Specific Dietary Deficiencies findings

  • Calcium

  • Iron

  • Vitamin D:

    • Rickets

  • Folic acid:

    • Prevention of neural tube defects and cleft defects


PICA findings

  • Ingestion of nonfood substances or atypical ingestion of foods

  • Pregnant women and young children

  • Commonly ingested substances

    • Lead paint

    • Soil contaminated by lead based gas fumes

  • Strong association w/ anemia

  • Treatment


What is failure to thrive
What is failure to thrive? findings

  • Organic vs Non-organic FTT:

    • Nonorganic, NOFTT; also called psychosocial failure to thrive

      • is defined as decelerated or arrested physical growth (height and weight measurements fall below the fifth percentile, or a downward change in growth across two major growth percentiles) associated with poor developmental and emotional functioning. Usually occurs in a child younger than 2 y.o w/ no known medical condition

    • Organic failure to thrive

      • occurs when there is an underlying medical cause.


FIGURE 9–14 findingsInfants with failure to thrive may not look severely malnourished, but they fall well below the expected weight and height norms for their age. This infant, who appears to be about 4 months old, is actually 8 months old. He has been hospitalized for feeding disorder of infancy.

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

© 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.


Ftt treatment
FTT Treatment findings

  • Based on individual child

  • Management:

    • Assessment and case findings

      • Infant/ child family hx

      • Paren (caregiver)- child interactions

      • Adult and feeding behaviors

    • Nursing Diagnoses

    • Planning and implementation

      • Monitor intake and growth patterns

      • Teach nutrition and feeding strategies

      • Observe feeding and parent-child interactions


Any s
Any ???s findings

Special thanks to Lorraine Murphy for helping write and give this lecture


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