Therapeutic Pediatric Nutrition Madhu Sharma
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1Therapeutic Pediatric Nutrition
Let thy food be thy medicine and thy medicine be thy food
—Hippocrates
23Therapeutic Pediatric Nutrition
Madhu Sharma MSc Foods and Nutrition Dietician Department of Pediatrics Advanced Pediatric Center Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Foreword BNS Walia
4Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
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Therapeutic Pediatric Nutrition
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2011
9789350252628
Typeset at JPBMP typesetting unit
Printed at
5Dedicated to
The memory of my beloved late parents, whose encouragement and aspirations inspired me to achieve what I have today6
7Foreword
Diet and disease are intimately related. Diet modifcation and diet restriction has been practised since the birth of medicine. As our understanding of altered physiology of the body in disease state has improved with new research, dietetics has become a more and more scientifc profession, rather than being just a catering and diet presentation service in a hospital setting (which unfortunately is still practised in some hospitals).
This book is a compendium of more than two decades of experience of Madhu Sharma in the pediatric section of a leading institution in India. The complex and serious clinical problems that enter the portals of this institution, require a coordinate effort by a multidisciplinary team of experts to restore a sick child to health and put him back to the path of normal health and development. In modern era, technical skill and recent advances in therapeutics often attract more attention, sometimes to the detriment of holistic medical care. It is often forgotten that care of a disease, does not necessarily ensure future health, which depends essentially upon good nutrition.
This book covers dietetic management of common as well as uncommon diseases of childhood. Each chapter is complete in itself and delineates in detail, every aspect of therapeutic dietetics, covering physiological background, pathogenesis of factors leading to nutritional disorders, nutritional requirements in the particular disease entity, the scientifc basis of the menu planning and development of recipes, to provide the calculated amounts of nutrients in a palatable form.
Although every chapter follows the same scheme of presentation, the chapters on diabetes mellitus, kidney disorders, celiac disease and enteral feeing need special mention as examples of sound instructions. Rare disorders like inborn errors of metabolism are also covered. The nutritional aspects of a child in the intensive care are not neglected.
The rationale of every recommendation is firmly based on scientifc data. Numerous tables in the text summarize the important recommendations, whereas the references reflects the extensive study based upon which the book is founded. The recipes display the experimental spirit of the author, who presents the selected dishes which are acceptable to children, are home-based and therefore affordable.8
I consider the book to be a most comprehensive collection of current thoughts on therapeutic dietetics for the sick child. It should be on the shelf of every medical library, pediatricians, pediatric nurses and hospital dieticians. Every one of them will benefit from the insights of the experienced author on what to feed a sick child and how to offer it. The book will serve a great need in promoting early recovery and sustain growth of the sick child, especially those suffering from complex or chronic diseases.
BNS Walia
Emeritus Professor Pediatrics
Former Director
Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh, India
9Preface
He that takes medicine and neglects diet, wastes the skill of a physician
—Chinese Proverb
In my earlier book Basic Pediatric Nutrition, I had dealt with issues of feeding a normal, disease-free child and ways of maintaining a healthy diet pattern. But, there is also another angle to nutritional issues of children that being the type of nutrition required for the sick child.
Often, it is observed that children during illness lose appetite and are unable to eat optimally. However, their requirements actually increase during illness due to the catabolic state that they are in, and hence, providing the right diet to the child becomes a great challenge. Besides, there are a number of diseases encountered among children, where dietary restrictions are required, e.g. in malabsorptive conditions like celiac disease, cystic fibrosis or even infammatory bowel disease. Treatment of celiac disease comprises only dietary modifcations and so it is the case of cystic fibrosis. Constipation in children is one of the most common problems encountered by pediatricians and dieticians. In fact, it could be a consequence of faulty diet pattern itself, which requires appropriate dietary counseling of the parents or caregivers.
There are an increasing number of children presenting with Type II diabetes of childhood. As with adults, along with insulin, management is based on what and how much a child should eat. In fact, most often, the dose of insulin also needs to be based on the dietary intake of the child. This is where the role of medical nutrition therapy comes in. There is another very common entity prevalent in children, that of seizures or epilepsy as it is largely known. In cases of uncontrolled seizures, it is a type of specifically calculated and designed diet regimen—the ketogenic diet which is known to control such seizures effectively.
Information regarding therapeutic dietary regimens for children is available in a number of books as part of larger chapters or along with those applicable to adults. In this book, an attempt has been made to deal with diseases related specifically to the pediatric population and discuss all common as well as not so common diseases in a single compilation. Besides, care has been taken to deal with the therapeutic aspects in a simple and easily comprehensible format.10
I hope this book shall be of great help to all students of Nutrition and Dietetics, as also nurses and clinicians associated with some nutritional care of a pediatric population. It would also serve as a useful guide for all trainers involved in the teaching of nutrition in colleges and other health care institutions.
Madhu Sharma
11Acknowledgments
I wholeheartedly acknowledge the inspiration received by Dr Walia to continue my effort to bring out a sequel to my first book on Basic Pediatric Nutrition for the benefit of all those closely associated with pediatric nutrition. His valuable suggestions from time to time during the writing of the manuscript have helped me shape my small endeavor to give shape to this compilation. I also thank all my friends and colleagues for their constant support and encouragement to complete this book. The help provided by my student Saloni in organizing the manuscript in the soft copy is highly appreciated.