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Pediatric Nutrition in Health & Disease
Madhu Sharma
SECTION 1: BASIC NUTRITION
1:
Functions of Food
BALANCED DIET
Principles of Planning a Balanced Diet
2:
Nutrient Requirements
NUTRITIONAL REQUIREMENTS DURING PREGNANCY AND LACTATION
Energy
Protein
Calcium
Iron
Folic Acid
Iodine
Vitamins
Fat Soluble Vitamins
Water Soluble Vitamins
NUTRITIONAL REQUIREMENTS OF INFANTS, CHILDREN AND ADOLESCENTS
Fluids
Energy
Proteins
Fats
Vitamins
Fat Soluble Vitamins
Water Soluble Vitamins
Calcium and Phosphorus
Iron
3:
Nutritional Assessment of Children
ANTHROPOMETRY
THE IAP GROWTH MONITORING GUIDELINES (2006)
DIETARY ASSESSMENT
24-Hour Dietary Recall Method
Food Frequency Method
CLINICAL ASSESSMENT
Dietary Assessment of Infants and Toddlers
Dietary Assessment Techniques
4:
Maternal Nutrition in Pregnancy and Lactation
INTRODUCTION
PRECONCEPTION NUTRITION
NUTRITION DURING PREGNANCY
Nutritional Recommendations During Pregnancy
Energy
Proteins
Gestational Weight Gain
Essential Fatty Acids
MICRONUTRIENTS IN PREGNANCY
Vitamins
Fat Soluble Vitamins
Iron
Zinc
Magnesium
Calcium
Dietary and Environmental Hazards During Pregnancy
Alcohol
Caffeine
Food Additives
Heavy Metals
Hypervitaminosis A
Tobacco
Special Considerations During Pregnancy
Hypoglycemia
Gestational Diabetes
Hypertension and Toxemia of Pregnancy
Lactation Period
Nutritional Needs During Lactation
5:
Nutrition for Premature Infants
MANAGEMENT OF THE PREMATURE INFANT
Goal
Enteral Nutrition
Contraindication for Feeding the Premature Infant
Feeding Protocol
Breastfeeding
Enteral Feeds
Intolerance to Feeding
NUTRITIONAL ASSESSMENT
ANTHROPOMETRIC MEASUREMENTS
Assessing Feed Intolerance
DISCHARGE OF THE PREMATURE INFANT
6:
Feeding of Infants (0–6 Months)
ADVANTAGES OF BREASTFEEDING
COLOSTRUM
FACTORS CAUSING LACTATIONAL FAILURE
EARLY INTRODUCTION OF TOP FEEDS
Mother's Employment
Mother's Problem of the Breast
Engorgement
Duct Obstruction
Mastitis
Sore Nipples
ROLE OF PRELACTEALS
Frequency and Duration of Exclusive Breastfeeding
Artificial/Formula Feeding
Adverse Affects of Bottle Feeding
Burping after Feeding
Duration of Breastfeeding
Breastfeeding During Illness
Breastfeeding Promotion Network of India (BPNI)
The Infant Milk Substitute Act (IMS Act)
Summary of Provision of the Code
7:
Nutrition for Older Children
BUILDING GOOD FOOD HABITS
Diet for the Preschool Child (2–5 Years)
RECOMMENDED NUTRIENTS AND FOOD GROUPS
Diet for School Children (6–12 Years)
WHAT ARE FOOD FADS
HOW TO MEET THE REQUIREMENTS (RIGHT SELECTION)
ANNEXURE
Low Cost Nutritious Recipes
8:
Nutrition for the Adolescent
FACTORS AFFECTING ADOLESCENT EATING PATTERN
Adolescent Related Nutritional Disorders
Obesity
STUNTING AND MALNUTRITION
IRON DEFICIENCY ANEMIA
CALCIUM DEFICIENCY
NUTRITION RELATED DENTAL DECAY
DIET AND VIOLENCE—A NEW DIMENSION
High Calorie (Junk) Malnutrition
Vitamin and Mineral Deficiencies
EATING DISORDERS
Summary of Recommendations in Eating Disorders
High-Risk Groups of Adolescents
Adolescent Pregnancy
Athletes
9:
Nutrition for the Athlete Child
PHYSIOLOGICAL EFFECTS OF EXERCISE
NUTRITIONAL RECOMMENDATIONS
Principles of Healthy Diet for a Sports Child
The Pregame Meal
The Post Meal Diet/Refuelling
Energy
Carbohydrates
Proteins
Fats
Vitamins and Minerals
Fluids
Exercise Recommendations in Specific Age Groups
Newborns—3 years
Ages 3–8 years
Ages 8–12 years
Ages 13–18 years
Ergogenic Aids
10:
Interaction of Nutrition and Infection in Children
INTRODUCTION
SYNERGISM AND ANTAGONISM
Metabolism and Infection
Decreased Food Intake
Decreased Nutrient Intake
Effect of Malnutrition on Infection
Interaction between Malnutrition, Disease and Immunity
Micronutrients and Immunity
Vitamin A
Vitamin C
Iron
Zinc
Effect of Infection on Malnutrition
Intestinal Parasites
Systemic Infections
Infection and Protein Nutrition Status
Infection and Growth and Development
11:
Vegetarianism in Children
ADEQUACY OF VEGETARIAN DIETS
NUTRITIONAL RISKS
Energy
Proteins
Calcium
Vitamin D
Iron
Zinc
Cobalamin (B12)
Meal Planning for a Vegetarian Child
12:
Food Allergies and Intolerances
PATHOGENESIS
COMMON FOOD ALLERGENS
Skin Manifestations of Food Allergy
Respiratory Manifestation of Food Allergy
Manifestations of GIT
Diagnosis of Food Allergy
MAINTENANCE OF FOOD DIARY
Elimination Diet
Oral Food Challenges
PRICK PUNCTURE SKIN TESTING
In Vitro Testing (RAST)
Tests are Positive
Oral Allergy Syndrome
CHINESE RESTAURANTS SYNDROME
SULPHITE SENSITIVITY
AURICULOTEMPORAL SYNDROME (FREY SYNDROME)
HEINER SYNDROME
ANAPHYLAXIS
CELIAC DISEASE
ALLERGIC EOSINOPHILIC GASTROENTERITIS
INFANTILE PROCTOCOLITIS
MIGRAINE
TREATMENT/MANAGEMENT
RECOGNIZING ALLERGIES IN CHILDREN
13:
Vitamin A Deficiency in Children
FUNCTIONS OF VITAMIN A
Growth
Role in Monitoring Healthy Epithelial Tissues
Red Cell Production
Antioxidant or Immune Functions
Pathogenesis
DEFICIENCY SIGNS OF VITAMIN A
Night Blindness (XN)
Conjunctival Xerosis (XIA)
Bitot's Spots (XIB)
Corneal Xerosis (X2)
Keratomalacia (X3B)
Vitamin a Deficiency in Specific Conditions
HYPERVITAMINOSIS A
Target Group for Vitamin A Supplementation
Requirements
Prevention of Vitamin A Deficiency
TREATMENT
Some Controversies About Vitamin A
Vitamin A, Beta Carotene and Cancer
Vitamin A and Osteoporosis
14:
Nutritional Anemia in Children
IRON DEFICIENCY ANEMIA (IDA)
Functions of Iron in the Body
In the Blood
In Muscle Tissue
Definition
Clinical Features of Iron Deficiency Anemia
Implications of Iron Deficiency Anemia
Failure to Thrive/Growth Retardation
Activity
Temperature Regulation
Mental and Psychomotor Response
Immune Response
Maternal Iron Deficiency
Gastrointestinal Affects
Etiology of Iron Deficiency
Inadequate Intake or Absorption
Increased Losses
Increased Demands
TREATMENT OF IDA
Meat, Fish and Amino Acids
Prevention of Iron Deficiency
Folate and B12 Deficiency—Megaloblastic Anemia
Folate Deficiency
Causes of Deficiency
CLINICAL MANIFESTATION
Vitamin B12 Deficiency/Cobalamin (Pernicious Anemia)
Clinical Manifestations
15:
Iodine Deficiency Disorders in Children
FUNCTIONS OF IODINE
IN ENERGY METABOLISM
GROWTH AND DEVELOPMENT
IN PREGNANCY AND LACTATION
Metabolism of Iodine
Spectrum of IDD
Goiter
Cretinism
Hypothyroidism
Psychomotor Defects
Imparied Mental Function
Assessment of IDD in a Community
Classification of IDD
Causes of IDD (Antithyroid Factors)
Antithyroid Compounds in Foods
Prevention of IDD
IODINE FORTIFICATION
Certain Points to be Considered While Using Iodized Salt
Iodized Oil Injecions
Iodine Tablets
Iodized Water
IDD the Indian Scenario
DIETARY SOURCES OF IODINE
16:
Zinc in Infant Nutrition
METABOLISM
Zinc Requirements
Implications of Zinc Deficiency
Zinc Status in Pregnancy
Zinc and Childhood Infections
Zinc Toxicity
Dietary Sources of Zinc
CONCLUSION
17:
Role of Other Micronutrients in Children
POTASSIUM
Functions
Potassium Deficiency
Signs and Symptoms of Potassium Deficiency
Requirements
Sources of Potassium
CALCIUM
Functions of Calcium
Risk Factors of Calcium Deficiency
Role in Infants
Role in Children
Role in Preadolescence and Adolescence
Calcium Requirements
Dietary Sources of Calcium
MAGNESIUM
Deficiency of Magnesium
Signs and Symptoms of Magnesium Deficiency
Requirements
Dietary Sources of Magnesium
VITAMIN D
Functions of Vitamin D
Vitamin D Deficiency
Requirements of Vitamin D
Sources of Vitamin D
18:
Nutrition Counseling—Role in Children
INTRODUCTION
GOAL
Nutrition Counseling Characteristics
Learning Process in Children
Attention
Perception
Memory
Thinking
Problem Solving
Counseling Techniques
Step 1: Assess
Step 2: Advise
Step 3: Agree
Step 4: Assist
Step 5: Arrange
Principles of Counseling
The Counseling Process
Assessing Dietary Habits
Identifying Changes Required
Setting Goals
Making Dietary Changes
Identifying Barriers to Change
Finding Support
Maintaining Changes
Counseling the Child
Role of the Parent
Cultural Influence
Feeding Relationships
Psychosocial Relationship with the Child
Model Behavior
Counseling the Child with Special Needs
19:
Probiotics—Role in Child Health
INTRODUCTION
Source of Probiotics
Probiotics—Criteria
Mechanism of Action
Clinical Uses
In Infants
Diarrheal Diseases
Allergy
Lactose Intolerance
Probiotic Food Supplements
Disadvantages of Probiotics
20:
Nutrition for Dental Health in Children
TOOTH DEVELOPMENT AND STRUCTURE
NUTRITIONAL INFLUENCE ON THE PRE-ERUPTED TEETH
ROLE OF SPECIFIC NUTRIENTS ON TOOTH MATURATION
Demineralization and Remineralization—Role of Fluoride
Dental Caries
Dental Erosion
Prevention of Dental Caries
SECTION 2: NUTRITION IN DISEASE
21:
Diet in Fever and Infections
PATHOGENESIS
Dietary Management
Energy
Proteins
Carbohydrates
Fats
Minerals
Vitamins
Fluids
Factors Involved in Feeding
Diets in Specific Conditions
Tuberculosis
Enteric Fever
Viral Hepatitis
22:
Enteral Nutrition in Hospitalized Patient
INDICATIONS FOR ENTERAL NUTRITION SUPPORT IN CHILDREN
Nutritional Requirements in Enteral Nutrition
Properties of an Enteral Feed
Nitrogen : Calorie Ratio
UNIFORMITY
Osmolality
Contraindications of Enteral Nutrition
Routes of EN
Nasogastric Feeding (NG Feeding)
Nasojejunal Feeding (NJ Feeding)
Gastrostomy Feeding
Methods of Administration of EN
Initiation of Advancement of Feeding
General Considerations
Continuous Drip Feeding
Complications of EN
Mechanical Complications
GI Complications
Metabolic Complications
23:
Protein Energy Malnutrition
24:
Childhood Obesity
DEFINITION OF CHILDHOOD OBESITY
What is BMI
What is a BMI Percentile
Pathogenesis of Childhood Obesity
Genetic Factors
Early Feeding vs. Obesity Risk
Metabolic Factors
Environmental/Lifestyle Factors
Other Factors
Assessment of Obesity
History
Management of Childhood Obesity
Socio Economic Status (SES)
Food Consumption and Eating Pattern
Food Availability
Food Preferences and Child Feeding Practices
Social Learning Environment/Early Learning
Parental Role
CONCLUSION
25:
Management of Severe Acute Malnutrition
DIAGNOSIS OF SAM
ADMISSION
In Patient Treatment
Phase 1
Phase 2 (Transition Phase)
DISCHARGE
FOLLOW-UP
FAILURE TO RESPOND
Problems of Individual Children
CRITERIA TO ASSESS FAILURE TO RESPOND
26:
Nutrition in Diarrheal Diseases
INTERACTION BETWEEN DIARRHEAL DISEASES AND MALNUTRITION
Oral Rehydration Therapy (ORT)
Dietary Management
Nutritional Management of Persistent Diarrhea
Pathogenesis of Persistent Diarrhea
DIETARY MANAGEMENT
27:
Diet in Constipation
IDIOPATHIC/FUNCTIONAL CONSTIPATION
MANAGEMENT
Medical Causes of Constipation
Surgical Causes of Constipation
Management of Constipation
DISIMPACTION
MAINTENANCE THERAPY
BEHAVIORAL THERAPY
FOLLOW-UP
28:
Diet in Inflammatory Bowel Disease
CROHN'S DISEASE (CD)
Ulcerative Colitis (UC)
INCIDENCE
AGE OF ONSET OF INFLAMMATORY BOWEL DISEASE
PATHOGENESIS
NUTRITIONAL IMPLICATIONS OF IBD IN CHILDREN
NUTRITIONAL MANAGEMENT OF IBD
GOALS OF MANAGEMENT OF CROHN'S DISEASE AND ULCERATIVE COLITIS
Crohn's Disease
Elemental Diets
NUTRITIONAL DEFICIENCIES
Ulcerative Colitis
Summary of Dietary Support for IBD in Children
Sample Menu for Children with IBD
29:
Nutrition Support in Short Bowel Syndrome
ETIOLOGY
PATHOPHYSIOLOGY
Nutritional Management in Short Bowel Syndrome
Stage 1
Stage 2
Role of Breast Milk
Electrolytes, Vitamins and Mineral Supplementation
Role of Fiber and Glutamine
Stage 3
Stage 1: PN
Stage 2: EN
Stage 3: Semi Solids
Nutritional Complications in SBS
30:
Nutritional Management in Celiac Disease
INCIDENCE
PATHOGENESIS—WHAT IS GLUTEN?
CLINICAL FEATURES OF CD
DIAGNOSTIC CRITERIA
AGE OF PRESENTATION
MANAGEMENT OF GFD
GOALS OF NUTRITIONAL THERAPY
COMPLIANCE ON GFD
Duration of Treatment/Follow-Up
GLUTEN CHALLENGE
FACTORS AFFECTING GLUTEN SENSITIVITY
COMPLICATIONS OF CELIAC DISEASE
Celiac Crisis
RECIPES FOR GLUTEN FREE DIET
Gram Laddoo
Chidwa Barfi
Chidwa Laddoo
Dosa
Sago Kheer
Rice Pura
Idli
SAMPLE MENU FOR GLUTEN FREE DIET
Breakfast
Midmorning
Lunch
Evening
Dinner
Bedtime
31:
Nutritional Support in Cystic Fibrosis
CLINICAL PRESENTATION
Pancreatic Insufficiency
Chronic Respiratory Involvement
Gastroesophageal Reflux
Growth Failure
CAUSES OF MALNUTRITION
Nutrition: A Risk Factor
Energy Losses
Increased Energy Expenditure
Low Energy Intake
GOALS OF NUTRITIONAL MANAGEMENT
Nutritional Support
Energy
Proteins
Fats
Carbohydrates
FEEDING OF INFANTS
Breast Milk
Feeding of Older Children
Electrolyte Supplementation
Vitamin and Mineral Supplements
Trace Elements
Route of Feeding
Pancreatic Enzyme Supplementation
Dosage of PES
Infants
Older Children
Administration of PES
General Guidelines for Use of PES
COMPLICATIONS OF CYSTIC FBROSIS
Diabetes Mellitus
Celiac Disease
ROLE OF FUNCTIONAL FOODS IN CYSTIC FIBROSIS
Fish Oil
Turmeric
32:
Diet in Liver Diseases
HEPATITIS
Management
CIRRHOSIS OF LIVER
INDIAN CHILDHOOD CIRRHOSIS
Etiology/Source
Management
Prevention
33:
Diet in Kidney Diseases
NEPHROTIC SYNDROME
Manifestation
Dietary Modifications in Nephrotic Syndrome
Fluids
Proteins
Sodium
Calories
Potassium
ACUTE RENAL FAILURE
Nutritional Management
Fluids
Proteins
Calories
Sodium
Potassium
CHRONIC RENAL FAILURE
Nutritional Management
Energy
Protein
Fluids
Sodium
Potassium
DIALYSIS
NUTRITIONAL MANAGEMENT OF TRANSPLANT PATIENTS
34:
Inborn Errors of Metabolism
PHENYLKETONURIA
DIAGNOSIS
DIETARY MANAGEMENT
ATYPICAL PHENYLKETONURIA
Green List
GALACTOSEMIA
Clinical Presentation
Dietary Management
Duration of Dietary Treatment
FRUCTOSEMIA
FRUCTOSE FREE DIET
MAPLE SYRUP DISEASE
Dietary Management
HOMOCYSTINURIA
Dietary Modifications
WILSON'S DISEASE
Dietary Modifications
35:
Nutritional Support in Juvenile Diabetes Mellitus
DIAGNOSIS/PRESENTATION
MEDICAL NUTRITION THERAPY IN TYPE I DIABETES MELLITUS
GOALS OF NURITION THERAPY
CARBOHYDRATE DISTRIBUTION FOR JUVENILE DIABETICS (CARBOHYDRATE COUNTING)
GLYCEMIC INDEX
Fiber
Proteins
Fat
Sodium
SUCROSE FOR DIABETIC CHILDREN
SWEETNERS
INSULIN REGIME AND DIET PLAN
EXERCISE AND HYPOGLYCEMIA
CONSIDERATIONS IN DIFFERENT STAGES OF CHILDHOOD
Infants
TODDLERS
SCHOOL CHILDREN
ADOLESCENTS
COMPLICATIONS OF DIABETES MELLITUS
Hypoglycemia
Diabetic Ketoacidosis
Illness and Hyperglycemia
Hypertension
SOMOGYI AND DAWN EFFECT
Nutrition Counseling and Follow-Up
ANNEXURE
1000 Calories Diabetic Diet
Percentage Distribution of Calories
Sample Menu
1200 Calorie Diabetic Diet
Percentage Distribution of Calories
Sample Menu
1400 Calorie Diabetic Diet
Percent Distribution of Calories
Sample Menu
1600 Calories Diabetic Diet
Percentage of Calories
1800 Calories Diabetic Diet
Percentage Distribution of Calories
Sample Menu
2000 Calories Diabetic Diet
Percentage Distribution of Calories
Sample Menu
36:
Dietary Management in Hypoglycemia
GLYCOGEN STORAGE DISEASE TYPES III AND VI
Debrancher Enzyme Deficiency
Leucine Sensitive Hypoglycemia
Ketotic Hypoglycemia
37:
Nutritional Support of the Critically Ill Child
INTRODUCTION
Nutritional Assessment
Indications for Nutrition Support in the ICU
GENERAL GOALS AND PRINCIPLES
Goals of Nutritional Support
Principles of Nutritional Support
Macronutrients (Calories and Protein Requirement)
Administering Nutrition
Enteral Nutrition
Parenteral Nutrition
MONITORING
Specialized Dietary Foods in the ICU
38:
Nutritional Management of Pediatric Heart Diseases
INTRODUCTION
CONGENITAL HEART DISEASE
Etiology
Factors Affecting Growth Failure in CHD
Management of CHD
Neonatal Period
Energy
Fluids
PEDIATRIC DYSLIPIDEMIAS
Management of Dyslipidemia
39:
Nutrition Support in Children with HIV/AIDS
40:
Nutritional Management of Cancer and Bone Marrow Transplant in Children
INTRODUCTION
Nutritional Implications of Cancer in Children
Protein Energy Malnutrition
Nutritional Assessment
Cachexia in Cancer
Adverse Effects of Cancer Therapy on Nutritional Status in Children
Chemotherapy
Surgery
Radiation
Nutritional Support for Children with Cancer
Route of Feeding
Oral Feeding
Enteral Feeding
Parenteral Nutrition
MARROW TRANSPLANT
Post-Transplant Course
Complications of Marrow Transplant
Graft vs Host Disease
41:
The Ketogenic Diet in Management of Epilepsy
HISTORY OF KETOGENIC DIET
The Story of Charlie
Mechanism of Action of KD
Selection of Patients for Ketogenic Diet
Type of Epilepsy
Age of the Patient
Motivation/Compliance
Failure of AEDs
Literacy and Socioeconomic Factor
Other factors
Initiating Ketogenic Diet
Phase 1
Phase 2
Phase 3
Diet Calculations
Planning of Recipes
Considerations or Special Categories of Patients
Fine Tuning of Ketogenic Diet
Tube Feeding of KD
Phase 4
Side Effects on KD
Long-Term Side Effects
Important Factors to be Considered on KD
The MCT Keto Diet
Discontinuation of Diet
Modified Atkins Diet
The Low Glycemic Index Treatment
INDEX
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