Pediatric Nutritional Support

Nutritional Assessment - Sizing Up Kiddos

• WHO Growth Charts (Z-scores):
  • Key indices: WAZ (Weight-for-Age), HAZ (Height-for-Age), WHZ (Weight-for-Height), BAZ (BMI-for-Age).
  • Moderate malnutrition: Z-score < -2 SD.
  • Severe malnutrition: Z-score < -3 SD.
• MUAC (Mid-Upper Arm Circumference, 6-59 months):
  • Severe Acute Malnutrition (SAM): < 11.5 cm.
  • Moderate Acute Malnutrition (MAM): 11.5 cm to < 12.5 cm.
• Biochemical Markers:
  • Albumin: Chronic indicator ($t½$ ~20 days); ↓ in chronic states.
  • Prealbumin (Transthyretin): Acute indicator ($t½$ ~2 days); better for monitoring response to nutritional support.
  • ⚠️ Both affected by inflammation, infection, and liver/renal disease.

⭐ WHZ (Weight-for-Height Z-score) is the most sensitive indicator for diagnosing acute malnutrition (wasting).

Energy & Macronutrients - Fueling Tiny Engines

• Energy Needs (EER):
  • Use WHO/Schofield equations: $EER = \text{formula based on age, sex, weight, activity}$.
  • Approx. RDA: Infants (0-6m) 100-120 kcal/kg/d; Children (1-3y) 80-100 kcal/kg/d.
• Protein:
  • Infants (0-12m): 1.5-2.5 g/kg/day.
  • Older children (>1y): 1 g/kg/day.
• Carbohydrates: 45-65% total energy.
• Fats: (Essential for brain development)
  • Infants (<2y): 30-40% total energy.
  • Children (>2y) & Adolescents: 25-35%.
• Maintenance Fluids (Holliday-Segar):
  • $Fluid = 100 \text{ml/kg for first } 10\text{kg} + 50 \text{ml/kg for next } 10\text{kg} + 20 \text{ml/kg for rest}$.

  ⭐ For catch-up growth, energy needs can increase by 20-50% above RDA.

Micronutrients & Deficiencies - Vital Tiny Sparks

Enteral & Parenteral Nutrition - Tubes & Veins

• Enteral Nutrition (EN): "If gut works, use it!" 📌
  • Indications: Functioning GI, inadequate oral intake.
  • Contra: GI obstruction, severe ileus, shock, NEC.
  • Feeds: Polymeric (intact gut), Semi-elemental (maldigestion), Elemental (severe malabsorption).
  • Complications: Aspiration, diarrhea, tube issues.
• Parenteral Nutrition (PN): Bypasses gut.
  • Indications: Gut failure (short bowel, severe IBD), prolonged NPO (>5-7 days).
  • Components:
    • Dextrose: GIR $GIR = (\text{Rate ml/hr} \times \text{Dextrose conc } %) / (\text{Weight kg} \times 6)$; target 4-6 mg/kg/min.
    • Amino Acids: 1.5-3 g/kg/day.
    • Lipids: 0.5-3 g/kg/day.
  • Complications: Line sepsis (CRBSI), PNALD, metabolic (hyperglycemia), refeeding syndrome.
    • Refeeding: Monitor PO₄, K⁺, Mg²⁺. Prevent: "Start low, go slow". ⚠️

⭐ Refeeding Syndrome: Severe hypophosphatemia (also ↓K⁺, ↓Mg²⁺) upon re-feeding malnourished patients. Monitor electrolytes; start feeds slowly.

High‑Yield Points - ⚡ Biggest Takeaways

• Exclusive breastfeeding for the first 6 months is paramount for infant health.
• Introduce complementary foods at 6 months alongside continued breastfeeding.
• Prevent iron deficiency anemia with screening and timely supplementation.
• Vitamin D (400 IU/day) is crucial for all breastfed infants.
• SAM management: F-75 for stabilization, F-100 for rehabilitation phase.
• Use low-osmolarity ORS for managing dehydration in acute diarrhea.
• Monitor growth using WHO growth charts regularly for early intervention.