[pronut-hiv] Nutrition and care of HIV infected infants and children

[pronut-hiv@healthnet.org]

 Nutrition and care of HIV infected infants and children (1)
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[From the moderators]

The information below is from Health Canada, Sante Canada. 1995 " A Comprehensive Guide for the Care of Persons with HIV disease" ?Module 2: Infants, Children & Youth." The College of Family Physicians of Canada. Mississauga, Ontario. 

-We would like to know if the recommended feeding and care practices for infants and children in the Canadian context are applicable to your context. 
-What recommendations and care practices are the same as those recommended in your country? 
- What is not realistic and needs to be adapted to your context? What are your suggestions? 
- From your experiences, what are some constraints that may hamper the implementation of these recommendations?     

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Nutritional Management of HIV-Infected infants and Children
Introduction
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Children with HIV infection are at high risk for malnutrition, which has an independent deleterious effect on immunocompetence. The etiology is complex, and contributing factors may occur singly or in clusters. The major causes of malnutrition include:
- Inadequate nutrient intake due to anorexia, nausea, oral and or/esophageal lesions, or generalized malaise and weakness
- Increased protein and energy requirements during hypermetabolic/hypercatabolic period induced by fever and secondary infections
- Increased energy cost of breathing related to respiratory infections
- Losses of protein, calories, fluids, and micronutrients with vomiting, diarrhea, and malabsorption.

Nutritional Requirements
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Nutritional requirements for energy, protein, and micronutrients are based on  age, height, weight, and sex. These requirements are increased by:
-The presence of fever and infection
-Losses due to diarrhea or vomiting
-Respiratory complications
-The need for catch up growth and weight gain.

Ability to Meet Predicted Requirements
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The following factors indicate increased risk of malnutrition:
-Anorexia, malaise
-Oral or esophageal, lesions, dysgeusia, dysphagia
-Diarrhea, nausea or vomiting, pain, fever
-Side effects of medications
-Delayed development associated with neurological disease, resulting in feeding method intolerance, regression in feeding ability, dysphagia, and/or oral motor dysfunction.

Psychosocial factors- including health status or lifestyle of the infected parent, financial concerns, access to appropriate social services, behavioral issues, feeding relationship between the child and  caregiver- may also influence the ability to meet nutritional needs. 

 
Nutrition for The Asymptomatic or Clinically Stable Child
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If growth is at an appropriate rate, nutritional requirements are similar to those healthy children. The Canadian Recommended Nutrient Intakes (RNI) are used. Multivitamin supplementation to 100% of the RNI may be beneficial if the child is not eating a well-balanced diet.

Nutrition For The Symptomatic and ill Child
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In cases of failure to thrive, energy and protein requirements are elevated for catch up growth. The RNI for weight for age (kg) divided by actual weight (kg). Multivitamin supplementation is usually recommended to 100% of the RNI.
Nutritional requirements depend on the on clinical picture, growth parameters, and past and current nutritional status. Energy requirements may be calculated based on basal metabolism and adjustment for stress, fever, sepsis etc. Proteins are increased by 50% to 100% of the RNI for weight for age. Micronutrient is assessed individually, and supplementation is given according to assessed needs. Consider recent intake, losses and elevated needs.

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