[pronut-hiv] Nutrition and care of HIV infected infants and children (2)

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Nutrition and care of HIV infected infants and children (2)
Dietary Management of Symptoms
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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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Dietary Management of Symptoms
Poor Appetite, Anorexia
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Children
-Serve small, frequent meals and snacks at regular intervals.
-Give choices among nutritional alternatives.
-Offer finger foods and encourage self-feeding
-Ensure that juice intake is not excessive
-Appetite may be better at a certain time of the day. Encourage intake during those times.
-Consider the use of oral nutritional supplements.

Food refusal and feeding problems
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-Ensure that there are no neurological impediments or clinical symptoms that can be treated
-Provide regularly scheduled meals and snacks. Do not allow "grazing "between scheduled meals and snacks.
-Limit the amount of time spent on meals to approximately 30 to 45 minutes, and 20 minutes for snacks.
-Encourage participation in shopping and meal preparation.
-Ensure that portion sizes are realistic.
-Ensure that mealtimes are relaxed and quiet.
-Reinforce small effort such as a taste of the food being offered.
-Link new nutrient-dense foods to old favorites.
-Continue to offer new foods in a relaxed, neutral manner.
-Caregivers should set an example by role-modelling appropriate eating behavior    

 Diarrhea
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-Replace fluids and electrolytes; use oral rehydration solution
-Do not withhold food longer than 24 hours
a) Infants
-Avoid concentrated formulas
-Consider the use of lactose-free milk based formula if diarrhea is prolonged.
-For unresponsive diarrhea with possible malabsorption, consider semi-elemental infant formula.
b) Children
-Avoid beverages high in concentrated sugar (fruit juice), as these may induce osmotic diarrhea.
-Soluble fiber may delay transit, whereas insoluble fiber may aggravate diarrhea.
-Serve small and frequent meals
-Consider the use of Lactaid-treated milk
-For unresponsive diarrhea with possible malabsorption, a low-residue, low-fat, restricted-lactose diet is usually recommended. An elemental oral nutritional supplement may be beneficial if accepted by the child.

Nausea/Vomiting
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If the medication cause nausea, adjust schedule to avoid mealtimes if possible
-Avoid greasy or very sweet foods
-Avoid cooking odors
-Try bland, salty, dry foods.
-Given beverages between, rather that with, foods.
-Encourage the child to eat slowly, sitting up.
-Consider anti-emetic medication if nausea is severe or there is vomiting

Oral and/or Esophageal Lesions 
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a) Infants
If the baby cannot suck, spoon liquids.
If the lesions are oral and intake is inadequate, consider nasogastric tube feeds. Esophageal lesions may preclude the placement of an enteral feeding tube.

b) Children
-Avoid acidic, salty, spicy, or rough foods.
-Provide smooth, soft, easy-to-chew, or blenderized foods.
-Serve food cold or at a room temperature.
-Provide a straw for drinking.

 


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