/
Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood

Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood - PowerPoint Presentation

stefany-barnette
stefany-barnette . @stefany-barnette
Follow
371 views
Uploaded On 2018-02-26

Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood - PPT Presentation

Maria Raspolic MS RD Santa Clara Valley Medical Center Objectives Review most common nutritional issues in AHC Provide recommendations to minimize above issues Review ketogenic diet as treatment for seizures ID: 636958

nutritional diet food con

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Management of Nutritional Issues Associa..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Management of Nutritional Issues Associated with Alternating Hemiplegia of Childhood

Maria

Raspolic

MS, RD

Santa Clara Valley Medical CenterSlide2

Objectives:

Review most common nutritional issues in AHC

Provide recommendations to minimize above issuesReview ketogenic diet as treatment for seizures

Management of Nutritional Issues Associated with Alternating Hemiplegia of ChildhoodSlide3

Poor growth

Dehydration

ConstipationDecreased bone mineral densityCommon Nutritional Issues Associated with AHCSlide4

Inadequate nutrient intakes

Decreased muscle tone

Oral motor dysfunction Limited growth potential Frequent illness, fatigue, infections Poor GrowthSlide5

Growth AssessmentSlide6

Provide food of high nutritional quality

Breakfast

: oatmeal, eggs, cream of wheat, yogurt, Carnation Instant Breakfast, meatLunch/Dinner: refried beans/cheese, lentils, tofu, almond/nut butter, avocados, fatty fish, meat, sweet potatoes, fried rice/mex rice

Snacks

: milk shakes/smoothies, cheese stick

InterventionSlide7

Liquid supplements

Concentrate infant formula to 24-30

kca/ozPediasure, Boost Kids Essential, Nutren JrEnsure, Nutren, Boost

Carnation Instant Breakfast

1.5 and 2

cal

/cc formulas

Intervention

con’t

. Slide8

3. Supplemental tube feedingChild not able to gain weight adequately

Excessive time needed to feed

Difficult decision for parentsGoal: improved quality of lifeDramatic improvement in nutritional statusIntervention con’t. Slide9

Inadequate fluid intakesExcessive fluid lossNeed for thickened liquids

Result in constipation, decreased appetite

Kidney stones, UTI, thickening of secretionsMonitor number of diapers, UADehydrationSlide10

100 cc/kg of body wt

for the first 10 kg

50 cc/kg for the second 10 kg20 cc/kg for the additional kgs44 lbs :2.2 = 22 kg1000 + 500 + 40 = 1540 cc

1540: 30 = 51

oz

How much fluid? Slide11

Provide hi nutritional value liquids:Milk, soy, rice, almond, coconut

Smoothies, milkshakes

? juiceRecomendation Slide12

Multifactorial causePoor intakes of fluids and solids

Low muscle tone/ GI motility

Low activity levelsLow fiber dietConstipationSlide13

Contributes to poor appetite

Abdominal distention/discomfort

IrritabilityAdequate fluid intakes and fiberHi fiber foods: cereal (5 gr/serving), legumes Sweet potatoes, fruits/vegetablesPrune or pear juice

Constipation

con’t

. Slide14

If additional help needed:Milk of magnesia

Lactulose

MiralaxBenefiberConstipation

con’t

. Slide15

Limited ambulationInadequate intakes of Ca

,

Phos, Vit DAnticonvulsant therapyLimited sun exposureIf untreated may lead to osteoporosis, bone deformities and fractures

Low Bone mineral DensitySlide16

1-3 years: 500mg

4-8 years 800 mg

9-18 years 1300 mgHow Much Calcium is Needed?Slide17

Food sources/ table

Food Source

Serving Size

Amount of Calcium per Serving

almonds

3 ounces

210 milligrams (mg)

blackstrap molasses

1 tablespoon

170 mg

broccoli (cooked)

1 cup

60 mg

canned salmon (with bones)

3 ounces

180 mg

canned sardines (with bones)

3 ounces

325 mg

collards

1 cup

265 mg

cottage cheese

1 cup

155 mg

hard cheese (cheddar,

swiss

)

1 ounce

225 mg

kale (cooked)

1 cup

95 mg

milk

1 cup300 mgmozzarella cheese1 ounce200 mgrhubarb (cooked)1 cup345 mgricotta cheese1⁄2 cup335 mgspinach (cooked)1 cup245 mgyogurt8 ounces425 mg

Calcium Sources in FoodSlide18

Calcium Carbonate

Viactiv

, Tumbs, CaltrateCalcium Citrate Citracal

Oyster Shell, Bone Meal

Calcium SupplementsSlide19

Sunshine Vitamin

Sunblock use prevents

Vit D productionAnticonvulsant meds (Phenobarb, Dilantin)Decreased absorption of Calcium

Limited food sources: fish liver oil, fatty fish,

egg yolk, mushrooms, milk (fortified)

Vitamin DSlide20

Recommend to check blood levels yearly

Goal: 30-60

mmol/dlSupplement 1000 IU/day 50 000 IU/ weekVit D3 (cholecalciferol) in the skin by sun expoVit

D2 (

ergocalciferol

) synthesized by plants

15 min sun exposure prevent

Vit

D deficiency

Vitamin D

con’t

.Slide21

Borusiak et al, 2012

128 children receiving one AED

24 % hypocalcemia25% hypophosphatemia13% low vit DPhenobarb, Depakote, Trileptal

, Dilantin

Vitamin D

con’t

. Slide22

Common in children with AHCComplete MVI recommended

Chewable tablet preferred

Liquid/soft gummy vits less mineralsBugs Bunny, Flinstone’s, Scooby Doo, NanoVites

Vitamin and Mineral DeficienciesSlide23

How does it work?Brain needs glucose from food

24 hours supply

Breakdown of fat produces ketones??? Prevention of seizuresKetogenic DietSlide24

2-3 months trial30% of the children seizure free30% significant reduction in seizures,

reduction in medication or no medication

Reminder do not respond or find it to hard to continue Chances of success?Slide25

Dehydration-check urine daily with keto

stick

Constipation-MOM, MiralaxKidney Stones- UA, trace amount of bloodNutrient deficiency- complete MVI, ck blood levels ZN, Se, Vit D

Decreased growth- adjust protein, kcal

Hi Cholesterol- replace butter with olive oil,

supplement with

carnitine

Side Effects of the dietSlide26

Gradual decrease in CHO over one week 2-3 day hospital admission

Fasting only in the AM

At lunch time full keto mealAllow fluids to meet hydration needSpec. gravity and ketones check with every void Initiation of the dietSlide27

Teach families how to calculate and prepare

meals

Keto meal planerComplexity of meals controlled by parentsReady to feed Ketogenic formula; KetocalRCF for tube feeding

Initiation of the Diet

con’t

. Slide28

Reduction of the ratio over couple of monthsMost parents find diet easier than anticipated

Ketogenic

diet is the most effective available treatment for intractable epilepsy todayAtkins dietDiscontinuation of the dietSlide29

Any Questions or Comments?