Pediatrics Nutrition

Nutrition, Calorie, and Fluid Requirements

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7 أقسام

Introduction

  • Nutrition is important for normal growth and development.
  • It is important for children > 1 year of age to eat a variety of foods from the 5 major food groups: vegetables,fruits, grains, protein, and dairy.
  • The required amount of nutrients varies,depending on age and gender.
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Daily Nutritional Requirements

Daily Nutritional Requirements
Age (years) Gender Energy (kcal/day) Protein (g/day) Fat (g/day)
1–3 — 1000 13 30–40
4–8 — 1200–1400 19 25–35
9–13 Male 1600–2000 34 25–35
Female 1400–1600 34 25–35
14–18 Male 2000–2400 52 25–35
Female 1800 46 25–35

 

  • Fats have 9 kcal/g of potential energy while carbohydrates and protein have approximately 4 kcal/g.
  • Dietary fat is the highest density source of potential energy.
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Daily Calories Requirements

Daily Calories Requirements
Age Calories (kcal/kg/day)
0–3 months 115
3–6 months 110
6–9 months 100
9–12 months 100
1–3 years 100
4–6 years 90–100
6–9 years 80
10–12 years 70
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Daily Protein Requirements

  • Protein requirements per kilogram gradually decrease over time.
Daily Protein Requirements
Age Protein (g/kg/day)
< 1 year 2–2.5
1–5 years 1.5–2
6–10 years 1–1.5
11–14 years 1
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Daily Elements and Vitamins Requirement

Elemental Requirements
Element Daily Dose Deficiency
Iron 10–15 mg Anemia
Calcium 800 mg Osteoporosis, Rickets
Magnesium 100 mg Muscle weakness
Phosphorus 600 mg Impaired growth
Zinc 2–3 mg Impaired immunity
Vitamin Requirements
Vitamin Daily Dose Deficiency
Vitamin A 200 IU Night blindness
Vitamin B1 1 mg Beriberi, Wernicke-Korsakoff syndrome
Vitamin B6 0.1–0.3 mg Anemia
Vitamin B12 0.4–0.5 mg Megaloblastic anemia
Vitamin C 40–50 mg Scurvy
Vitamin D 400 IU Rickets
Folic acid 400 mcg Megaloblastic anemia
Macronutrients
Nutrient Daily Dose Deficiency
Carbohydrates 10 mg/kg —
Fat 0.5 mg/kg Hormonal imbalance, fat-soluble vitamin deficiency
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Calculating Daily Caloric and Fluid Requirements

  • Many methods are available to treat and diagnose fluid and electrolyte abnormalities. 
  • The Holliday-Segar formula is used to answer exam questions on dehydration because It relates water loss to the caloric expenditure.
    • Remember, the Holliday-Segar Formula is also known as the 4-2-1 rule 

Remember, these methods are approximations, and it is possible to underestimate or overestimate calorie requirements.

Holliday-Segar Formula for Maintenance of Calories and Fluids
Weight (kg) Daily Fluid Requirement
(kcal or mL/day)		 Hourly Fluid Requirement
(kcal or mL/hour)
0–10 kg 100 mL/kg/day 4 mL/kg/hour
10–20 kg 1000 mL + 50 mL/kg/day for each kg >10 40 mL + 2 mL/kg/hour for each kg >10
> 20 kg 1500 mL + 20 mL/kg/day for each kg >20 60 mL + 1 mL/kg/hour for each kg >20

 

Practice Questions 

  1. Calculate the total kcal per day for a 25 kg patient

    (100 x 10) + (50 x 10) + (20 x 5)
    or
    1,000 + 500 + 100= 1,600 kcal per day

  2. Calculate the Daily Fluid requirement for a 35 kg patient

    (100 x 10) + (50 x 10) + (20 x 15)
    or
    1,000 + 500 + 300= 1,800 ML per day

 

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Dehydration and Fluid Deficit Calculation

Degrees of Dehydration
Parameter Mild Moderate Severe
% Weight Loss - Infant 5% 10% >15%
% Weight Loss - Child 3–5% 6–9% >10%
Heart Rate (HR) Normal Tachycardia Tachycardia
Blood Pressure (BP) Normal Normal Decreased
Respiratory Rate (RR) Normal Tachypnea Deep, rapid breathing
Thirst Normal Increased Thirst Intense
Mucous Membranes Normal Dry Cracked
Tears Normal Decreased Dry, sunken eyes
Anterior Fontanelle Normal Sunken Very Sunken
Capillary Refill & Skin Turgor <2 seconds 2–4 seconds, ↓ skin turgor >4 seconds, tinted skin, cool, mottled
Urine Output Normal or ↓ Oliguria Oliguria or anuria
Behavior Normal Irritable Lethargic
Estimated Fluid Loss 30–50 mL/kg 60–100 mL/kg >100 mL/kg

 

  • Oral rehydration is the preferred treatment for children with mild or moderate dehydration.
  • For mild dehydration →30-50 mL/kg of an oral rehydration solution (ORS).
  •  For moderate dehydration → 60-100 mL/kg of ORS.
  •  For severe dehydration→ IV fluid infusion of normal saline or lactated Ringer’s until the patient has normal pulse and mentation, and then complete rehydration with ORS.

 

Practice Questions 

A 1 year old male patient, Weight = 12 kg, presented to OPC with a history of vomiting and diarrhea. On Examination, the patient was tachyonic, tachycardic, with dry lips and mucous membranes and sunken eyes. BP is normal. Calculate the total fluid requirement in 24 hours for this patient. 

    1. Calculate the Maintenance Fluid

      (100 x 10) + (50 x 2)
      or
      1,000 + 100 =1100 ML per day


    2. Calculate the Deficit Fluid Requirement 
      • Patient has moderate dehydration, estimated weight loss for his age= 10%
      • Calculate the Deficit Fluid

        Weight * % Deficit* 10
        12*10*10= 1200 ML 


    3. Calculate the total fluid requirement

      1100+1200=2300 ML per day or 95 ML per hour. 
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