Pediatric Nutrition

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- Enteral Feedings in the Pediatric Patient:
    - advance feedings as follows:
    - begin w/ 10-15 ml Pedialyte qq 2-3 hrs;
    - incr by 2-5 ml increments overe the next 12-24 hrs until infant
          is receiving 30-45 ml of Pedialyte q3hr;
    - pt is then begun w/ half strength formula for 24 hrs followed
          by full strength formula q 3-4 hrs at volumes calculated to meet
          child's fluid and nutritional requirements;
    - in early post operative period, non lactose containing formulas
          such as Isomil or ProSobee may be better tolerated;
Composition of Infant Formulas
  Formula       Kilocalories     Na     K     Ca     P     Fe     Osm
Breast Milk   0.67 kcal/ml       7     14   340   162     1.5   100
Cow's   Milk   0.67             25     35   1240   950     1.0   270
Enafamil       0.67             11     19   546   462     -     285
Nutramigen     0.67             14     21   630   473   13.0   460
Portagen       0.67             14     21   630   473   13.0   210
Progestimil   0.67             14     17   630   473   13.0   311
ProSobee       0.67             18     19   788   525   13.0   250
Similac       0.67             11     19   580   430     -     285
  Electrolyte Content of Body Fluids (Pediatrics)
  Fluid         Na:mEq/l K:mEq/l Cl:mEq/l HCO3
  ----------------------------------------------------------------
  Gastric       10-115   5-35     10-155     0
  Pancreatic   115-150   5-10     55- 95   115
  Ileal         105-145   5-30     90-135   30
  Cecal             50     10         40
  Bile         130-165   5-15     90-120   15
  Saliva         35- 60     10         35   50
  @RXDIARREA[Diarrhea           50     35         40   45
  ----------------------------------------------------------------
                  Adluts             Children
  ----------------------------------------------------------------------
  Na (as NaCl)   80-120 mEq/24hr     3-4 mEq/kg/24hr   [ 3gm NaCl = 130 mEq
  Cl             80-120
  K             50-100             2-3 mEq/kg/24hr
  Mg                 20
  Ca             1-   3 gm/day
  -----------------------------------------------------------------------
Infant Formulas:
Formula           Indications                       Comments
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Enfamil     Full term Infants; supplement   Contains Nonfat Milk, Lactose,
Similac     to breast feeding;               soy, & coconut oil; Vit; w/ &
SMA                                         w/o Fe, has 20 cal/oz;
ProSoBee     Milk Sensitive Infants           Lactose-free; contains corn syp
Isomil                                       solids, soy proteins, soy/coc-
                                            anut oil; Vit & Fe; 20 cal/oz
Pregestimil   Disaccharidase deficiency;     Enzymatically hydrolzyed to re-
              food allergy; defects in dig-   duce allergenicity; Vit & Fe;
              estion or absorption;           MCT & Corn Oil
Pedialyte   Supplies H20 calories & electo-   Contains H20, Dextrose, Na, K,
Lytren     lites for maintenance when usual   Citrate, Mg, Ca, Cl; Pedia-
            feedings are held; replace mild-   lyte 6 cal/oz; Lytren 9cal/oz
            mod fluid losses
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Daily Electrolyte and Mineral Requirements
                            Amount
Element             Neonates       Infants and Children
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Sodium           1.6- 9.0 mEq/kg       2- 4   mEq/kg
Potassium       1.4-10.0 mEq/kg       2- 3   mEq/kg
Chloride         1.1- 4.5 mEq/kg       2- 3   mEq/kg
Phosphorous     1.0- 2.0mmol/kg       1- 2   mmol/kg
Magnesium           80.0 mEq/kg     30-60   mEq/kg
Calcium gluconate   150.0 mEq/kg     400-1200 mEq/kg
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Note: Specific Electrolytes:
Potassium: Premature infants may require additional K, noting immature
  renal function or if infants is on diuretics;
Calcium and Phosphorous: Note that Serum Ca may not reflect needs for Bone
  growth;