DIET FOR INFECTIOUS

DISEASE IN CHILDREN
Dietetics for Infectious Disease and
Deficiency
References
• Almatsier, S. 2004. Penuntun Diet
• Mahan LK & Escott-Stump S. 2004. Krause’s Food,
Nutrition, & Diet Therapy
Differences between children and adults
• Children grow and thrive
• Energy and protein needs of children per kg BW are
higher than adults
Children Growth Standar
• WHO 2005
• CDC
• Differentiated by gender

• Index of the nutritional status of children:

• Weight for age (W/A)
• Height for age (H/A)
• Weight for height (W/H)
• Body mass index for age (BMI/A) → Age >24 months
Children Nutritional Needs
Goals of the nutritional needs of infants and children:
• Growth and development of physical and psychomotor
• Physical activity
• Provide adequate nutrition for the necessities of life that is
for maintenance and / or restoration and improvement of
health
Energy Needs
• Calculation of energy needs in children are based on ideal
weight for actual height (median weight/z-score 0 for
height during measurement)
• Equation:
Energy needs = ideal weight* x energy needs for age group**

*weight for actual height on WHO 2005 median (for 0-5 y.o.
child)
weight for actual height on 50 percentile CDC graph (for >5 y.o.
child)
**age based on actual height
Daily Energy Adequacy for Children and
Infants
Age group Energy Adequacy
(years) (kcal/kgBW/day)
0-1 110-120
1-3 100
4-6 90
Male Female
7-9 80-90 60-80
10-14 50-70 40-55
14-18 40-50 40

Source: WKPG-LIPI 2004

Example of energy needs calculation
• A boy aged 4 years and 6 months with a weight of 12 kg
and height 96 cm, how much is his energy needs?
Example of energy needs calculation
• A boy aged 4 years and 6 months with a weight of 12 kg
and height 96 cm, how much is his energy needs?
• Age based on actual height : 3 years
• Ideal weight for 96 cm height : 14 kg
• Energy needs = ideal weight x energy adequacy for 3.y.o
= 14 x 100 kcal
Energy needs = 1400 kcal
Protein Needs
• Minimal biological needs of protein or amino acid that
used to maintain the functional needs of the individual.
• The protein requirement from birth to age 1 year is very
high in relation to the speed of growth of the child.
• The protein needs of infants / children 10-15% of total
energy
• Determining the protein needs of children is calculated
based on ideal body weight corresponding actual height
Daily Protein Adequacy for Children and
Infants
Age Group Protein Adequacy
(years) (g/kgBW/day)
0-1 2.5
1-3 2
4-6 1.8
7-9 1.5
10-18 1-1.5

Source: WKPG-LIPI 2004

Fat Needs
• Major energy source for all body organs
• Necessary for the absorption of vitamins A, D, E, and K
• Sources of essential fatty acids
• Essential fatty acid deficiency can lead to inhibition to the
development and growth, interfere with vision and
neurological development
• The fat needs for infants and children is 25-35% of the
total energy.
Carbohydrate Needs
• Sources of energy contained in various foods
• Babies who breastfeed got 40% of calories from lactose
• Carbohydrate needs increased if the baby had been given
other foods that contain lots of starch.
• Carbohydrate needs in children 55-65% of total energy
Fluid Needs
• It should be noted especially for the baby because baby is
easily dehydrated
• Fluid needs are closely related to energy intake
• Daily fluid requirements by BW according to the Holliday-
Fresh method

Body weight (kg) Fluid needs (ml)

0-10 100 ml/kg
10-20 1000 ml+50 ml/kg more than10 kg
>20 1500 ml+20 ml/kg more than 20 kg
Nutritional Screening
• Aims to identify the patients who are at risk, not at risk of
malnutrition, or special conditions
• Ideally, screening is performed on a new patient 1x24
hours after the patient's admission
• Screening methods should be brief, rapid, and adapted to
the conditions and agreements in each hospital
• Examples of screening methods for children :
• Malnutrition Universal Screening Tools (MUST)
• Malnutrition Universal Tools
• Paediatric Yorkhill Malnutrition Score (PYMS)
• Screening Tool for Assessment of Malnutrition (ISTAMP)
• Strong Kids
Strong Kids Nutritional Screening
1. Does the patient look thin?
a. No (0) b. Yes (1)
2. Is there any weight loss over the last 1 month? (Based on an objective
assessment of BW data / subjective assessment of the patient's parents
OR for infants <2 years rise of BW during the last 3 months)
a. No (0) b. Yes (1)
3. Is there any of the following conditions?
* Diarrhea> 5 times / day and or vomiting> 3 times / day in the last week
* Reduced food intake during the last week
a. No (0) b.Ya (1)
4. Are there circumstances that lead to disease or patients at risk of
malnutrition?
a. No (0) b. Yes (2)

Interpretation of scores:
0 Low Risk 1-3 Medium risk 4-5 High risk
INFECTIOUS DISEASE IN
CHILDREN
HIV/AIDS
• AIDS is a collection of symptoms that arise due to
decreased immunity caused by HIV
• Mode of transmission: body fluids → blood, semen,
vaginal fluid, breast milk
• At risk of a decline in nutritional status due to lack of food
intake due to various reasons eg infectious diseases so
that nutrient requirements increase.
• Please note psychosocial factors and safety of food and
beverages
Goals of Diet
• Increase immune through optimal nutrition status
• Achieve and maintain normal body weight and prevent
failure to thrive
• Give intake of macro and micro nutrients according to the
increases needs of children associated with infection
• Keep food and drug interactions so that drugs and
nutrients absorption are optimal
• Prevent and reduce the risk of opportunistic infections
• Achieve optimal quality of life for children
Requirements and Principles of Diet
Infants
• Breas tmilk is media transmission of HIV from mother to child
(MTCT)
• MTCT prevention efforts to replace breast milk with formula in
newborns from mothers with HIV (+)
• Requirements of formula given: AFASS (Acceptable, Feasible,
Affordable, Sustainable, Safe)
• If AFASS can not be met, given exclusive breastfeeding for 6
months. If prior 6 months AFASS met, breastfeeding was
stopped and given formula
• Avoid breastfeeding combined with formula
• Energy and macro-nutrients needs according to requirement of
age
• Baby food started to be given at 6 months
Requirements and Principles of Diet
Children
• Energy needs: 6-8 months according to normal requirements,
9-11 months +300 kcal, 12-23 months +550 kcal. The
correction factor: asymptomatic + 10%, symptomatic + 20-30%
, symptomatic + weight loss + 50-100%
• The protein needs of 100-150% of normal requirement of age
• Fat needs by 25-30% of total energy needs. Choose a short
chain fatty acids for better absorption and prevent diarrhea.
• Enough carbohydrate
• Enough vitamins and minerals(vitamin A, B complex, C, Ca,
Zn, Fe)
• Schedule and frequency of eating according to the conditions
and use of ARV drugs
• Enough fluid and increased if the condition of diarrhea,
vomiting, or fever
Diarrhea
• A condition that occurs characterized by a change in
frequency of stool both in the expenditure and the form or
consistency of stool becomes more liquid.
• The frequency of > 3 times / day or volume> 300 ml
• Acute diarrhea and chronic diarrhea
• Cause: osmotic diarrhea, secretory diarrhea, exudative
diarrhea, diarrhea due to short bowel
Goals of Diet
• Meet the nutrient requirements for catch-up
growth process without aggravating the function
and system of gastrointestinal organ
• Prevent and reduce the risk of dehydration
Requirements of Diet
• Not fasted, give Oral Rehydration Solution (ORS)
• Normal energy needs based on the ideal height
• Protein 10-15% of total energy
• Fat 30% of total energy
• Carbohydrates 50-55% of total energy
• Rehydration fluids as needed
• The need for vitamins and minerals in accordance with AKG
• In the event of hypokalemia give foods high in potassium
• Zn mineral supplements given at least 14 days (WHO
recommendation)
• Small portions with often frequency (at least 6 times per day)
• Small volume gradually according to ability
• Administration of parenteral, enteral, oral or a combination
according to ability and clinical condition.
European Society for Paediatric
Gastroenterology Hepatology and Nutrition
Recommendation
• Using ORS
• Given hypotonic fluid
• Quick oral rehydration (within 3-4 hours)
• Restore child's diet to normal food as soon as possible
• Do not impose special formula milk without indication
• It is not justified to give diluted milk
• Breast milk should be given
• Supplements with ORS
• Anti diarrhea is not required
Diet Administration
• Regular food, adapted to the abilities and the clinical
condition of the child after dehydration gradually resolved
and the child's age
• Baby: creamed foods (milk porridge, fruit, and crackers
mashed with water / milk, pureed steamed rice/ breda)
• Continued with pureed food → soft food → regular food
Critical illness/Hypercatabolism condition
• Burns
• Trauma
• Infection
• Sepsis

• Patients with critical illness caused by trauma and burns

will experience changes in basic metabolism of the body
(metabolic stress)
Goals of Diet
• Provide food as early as possible in order to prevent the
rise and growth of the inflammatory system response
syndrome, multi organ system failure, and infections
• Suppresss catabolism and protein loss
• Maintain organ function and prevent the dysfunction of the
cardiovascular, respiratory and immune system
• Maintain the balance of calories and nitrogen
• Ensure that children can grow and develop optimally
• Meet the needs of energy, protein, and vitamins to
accelerate wound healing and recovery of the patient's
nutritional state
Principles of Calculation
• Determine basal calorie needs
• Determine stress factor
• Calculate needs of catch up growth
Requirements of Diet
• Energy needs could not use the calculation of healthy
children. Determine the basal energy needs and then
adapted to the conditions of hypermetabolism.

Total energy needs = basal calorie needs + stress factor

Basal calorie needs can be calculated by:
1. Harris Benedict for infants (kcal/24h) =
22.1 + 31.05 BW+1.16 H
2. Schofield Formula
3. Seashore Formula: basal calorie = (55-2A) x BW
4. 50% from AKG based on age
Basal calorie needs based on age and
gender (Schofield)
Age (years) Male Female
0-3 0.617BW+15.174H-617.6 16.252BW+10.232H-413.5
3-10 19.59BW+1.303H+414.9 16.969BW+1.618H+371.2
10-18 16.25BW+1.372H+515.5 8.365BW+4.65H+200
>18 15.057BW+1.004H+705.8 13.623BW+23.8H+98.2
Stress Factor
• Based on physiological stress of the patient.
• Fever 12% every 1oC
• Heart failure 15-25%
• Big operation 20-30%
• Burns up to 100%
• Severe sepsis 40-50%
Protein Needs
• The aims of giving protein is to maintain positive protein
balance.
• 0-2 years 2.5-3 gram/kgBW/day
• 2-13 years 2-2.5 gram/kgBW/day
• >13 years 1.5-2 gram/kgBw/day
• Or protein is given in 15-20% from total energy needs
• Fat needs: 30% of total energy needs
• Carbohydrate needs: 50-60% of total energy needs
• Mineral: given in high amount especially Fe, K, Zn, Mg, P,
Na, Ca → in the form of supplementation
• Fluid and electrolyte: Holiday-Fresh equation