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Managing children and adolescents on parenteral nutrition: challenges for the nutritional support team

Published online by Cambridge University Press:  07 March 2007

Tracey Johnson  and
Elaine Sexton
Tracey Johnson*
Affiliation:
Department of Dietetics, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
Elaine Sexton
Affiliation:
Department of Nutritional Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
*
*Corresponding author: Tracey Johnson, fax +44 121 333 8021, email [email protected]
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Abstract

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Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.

Keywords

Parenteral nutritionIntestinal failureChildren and adolescents
Type
BAPEN Symposium 1 on ‘Nutritional support in children and adolescents’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 3 , August 2006 , pp. 217 - 221
Copyright
Copyright © The Nutrition Society 2006

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