The incidence of cardiac defects is approximately 8-10 in 1000 live births. The energy requirement of a child with CHD is often very high as the heart has to work more.
The child with a cyanotic defect and/or pulmonary artery hypertension (PAH) is especially at risk of failure to thrive.
These children need to be followed up with periodic dietary counseling since they suffer from feeding issues like nausea, lack of appetite, irritability, loose stool, inability to digest some food, lactose intolerance and delayed teeth eruption.
Levels of malnutrition in children with CHD correlate with the type of heart defect and severity of hemodynamic disturbances.
Some of the causes are as follows :
- Decreased food intake due to fatigue, early satiety, delayed feeding, and gastrointestinal morbidity.
- Decreased oxygen in the blood
- Poor absorption of nutrients from the GI tract
- Fluid restriction
- Frequent use of antibiotics affecting gut flora.
Cardiac Cachexia is a dynamic process of non-intentional weight loss in a nonedematous state and is a syndrome of tissue wasting, associated with significant morbidity and mortality.
Pediatric CHD is very different from adult cardiac disease and the child will benefit from the extra calories in fat.
The requirement of micronutrient:
- Elemental Zn 1-3mg/kg ABW (No longer than 2 weeks).
- Selenium 2mg/kg BW with a maximum of 30mg/day (Zn and Se if there are FTT and low serum level)
- Iron 2mg/kg/day for prophylaxis. 6mg/kg/day if Fe deficient. The multivitamin should contain folic acid, niacin, thiamine, B12 and Vit E.
- Sodium – the restriction can be moderate so that the food is palatable, but salty food should be avoided.
||Fluid Volume per 24 hrs
|Age 0-6 months
||150ml / kg
|Age 6-12 months
||120ml / kg
|Infants and children 10-20kg
||1000ml + 50ml/kg over 10 kg
Do not alter the medically indicated fluid restriction
Parents and caregivers sometimes make small, yet significant errors which affect the growth and well being of the child.
Pediatric Nutrition for the child with CHD should be optimized at each stage for growth without exceeding the digestive capabilities of the child while fortifying the small amount of food ingested by the child for better calorie and protein intake.
The parents or caregivers should persevere in feeding the child adequately.
Priya Dwivedi, Dietitian at Brahmananda Narayana Multispeciality Hospital, Jamshedpur, Jharkhand