The A.S.P.E.N.

PEdiATric NuTriTioN SuPPorT

corE curriculum

EDITOR-IN-CHIEF
Mark R. Corkins, MD, CNSP, SPR, FAAP
Associate Professor
Indiana University School of Medicine, Riley Hospital for Children
Indianapolis, IN

SECTION EDITORS
Jane Balint, MD
Director, Intestinal Support Service
Pediatric Gastroenterology, Hepatology and Nutrition
Nationwide Children’s Hospital
Columbus, OH

Elizabeth Bobo, MS, RD, LDN, CNSD

Clinical Dietitian, Gastroenterology and Nutrition
Nemours Children’s Clinic
Jacksonville, FL

Steve Plogsted, PharmD, BCNSP

Clinical Pharmacy Specialist
Nutrition Support Pharmacist
Nationwide Children’s Hospital
Columbus, OH

Jane Anne Yaworski, MSN, RN

Clinical Nurse Specialist/Nutrition Support Service/Intestinal Care Center
Children’s Hospital of Pittsburgh
Pittsburgh, PA

MANAGING EDITOR
Nina D. Seebeck

AMERICAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is a scientific society whose members are health care professionals—physi-
cians, dietitians, nurses, pharmacists, other allied health professionals, and researchers—dedicated to assuring that every patient receives optimal
nutrition care.

A.S.P.E.N.’s mission is to serve as a preeminent, interdisciplinary, nutrition society dedicated to patient-centered clinical practice worldwide through
advocacy, education, and research in specialized nutrition support.

NOTE: This publication is designed to provide accurate authoritative information in regard to the subject matter covered. It is sold with the under-
standing that the publisher is not engaged in rendering medical or other professional advice. Trademarked commercial product names are used only
for education purposes and do not constitute endorsement by A.S.P.E.N.

This publication does not constitute medical or professional advice, and should not be taken as such. To the extent the information published herein
may be used to assist in the care of patients, this is the result of the sole professional judgment of the attending health professional whose judgment is
the primary component of quality medical care. The information presented herein is not a substitute for the exercise of such judgment by the health
professional.

All rights reserved. No part of this may be used or reproduced in any manner whatsoever without written permission from A.S.P.E.N. For informa-
tion write: American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805; (301)
587-6315, www.nutritioncare.org, email: [email protected].

Copyright © 2010. American Society for Parenteral and Enteral Nutrition.

ISBN: 978-1-889622-14-9

Printed in the United States of America.

Second Printing
Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v 7. Water-Soluble Essential Micronutrients . . . . . . . . . . . . . 56

Winston Koo, MBBS, FACN, CNS
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Judith Christie, RN, MSN
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv May Saba, PharmD, BCNSP
Mirjana Lulic-Botica, BSc, BCPS
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Letitia Warren, RD, CSP
Acknowledgments & Dedication . . . . . . . . . . . . . . . . . . . . . . . xix 8. Fat-Soluble Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Winston Koo, MBBS, FACN, CNS
May Saba, PharmD, BCNSP
PART I Mirjana Lulic-Botica, BSc, BCPS
INTRODUCTORY AND BASIC PHYSIOLOGY Judith Christie, RN, MSN
1. Mechanics of Nutrient Intake . . . . . . . . . . . . . . . . . . . . . . 3 9. Fluids and Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Mark R. Corkins, MD, CNSP, SPR, FAAP Gerald L. Schmidt, PharmD, BCNSP
Carol G. McKown, DDS, MS
Anna M. Dusick, MD
2. Gross Digestion Principles: Gastric Grinding PART II
and Gastrointestinal Motility . . . . . . . . . . . . . . . . . . . . . 11 AGE-SPECIFIC NUTRITION FOR GROWTH
Jane P. Balint, MD AND DEVELOPMENT
3. Carbohydrates: Changes with Development . . . . . . . . . . 17 10. Nutrition and Early Development . . . . . . . . . . . . . . . . 105
Seema Mehta, MD Russell J. Merritt, MD, PhD, FAAP
Robert J. Shulman, MD Barbara Marriage, PhD, RD
Ricardo Rueda, MD, PhD
4. Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Peggy R. Borum, PhD 11. Human Milk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Jacqueline J. Wessel, RD, CNSD
5. Protein Digestion, Absorption, and Metabolism . . . . . . . 31
Richard A. Helms, PharmD 12. Infant Formulas and Complementary Feeding . . . . . . 129
Emma M. Tillman, PharmD Kelly Green-Corkins, MS, RD, CNSD
Anup J. Patel, MD Timothy Sentongo, MD
John A. Kerner, MD
13. Growth Assessment and Monitoring . . . . . . . . . . . . . 143
6. Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Timothy Sentongo, MD
Winston Koo, MBBS, FACN, CNS
14. Obesity and Metabolic Disorders . . . . . . . . . . . . . . . . 149
Mirjana Lulic-Botica, BSc, BCPS
Michelle Battista, BS, PhD Candidate
May Saba, PharmD, BCNSP
Robert Murray, MD
Letitia Warren, RD, CSP
15. Lipid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Shirley Huang, MD
Melanie Katrinak, RD, CSP, LDN

iii
iv CONTENTS

16. Use of Fad and Popular Diets . . . . . . . . . . . . . . . . . . . 169 30. Oncology, Hematopoietic Transplant,
Catherine Christie, PhD, RD and Survivorship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Julia A. Watkins, PhD, MPH Nancy Sacks, MS, RD, LDN
Judith C. Rodriguez, PhD, RD Elizabeth Wallace, RD, CNSC, LDN
Seema Desai, MS, RD, LDN, CNSD
17. Sports Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Vinod K Prasad, MD, MRCP (London)
Jackie Buell, PhD, RD, LD, ATC, LAT
David Henry, MS, BCOP
Diane L. Habash, PhD, RD, LD
Virginia Guzikowski, MSN, CRNP
Liesje Nieman Carney, RD, CNSD, LDN
Beth Bogucki Wright, MS, RD, CSP, LDN
PART III Susan Rheingold, MD
DISEASE STATES AND NUTRITION
31. Trauma and Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
18. Developmental Delay . . . . . . . . . . . . . . . . . . . . . . . . . 191 Arlet G. Kurkchubasche, MD
Kathleen J. Motil, MD, PhD
32. Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
19. Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Arlet G. Kurkchubasche, MD
Christina Fitzgerald, MS, RD, LDN
Betsy Hjelmgren, MS, RD, LDN, CSP
20. Food Allergies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 PART IV
Mary Beth Feuling, MS, RD, CD, CNSD NUTRITION CARE OF THE PEDIATRIC PATIENT
Michael B. Levy, MD
33. Assessment of Nutrition Status by Age
Praveen S. Goday, MBBS, CNSP
and Determining Nutrient Needs . . . . . . . . . . . . . . . . 409
21. Diabetes Mellitus and Other Endocrine Disorders . . . 226 Liesje Nieman Carney, RD, CNSD, LDN
Diane Olson, RD, CNSD, CSP, LD Jennifer Blair, MA, RD, CSP, LDN
W. Frederick Schwenk II, MD
34. Parenteral and Enteral Nutrition Support:
22. Inborn Errors of Metabolism . . . . . . . . . . . . . . . . . . . 232 Determining the Best Way to Feed . . . . . . . . . . . . . . . 433
Bridget Reineking, MS, RD, CD Liesje Nieman Carney, RD, CNSD, LDN
Sandra van Calcar, PhD, RD, CD Andrea Nepa, MS, RD, CSP, LDN
Sherri Shubin Cohen, MD, MPH
23. Cardiac Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Amy Dean, MPH, RD, LDN
Anupama Chawla, MD, CNSP, DCH (UK) Colleen Yanni, MS, RD, LDN
Janice Antino, RD, MS, CNSD, CSP Goldie Markowitz, MSN, CRNP
Mindy Freudenberg, RD, MS, CNSD
35. Implementation of the Plan . . . . . . . . . . . . . . . . . . . . 448
24. Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Beth Lyman, RN, MSN
Christina L. Nelms, MS, RD, CSP, CNSC, LD Jennifer M. Colombo, MD
Marisa Juarez, MPH, RD, LD Jodi L. Gamis, OTR
Bradley A. Warady, MD
36. Evaluation and Monitoring of Pediatric Patients
25. Gastrointestinal Disease . . . . . . . . . . . . . . . . . . . . . . 283 Receiving Specialized Nutrition Support . . . . . . . . . . 460
Donald George, MD Elaina Szeszycki, PharmD, BCNSP
Elizabeth Bobo, MS, RD, LDN, CNSD Wendy Cruse, MMSc, RD, CNSD
26. Hepatic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Michelle Strup, PharmD
Samuel A. Kocoshis, MD 37. Ethical Issues in the Provision of Nutrition . . . . . . . . 477
Renee A. Wieman, RD, CSP, LD, CNSD Patrick M. Jones, MD, MA
27. Intestinal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Brian Carter, MD
Robert H. Squires, Jr., MD
28. Pulmonary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 323 Test Your Knowledge Answers . . . . . . . . . . . . . . . . . . . . . . . 487
Allison Mallowe, RD, LDN
Suzanne Michel, MPH, RD, LDN
Maria Mascarenhas, MBBS
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
29. Organ Transplantation . . . . . . . . . . . . . . . . . . . . . . . . 337
Anita Nucci, PhD, RD, LD
Sharon Strohm, MBA, RD, LDN
Neelam Katyal, MS, RD, LDN
Beth Lytle, RD, LDN