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Good nutrition and maintaining body weight by taking in enough healthy calories is an important goal. A dietitian from the health care team will be scheduled to meet with you and your child in the clinic one to two times per year or more frequently if necessary. The dietitian can also be scheduled at your request any time you have questions or concerns.
Good nutrition is important for several reasons. Good nutrition is absolutely necessary for the body to heal. Poor nutrition can increase your child’s chances of developing an infection. Poor nutrition and infection will hurt the immune system, making it unable to work well so that it can keep your child healthy.
There are many causes of poor nutrition in children with HIV:
- As discussed earlier, nausea and vomiting can add to poor nutrition.
- Diarrhea can be a side effect of medication or can be caused by infection. If left untreated, diarrhea can lead to dehydration, malnutrition, and wasting.
- Loss of appetite due to mouth sores or pain from swallowing caused by thrush, herpes infection or other infections can lead to a decrease in calories taken by the patient. Foods that are salty, spicy, crunchy or dry may cause pain and make them more difficult to eat. When someone has one of these problems, it is best to try foods that are soft, smooth, and served cold or at room temperature. If a patient is complaining of one of these problems, treatment is usually needed and the doctor should be notified.
- Sometimes poor nutrition is related to being unable to buy food secondary to a lack of money. If this is a problem, please contact the health care team so that one of the social workers can work with you to see if assistance is available.
- As HIV disease advances, it puts more stress on the body and requires an increase in energy to do all its usual work. This is called increased metabolism. If calories are not increased to meet this new energy need, weight loss will occur. People with fever and infection will also have increased metabolism and need extra calories.
- Sometimes, people eat enough healthy calories, but because of the HIV and its associated problems, the body is not able to use those calories properly. This is called malabsorption. If this condition occurs, an evaluation by the doctor and dietitian is necessary to help find the cause.
- Sometimes, people may not find eating as enjoyable as they once did because they can have a decreased sense of taste due to medications or infections. In this case, it may be necessary to increase the appetite with medications called appetite stimulants.
Malnutrition can lead to weight loss and wasting syndrome. Often in the more advanced stages of HIV/AIDS, the body will burn up calories very fast. If a person is unable to eat enough calories no matter how hard they try, supplements may be necessary. The dietitian can suggest things to help with weight gain including the following:
- Drink milk with meals instead of juice, tea, water, or soft drinks. Milk has more calories and protein. Choose whole milk over low fat milk. If you do not like milk, try milkshakes, chocolate milk, buttermilk, egg nog, or ice cream and cheese.
- Use milk instead of water to make soups and hot cereals.
- Add calories to milk by mixing it with dry powdered milk or Carnation Instant Breakfast.
- Nonfat dry milk powder can be added to a lot of foods to give them more protein and calories. Adding the powder will not change the taste of the food. Try adding it to meatloaf, hamburger patties, casseroles, macaroni and cheese, cereal, scrambled eggs, mashed potatoes, milkshakes, and pudding.
- Use ice cream as a snack or dessert.
- Cheese added to foods will increase calories. Cheese can be added to eggs, meatloaf, hamburger, spaghetti, mashed potatoes, vegetables, salads, soups, chili, and toast. You can also add extra cheese to pizza, macaroni and cheese, or to casseroles if trying to gain weight.
- Peanut butter can be added to the following foods: on top of pancakes or waffles, apples, bananas or pears, blended into milkshakes, served with celery, cookies, or crackers. Remember, peanut butter should not be given to children under two years of age due to risk of choking.
- If there is no vomiting or diarrhea associated with the weight loss, the following tips may be useful. Add salad dressings to baked potatoes or use as a dip for vegetables. Add sour cream to potatoes, vegetables, chili, salad, and soup. Whipping cream can be added to pies, fruit, puddings, and other desserts. Gravy and cream sauces can be added to meats and vegetables.
- All children should be given daily vitamins. In children who are very young, a liquid vitamin will be prescribed. Older children should take Flintstones Complete vitamins.
It is important to remember that children can become quite picky about food and that there are certain developmental stages where food intake naturally decreases. To avoid making an issue of weight gain, never force feed. If a child refuses to eat, other methods such as tube or IV feeding may need to be explored with the health care team.
It is also important that children do not get overweight if possible. Good nutrition and exercise are important to keep this balance. If a child is overweight, we do not encourage weight loss usually. Rather, we encourage efforts to maintain the weight at its current level while height continues. If you have questions, they can be addressed with the dietitian.
[Keywords:HIV]
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