Guidelines for an Integrated Approach to the Nutritional Care of HIV-Infected Children (6 Months-14 Years)

Overview

In the area of nutrition and HIV, children deserve special attention because of their additional needs to ensure growth and development and their dependency on adults for adequate care. It was therefore proposed to first develop guidelines for children and thereafter consider a similar approach for other specific groups.

The content of these guidelines acknowledges that wasting and undernutrition in HIV-infected children reflect a series of failures within the health system, the home and community and not just a biological process related to virus and host interactions. In trying to protect the nutritional well-being or reverse the undernutrition experienced by infected children, issues of food insecurity, food quantity and quality as well as absorption and digestion of nutrients are considered. Interventions are proposed that are practical and feasible in resource-poor settings and offer a prospect for clinical improvement.

The guidelines do not cover the feeding of infants 0 to 6 months old, because the specialised care in this age group is already addressed in other WHO guidelines and documents.

Contents

• Acknowledgement
• Acronyms
• Introduction
• SECTION 1. ASSESS, CLASSIFY AND DECIDE A NUTRITIONAL CARE PLAN
  • Step 1. Assess and classify the child's growth
  • Step 2. Assess the child's nutritional needs
  • Step 3. Decide a Nutrition Care Plan
    • Set Targets for Energy and Micronutrient Intakes
    • Nutritional supplements to provide additional energy
    • Therapeutic feeding for children with severe malnutrition
    • When to change Nutritional Care plans
    • Entry and exit criteria for nutritional supplements
    • Entry and exit criteria for therapeutic feeding
    • Nutrition Care Plan A for the child who is growing well ± ART
    • Nutrition Care Plan B for the child with poor weight gain or increased nutritional needs
    • Nutrition Care Plan C for the severely malnourished HIV-infected child
• SECTION 2. IMPLEMENT THE NUTRITION CARE PLAN
  • Step 4. What does the child eat and drink?
  • Step 5. Discuss who gives the child his/her food and how the child eats
  • Step 6. Assess if there is food and income at home
    • When to provide Family Food Support
    • When to stop Family Food Support (consider combination of the criteria below)
  • Step 7. Discuss exercise and avoiding risk factors for malnutrition
    • Exercise and play
    • Avoiding infections
    • Hygiene and food safety
    • Immunizations
    • Regular (prophylactic) cotrimoxazole
    • Regular (prophylactic) vitamin A supplements every 4-6 months (IMCI schedule)
    • De-worming
  • Step 8. Decide if to refer and when to review
• SECTION 3. CHILDREN WITH SPECIAL NEEDS
  • Step 9. The HIV-infected child with special needs
    • A Eating during and when recovering from an illness
    • B Poor appetite (anorexia)
    • C Sore mouth or throat
    • D Change in taste
    • E Children with diarrhoea
    • F Nausea and/or vomiting
    • G Anaemia
  • Step 10. Children on antiretroviral treatment
    • What to do if a child on ART is gaining weight well
    • What to do if a child on ART is not gaining weight
    • What to do if the child has nausea and vomiting when taking antiretroviral drugs
    • Check for metabolic abnormalities
    • Routine monitoring of children on ART for metabolic disorders
• References
• Appendix I Staging criteria for children infected with HIV
• Appendix II Composition of different Therapeutic Feeding options
• Appendix III Home-based foods to increase energy intake
• Appendix IV Suggestion sheets to improve food intake
• Appendix V Guiding Principles for Complementary Feeding of the Breastfed Child (2003)
• Appendix VI Guiding principles for feeding non-breastfed children 6-24 months of age (2005)
• Appendix VII Five Keys to Safer Food
• Chart booklet
• Guide for local adaptation

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