This document discusses pediatric metabolism and its impact on energy requirements. It begins by defining pediatric metabolism as the complex biochemical processes that convert food into energy to sustain life and growth in children. Key factors that influence a child's metabolic rate and energy needs include genetics, age, and growth and development. The document also covers calculating a child's basal energy, protein, fluid needs and considerations for nutritional support and management of malnutrition for critically ill children in the intensive care unit.

1. PEDIATRIC METABOLISM
AND ITS IMPACT ON
ENERGY REQUIREMENTS.

2. Definition of Pediatric Metabolism:
Pediatric metabolism refers to the complex biochemical processes that
occur within a child's body to convert food into energy and sustain life.
It involves the breakdown and utilization of nutrients obtained from food.
Importance of Understanding Energy Requirements in Children:
Children's energy needs are not only crucial for growth and development
but also for maintaining overall health and well-being.
For example, energy is needed for physical activities, cognitive
development, and immune system function.
Introduction

3. METABOLISM BASICS
Overview of Metabolism in Children:
Metabolism encompasses all chemical reactions in the body,
including those that build up (anabolism) and those that break down
(catabolism) substances.
Examples of anabolic processes (e.g., building muscles) and catabolic
processes (e.g., breaking down food for energy).

4. FACTORS INFLUENCING PEDIATRIC
METABOLISM
Genetic Factors:
 Genetics plays a significant role in determining a child's metabolic rate. For instance, some
children may inherit genes that result in a faster or slower metabolism.
 Identifying these genetic variations can help us personalize dietary recommendations.
Age-Related Changes:
 A profound understanding of age-related metabolic changes is essential. Infants and
young children require more energy per unit of body weight due to rapid growth and
development.
 With age, metabolic rates decline, affecting energy needs.
Influence of Growth and Development:
 The pediatrician's role is to recognize the energy-intensive nature of growth and
development in children. For instance, the immense energy expenditure required for bone
and muscle growth in adolescents.
 A comprehensive understanding of the interplay between metabolism and growth is vital.

5. ENERGY SOURCES
Role of Carbohydrates, Proteins, and Fats:
 In pediatric care, we emphasize the distinct roles of macronutrients in energy
provision and bodily functions.
 Carbohydrates supply quick energy, proteins support tissue growth and repair,
while fats serve as energy reservoirs for prolonged needs.
Dietary Requirements for Children:
 Understanding the specific dietary requirements for children of different ages and
developmental stages is critical.
 For example, infants require a diet rich in fats and proteins for brain and tissue
development, whereas older children need a more balanced intake of
macronutrients.

6. COMPLICATIONS RELATED TO
MALNUTRITION IN CHILDREN IN THE
ICU:
Delayed Wound Healing: Malnourished children often experience
delayed wound healing post-surgery, which can increase the risk of
infection and scarring. Proper nutrition is crucial for the synthesis of
collagen and other components necessary for tissue repair.
Impaired Immune Function: Malnutrition weakens the immune
system, making children more susceptible to infections. In the ICU,
where patients may already be dealing with infections or injury-
related inflammation, compromised immunity can lead to more
severe complications.

7. Muscle Wasting: Malnourished children may experience muscle
wasting, known as cachexia, which can result in weakness and
decreased mobility. In an ICU setting, maintaining muscle mass is
essential for mobility and recovery.
Organ Dysfunction: Malnutrition can lead to dysfunction of vital
organs, such as the heart, liver, and kidneys, which can be
exacerbated by the stress of critical illness. These complications can
further compromise a child's ability to recover.

8. MANAGEMENT OF MALNUTRITION
IN THE ICU:
Early Assessment: In pediatric medicine, early identification of
malnutrition is crucial. The nutritional status of children admitted to
the ICU should be assessed upon admission, and a nutrition plan
should be initiated promptly.
Nutritional Support: Depending on the child's condition, enteral
(feeding through the gastrointestinal tract) or parenteral (intravenous)
nutrition may be initiated. Enteral nutrition is preferred when feasible,
as it helps maintain gut integrity and function. Specialized formulas
are often used to meet specific nutrient needs.

9. MANAGEMENT OF MALNUTRITION
IN THE ICU:
Energy and Protein Requirements: Calculating precise energy and
protein requirements is essential. Pediatricians and nutritionists work
together to determine the child's individual needs based on factors
like age, weight, and the severity of illness.
Micronutrient Supplementation: In pediatric medicine, micronutrient
deficiencies are common in critically ill children. Supplementation of
vitamins and minerals, such as vitamin D, zinc, and selenium, may be
necessary to support recovery.

10. MANAGEMENT OF MALNUTRITION
IN THE ICU:
Regular Monitoring: Nutritional support in the ICU requires close
monitoring. Parameters such as weight, growth, laboratory values,
and clinical status are regularly assessed to adjust the nutrition plan
as needed.
Multidisciplinary Approach: Managing malnutrition in the ICU is a
collaborative effort involving pediatricians, dietitians, nurses, and
other healthcare professionals. Regular communication and
coordination are vital to ensure that the child receives optimal
nutrition and care.
Rehabilitation and Physical Therapy: To counteract muscle wasting
and weakness, physical therapy and rehabilitation play a crucial role
in the ICU. These interventions help maintain muscle mass, mobility,
and overall functional recovery.

11. CALCULATING NUTRITIONAL REQUIREMENTS IN
CHILDREN IN THE INTENSIVE CARE UNIT
Formula for Calculating Basal Energy Expenditure (BEE):
 One commonly used formula is the Schofield equation:
 For children aged 0-3 years:
 BEE (kcal/day) = 89 x weight (kg) - 100
 For children aged 3-10 years:
 BEE (kcal/day) = 87 x weight (kg) - 75
 For children aged 10-18 years:
 BEE (kcal/day) = 30 x weight (kg) + 70
Factors to Consider:
 In the ICU, you should also consider factors like illness severity, stress, and activity level
when calculating energy requirements. These factors may increase energy needs.
Example:
 Calculate the BEE for a 5-year-old child weighing 18 kg.
 Using the formula for children aged 3-10 years:
 BEE = 87 x 18 - 75 = 1551 kcal/day (rounded to the nearest whole number)

12. PROTEIN REQUIREMENTS:
Protein is essential for tissue repair, immune function, and overall
recovery. It's measured in grams (g) per kilogram (kg) of body weight.
Recommended Protein Intake:
 Typically, a protein intake of 1.5-2.5 g/kg/day is recommended for critically ill
children. The specific amount depends on the child's condition and the severity of
illness.
Example:
 For a 20 kg child in the ICU with severe burns, you may target a protein intake of
2.0 g/kg/day.
 Protein requirement = 2.0 g/kg x 20 kg = 40 g of protein per day.

13. FLUID REQUIREMENTS:
Fluid Requirements:
Fluid requirements are essential to maintain hydration, circulation, and organ
function. They are typically calculated based on maintenance fluid requirements
and additional fluids to compensate for losses.
Maintenance Fluid Requirement:
 The Holliday-Segar method is often used to calculate maintenance fluids:
 For the first 10 kg of body weight: 100 mL/kg/day
 For the next 10 kg of body weight: 50 mL/kg/day
 For every kg above 20 kg: 20 mL/kg/day
Additional Fluid Requirements:
 These include fluids for ongoing losses (e.g., diarrhea, insensible losses due to fever) and
specific medical conditions. It's essential to adjust for these needs.
Example:
 Calculate the maintenance fluid requirement for a 25 kg child:
 For the first 10 kg: 10 kg x 100 mL/kg = 1000 mL
 For the next 10 kg: 10 kg x 50 mL/kg = 500 mL
 For the remaining 5 kg: 5 kg x 20 mL/kg = 100 mL
 Total maintenance fluid requirement = 1000 mL + 500 mL + 100 mL = 1600 mL/day.

14. CONCLUSION
In the realm of pediatric care, a deep understanding of pediatric
metabolism and its profound influence on energy requirements is
paramount.
We've explored the intricate biochemical processes that sustain life,
growth, and development in children.
From the factors influencing metabolism to the role of
macronutrients, we've delved into the critical aspects of pediatric
nutrition.
Additionally, we've discussed the unique considerations for children
in the intensive care unit, emphasizing the importance of
individualized nutrition plans to support recovery