The nutritional status of a child will significantly affect the incidence and severity of HIV-related illnesses, such as tuberculosis and diarrhoea. In addition, HIV-related illnesses also have severe nutritional consequences that commonly precipitate appetite loss, weight loss and wasting. Clinical situations that may impair the nutrition of HIV-infected children are recurrent or chronic infection, fever, intestinal infections, oral or oesophageal lesions, and persistent diarrhoea. Box 28.1 summarises some of the key issues that need to be considered when thinking about the nutritional needs of HIV-infected children.
Box 28.1 Nutritional management of HIV-infected children
- Increase energy intake by 50% to 100% over normal requirements in children experiencing weight loss.
- Identify local foods that are available and affordable, and provide advice for the caregiver on energy requirements. For the type of local foods that are available, you may find it useful to refer to a local food adaptation table.
- HIV-infected children from the age of six months should receive vitamin A supplements every four to six months (100,000 IU for infants up to 12 months, and 200,000 IU for children above 12 months.) This level is consistent with the current WHO recommendations for the prevention of vitamin A deficiency in all children.
- For persistent diarrhoea, refer to the IMNCI Module.
- Feeding and increased fluids should continue during illness. The child may develop nausea and vomiting as a result of ARV drugs. Encourage small, frequent fluids, and give foods that the child likes. Let the child eat before medication. For a child with sores in the mouth, give soft and mashed food, or give paracetamol half an hour before solid feeding.
Note: you will also learn more on this topic in the IMNCI Module.