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Aktuelle Ernährungsmedizin 2014; 39(04): 270-283
DOI: 10.1055/s-0034-1370237
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© Georg Thieme Verlag KG Stuttgart · New York

Pädiatrische Ernährungsmedizin

Pediatric Clinical Nutrition
M. B. Krawinkel
Institut für Ernährungswissenschaft und Zentrum für Kinderheilkunde & Jugendmedizin, Justus-Liebig-Universität
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Publikationsverlauf

Publikationsdatum:
07. August 2014 (online)

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Zusammenfassung

Die Ernährungsmedizin hat zentrale Bedeutung im Fach Kinderheilkunde und Jugendmedizin, da sie sich sowohl mit der Gewährleistung „normaler“ Entwicklung körperlicher und geistiger Funktionen beschäftigt, als auch für viele Krankheitsbilder spezifische Ernährungstherapien beinhaltet. In einem Artikel dieser Art können lediglich ausgewählte Themen kurz angesprochen werden. Die Entwicklung der künstlichen Ernährung ist eine noch relativ junge Dimension pädiatrischer Ernährungsmedizin.

Eine ganze Reihe angeborener Stoffwechselstörungen bedürfen einer spezifischen Ernährungstherapie, für die die genaue Kenntnis der Stoffwechselwege der Nährstoffe und ihrer Metaboliten unabdingbare Voraussetzung ist. Bei Magen-Darm-Erkrankungen ist die diätetische therapeutische Intervention essenziell. Schließlich sind heute Kinder mit chronischem Darmversagen, die noch bis vor ca. 30 Jahren für nicht lebensfähig erachtet wurden, langfristig künstlich ernährt und darunter gediehen und gewachsen.

Während in der Klinik ein wesentliches Feld der pädiatrischen Ernährungsmedizin die Ernährung von Frühgeborenen und schwer kranken Kindern darstellt, stehen in der ambulanten Medizin die Ernährungsberatung und die Durchführung von Therapien in Kooperation mit Spezialambulanzen im Vordergrund. Gleichzeitig mit dem Verschwinden von Unterernährung und Mangel an einzelnen Nährstoffen, die heute bei uns nur noch als Folge von schwerer Vernachlässigung und „nutritiver Kindesmisshandlung“ vorkommen, ist eine neue Herausforderung mit der Prävention und Behandlung der Adipositas gewachsen. Für zahlreiche Ernährungsstörungen im Kindesalter gibt es Leitlinien, die je nach Stand des Wissens auf mehr oder weniger „harte“ Evidenzkriterien aufgebaut sind.

Abstract

Nutrition medicine is an essential part of paediatrics and adolescent medicine because it is concerned with normal physical and mental development and with specific nutrition interventions for a number of diseases. Artificial oral, enteral, and parenteral nutrition have been developed more recently.

A number of inborn errors of metabolism require specific nutrition therapies, and the detailed knowledge about the metabolic pathways of nutrition substrates and their metabolites is mandatory. For gastrointestinal diseases in children dietary therapies are essential part of any treatment. Finally, children with chronic gut failure can get parenterally nourished over long periods and achieve near normal or normal growth and development.

In children’s hospitals the nutrition of premature babies and severely ill children is focus of nutrition medicine whilst outpatient settings deal with nutrition counselling and specific longterm therapies in and in cooperation with specialized clinics.

With disappearance of undernutrition and lack of single nutrients observed in cases of neglect and “nutritive maltreatment” overweight and obesity have appeared as a new challenge. Guidelines have been developed for various paediatric nutrition topics; they are based on more or less scientific evidence depending on the state of knowledge at the time of guideline preparation.

Schlüsselwörter

Kinderernährung - Stoffwechselstörungen - Diarrhöen - Unterernährung - Adipositas

Keywords

infant and child feeding - metabolic diseases - diarrhea - undernutrition - obesity
 

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