Nutritional Management of Pediatric Short Bowel Syndrome

Ana Abad-Sinden, MS, RD, CNSD, Director, Dietetic Internship Program, Pediatric Nutrition Support Specialist and James Sutphen, M.D., Assistant Professor, UVA Health System, Department of Nutrition Services, Charlottesville, VA. Pediatric short bowel syndrome (SBS), usually caused by massive intestinal resection, presents a significant nutritional challenge to the pediatric clinician. The overall clinical course and nutritional outcomes of SBS are impacted by various factors including remaining intestinal length and site, functional differences between the proximal and distal small intestine, and the presence of the colon. Nutritional management of SBS can be variable from patient to patient and can be divided into three stages: parenteral nutrition, enteral nutrition, and introduction of solid foods. Optimization of parenteral nutrition with a balanced fuel mix of carbohydrate, protein and fat should be provided to meet energy needs and promote growth during the first few weeks of nutritional management. Following fluid and electrolyte stability and demonstrated growth on parenteral nutrition, enteral nutrition with semi-elemental or elemental formulas should be initiated in a timely manner to promote intestinal adaptation. Because electrolyte and fat-soluble vitamin loss can impair optimal growth, infants and children with SBS often require supplementation with sodium and pediatric multivitamins and also benefit from supplementation with fiber and glutamine. Introduction of age appropriate low simple carbohydrate, high protein foods using small frequent feedings during the day further promote intestinal adaptation as well as oral-motor skills. The following article will present a comprehensive overview of nutritional management in the pediatric patient with SBS with practical guidelines for the clinician. James Sutphen