Nutrition Interventions for Children with Special Health Care Needs

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Chapter 7 - Nutrition Interventions for Diarrhea Assessment Intervention Evaluation/ Outcome Close, frequent followup is indicated to see if appropriate medical recommendations are being followed or are effective in decreasing the amount or frequency of diarrhea. Medication may be indicated in some cases (e.g., pancreatic enzymes in cystic fibrosis, sulfasalazine or corticosteroids in inflammatory bowel disease). Work with primary care provider or medical consultant. Medical evaluation may include different studies, depending on the clinical situation, diagnosis (if known), and duration and severity of diarrhea: • Stool cultures and studies may be done for infectious causes and fat content • Blood tests may be done for electrolytes, specific micronutrients: vitamin E and B12 (if problems with ileal absorption), total protein, albumin, d-xylose, carotene • Sweat test • Gastrointestinal x-rays and/or sigmoidoscopy or colonoscopy and biopsy Physical examination to include not only assessment of hydration status, but also assessment of nutritional status. Dietary Dietary triggers of diarrhea are identified and eliminated from food pattern. If food allergy or intolerance is suspected, try eliminating specific foods that seem to be related to the diarrhea. Caution must be taken that an elimination diet is not so extreme that it leads to inadequate nutrient intake. Obtain a diet history and compare with stool history to determine possible relationships between foods and diarrhea. Food pattern provides adequate amounts of energy, protein, and vitamins and minerals. For example, evaluate whether or not onset of diarrhea coincides with introduction of cow’s milk or cow’s milk protein formula (cow’s milk protein sensitivity, lactase deficiency); cereals or bread (glutensensitive enteropathy); foods with table sugar added, (sucrase deficiency). Provide instruction about special diets when indicated (such as lactose-free diet for lactase deficiency, gluten-free diet for gluten-sensitive enteropathy, low fructose for fructose intolerance, etc.) 6-8 90 Nutrition Interventions for Children With Special Health Care Needs Consider obtaining a 3-7 day food record and a 3-7 day stool record. Close, frequent follow-up is indicated to see if appropriate dietary recommendations are being followed or are effective in decreasing the amount or frequency of diarrhea.
Assessment Intervention Evaluation/ Outcome Food pattern does not contribute to diarrhea. For chronic nonspecific, diarrhea consider decreased fruit juice intake and increased fat and fiber intake 9,10 Evaluate ratio of energy from fat and carbohydrate in the diet (low fat diet may contribute to nonspecific diarrhea) 3,9 Evaluate volume of liquids ingested and amount of fruit juice consumed. 3,9 Tube feeding does not contribute to diarrhea. Consider adjustments to tube feeding formula, rate, as indicated. If child is tube-fed evaluate the type and preparation of formula, rate of feeding, tube position (gastric or small bowel), care of feeding bags and tubes, etc. Consider changing to a formula with added fiber .3,10 Section 2 - Problem-Based Nutrition Interventions Nutrition Interventions for Children With Special Health Care Needs 91 *See Chapter 2
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Nutrition Interventions for Childre
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Kay Kopp, OTR/L Occupational Therap
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Appendices Appendix A Sample Screen
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ii Nutrition Interventions for Chil
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Population “Children with special
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vi Nutrition Interventions for Chil
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Chapter 1 - Nutrition Screening and
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Chapter 2 - Anthropometricss needs,
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Chapter 2 - Anthropometricss Statur
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Chapter 2 - Anthropometricss Techni
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Chapter 2 - Anthropometricss paraly
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Chapter 2 - Anthropometricss time a
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Chapter 2 - Anthropometricss measur
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Chapter 2 - Anthropometricss Mild m
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Chapter 2 - Anthropometricss 9. Re-
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Chapter 2 - Anthropometricss 5. Per
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Chapter 2 - Anthropometrics Table 2
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Chapter 2 - Anthropometricss Refere
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Chapter 2 - Anthropometricss 26. Kr
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Chapter 3 - Physical Activity for C
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Chapter 12 - Accommodating Special
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Chapter 12 - Accommodating Special
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Chapter 13 - Nutrition Intervention
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Chapter 22 - Ketogenic Diet for Sei
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Appendix A Please list any other nu
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Appendix A Baby formula What kind o
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Appendix B Manufacturer Description
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Appendix C 282 Nutrition Interventi
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Appendix D 284 Nutrition Interventi
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Appendix E 292 Nutrition Interventi
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Appendix E Table 3: Parent-Specific
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Appendix F Percentiles of Upper Arm
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Appendix F 302 Nutrition Interventi
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Appendix G 304 Nutrition Interventi
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Appendix H 312 Nutrition Interventi
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Appendix I 320 Nutrition Interventi
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Appendix J 328 Nutrition Interventi
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Appendix K 336 Nutrition Interventi
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Appendix K 338 Nutrition Interventi
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Appendix L 340 Nutrition Interventi
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Appendix M 342 Nutrition Interventi
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Appendix M 344 Nutrition Interventi
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Appendix N Gastrostomy Tube Feeding
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Appendix N activities. When feeding
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Appendix N Feeding Sets/Extensions
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Appendix N Fluid and Electrolytes W
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Appendix N osmolality of full-stren
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Appendix N Modular Products Modular
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Appendix N his family, and the home
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Appendix N • The feeding tube may
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Appendix N equipment. The Special S
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Appendix N Table N-2: Common Compli
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Appendix N Complication Possible Ca
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Appendix N 368 Nutrition Interventi
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Appendix O Some conditions increase
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Appendix O Table O-3: Recommended P
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Appendix O 374 Nutrition Interventi
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Appendix P Diet Prescription for Me
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Appendix Q Goals Considerations for
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Appendix R Condition Description Nu
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Appendix R Condition Description Nu
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Appendix R References 1. Ekvall SW
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Appendix S Table S-1: Infant Formul
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Appendix S Comments Osmolality (mOs
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Appendix S Table S-2: Pediatric For
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Appendix S Table S-3: Modular Produ
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Appendix S Comments Energy (kcal) P
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Appendix S Contact Information Abbo
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Appendix T Powdered Formulas Accura
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Appendix T Table T-1: Liquid Concen
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Appendix T 402 Nutrition Interventi
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Appendix U Nutrition Strategies for
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Appendix U ADA Pocket Guide to Nutr
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Glossary Autism Spectrum Disorders
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Glossary Early intervention service
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Glossary Length (recumbent length)
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Glossary Stadiometer moveable headb
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Index specialist 98 target 108 Bink
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Index elemental formula 348 elimina
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Index I ICF. See International Clas
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Index risk indicators 4 screening 1
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Index suppositories 72, 77 Surmonti
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