Nutrition Interventions for Children with Special Health Care Needs

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Chapter 8 - Oral-Motor Feeding Problems • the child’s ability to achieve and maintain an appropriate behavior and state of alertness for feeding • the stability of the child’s physiologic functions to support feeding (e.g., stability of heart rate or respiratory rate) • coordination of feeding, swallowing, and breathing • swallowing function using videoflouroscopic swallowing study (VFSS), if indicated (2) Difficulties in parent-child interaction may also be associated with oral-motor feeding problems. It is often difficult to differentiate between physical, behavioral, and interactional problems. Thus, it is necessary to consider all three when evaluating a child for oralmotor feeding problems (3). In addition, related medical problems such as gastroesophageal reflux (GER) may influence the child’s feeding ability. If the child associates eating with the pain that often accompanies GER, the child may be resistant to feeding and food intake may decline dramatically. If GER is suspected, further evaluation by the child’s primary physician or a gastroenterologist is indicated. Since most feeding problems have multiple underlying factors that contribute to the overall nutritional and feeding deficits, a team approach is the most effective method to thoroughly assess and intervene with the oral-motor feeding problems. In addition to the occupational, speech, or physical therapist, this team should include a registered dietitian (RD), a pediatrician, or other primary health care provider and the caregivers. The team may often also include a nurse or social worker to address the psychosocial issues that frequently occur concurrently with the feeding problem (see Chapter 9). Appropriate interventions can significantly improve the child’s basic feeding skill as well as improve the ease of feeding for the caregiver. Mealtimes can become more satisfying for the child and family promoting better growth and nutrition. Intervention may include: • proper positioning during feeding • specific therapeutic activities to improve basic oral motor skills • specific food types or textures to support the child’s level of oral motor control and swallowing function while ensuring adequate nutrient intake • adapted feeding utensils • specialized feeding techniques (4) If the child is still unable to consume an adequate intake and/or it is unsafe for the child to eat, partial or full nutrition may need to be given via a nasogastric or gastrostomy tube. 94 Nutrition Interventions for Children With Special Health Care Needs
Section 2 - Problem-Based Nutrition Interventions Planning and implementation of any feeding interventions should be done in collaboration with the caregivers and the other members of the team. Treatment strategies should be arranged so that they support caregiver priorities, improve nutrition and improve underlying oral-motor and feeding problems. Table 8-1 describes the developmental sequence of oral-motor and self-feeding skills. Table 8-2 presents guidelines for nutrition assessment, intervention and evaluation/ outcome for children with oral-motor feeding problems. Nutrition Interventions for Children With Special Health Care Needs 95
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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 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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