Nutrition Interventions for Children with Special Health Care Needs

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Chapter 8 - Oral-Motor Feeding Problems Table 8-1: Developmental Sequence of Oral-Motor and Self-Feeding Skills Age Reflexes Jaws and Cheeks Lips Tongue Swallowing Self-Feeding • Hand-tomouth activity • Suck-swallow sequence 1:1 at start of feed; 2-3:1 toward end of feed • Air swallow common • Fills oral cavity • Provides compression and suction during sucking • Upper lip exerts more pressure than lower in sucking • No lateral lip closure • Lips closed at rest • Fat pad present • Primary jaw movement downward during sucking • Palmomental • Rooting • Gag • Phasic bite Term to 1 month • Expects feeding at regular intervals See above • Fat pad thinning • Lateral borders close on nipple 1-2 months • Visual recognition of nipple • Pats bottle or breast • Can voluntarily inhibit suck to look or listen • Tongue protrudes in anticipation of feeding or if nipple touches lip • Ejects food voluntarily • Smacks lips • Protrudes lips to surround nipple • Buccal cavity begins to develop • Palmomental and phasic bite disappearing 3-4 months • Begins finger feeding • Plays with spoon • Choking rare on breast or bottle • One sip at a time from a cup • No gagging on pureed food • Tongue moves in up and down manner with pureed foods; no lateralization • Tongue still in anticipation of food • Tongue protrudes before swallow • Draws in lower lip when spoon removed • Upper lip active in cleaning food from spoon • Purses lips at corners • Buccal cavity developed • Up and down munching and biting • Inner cheeks draw inward during eating • Positions mouth for spoon • Rooting begins to diminish • Gag elicited farther back in mouth 96 Nutrition Interventions for Children With Special Health Care Needs 5-6 months
Age Reflexes Jaws and Cheeks Lips Tongue Swallowing Self-Feeding • Feeds self cracker • May hold bottle • Does not gag on ground foods or soft semisolids • Tongue begins lateral shift when food is at side of mouth • Blows “raspberries” • Upper lip moves downward and forward to actively clean spoon • Mature gag • Munching continues • Jaw closes on solid then sucks it • Jaw held closed while a piece of soft solid is broken off 7-8 months • More precise finger feeding • Reaches for spoon, may insert crudely in mouth • Drinking from cup • Takes 1-3 sucks before stopping to swallow and breathe • Lateral movements to transfer food from center to sides of mouth • Lips active with jaw during chewing • Briefly closes lips on cup rim • Munches with diagonal movements as food is transferred from center to sides • Voluntary biting on food and objects 9 months Section 2 - Problem-Based Nutrition Interventions • Finger feeds ependently • Holds and lifts cup but has spillage • Brings spoon to mouth but inverts spoon before mouth • Fills spoon poorly • Taking increased amount of liquids from cup • Takes 4-5 continuous swallows • Swallows ground, mashed or chopped table foods without gagging • Lateralizes from center to sides • Licks food from lower lip • Intermittent tongue tip elevation • Lips closed during swallow with no food or liquid loss • Lower lip is drawn inward to be cleaned by upper gums • Controlled, sustained bite on soft cookie • Begins rotary chewing movements 12 months Nutrition Interventions for Children With Special Health Care Needs 97 Adapted from Glass, RP and Wolf, LS. Approaches and Strategies for the Occupational Therapist in Early Intervention, p. 132.
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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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Page 118 and 119: Chapter 9 - Behavior Issues Related
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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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Nutrition Interventions for Children with Special Health Care Needs

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