Nutrition Interventions for Children with Special Health Care Needs

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Chapter 9 - Behavior Issues Related to Feeding addresses both dysfunctional family dynamics as well as implement a behavioral feeding intervention. If nutritional status, failure-to-thrive, or other medical issues are significantly problematic, inpatient treatment for the child may be indicated. While feeding may initially be handled by an inter-disciplinary team of hospital clinicians, the primary caregiver should ultimately receive direct practice in utilizing new feeding patterns with the child prior to discharge (10). Table 9-1: Typical Reinforcers for Eating or Food Refusal Example Most likely to occur when… Least likely to occur when… Reinforcer: Tangible • getting a kiss • getting a new toy • distraction • changing of activities • bandaid • food/drink • comfort item • this is the most effective way to ensure that the tangible item will be provided • the tangible item has been provided in the past for this behavior • the tangible item is not readily available • something in the environment leads the child to believe that the item is about to become less readily available • the tangible item is readily available • the item has never been provided after this behavior • there is an easier and equally reliable way to gain access to the item Reinforcer: Internal – Generally, no pattern to occurrence or the pattern is relative to sleep or medication schedule. • facial grimace • muscle contraction/ extension • random selfinjurious behavior • behaviors designed to access deep pressure (in the form of physical assistance or restraining) • child is alone and no one is likely to respond • no pattern to occurrence • in the midst of a preferred, low demand, high attention activity • high level of sensory input • low level of sensory input 114 Nutrition Interventions for Children With Special Health Care Needs
Section 2 - Problem-Based Nutrition Interventions Example Most likely to occur when… Least likely to occur when… Reinforcer: Attention (Adult’s Behavior) • encouraging • looking at the child • talking to the child • explaining • approaching • touching • taking to time-out • helping • wiping nose or eyes • repeating • asking • scolding Reinforcer: Escape (Child’s Behavior) • ignoring • not doing the task • screaming • being sent to timeout • turning away • being passive • doing it poorly • self-injury • aggression • charming behavior • asking questions • changing positions • going to the bathroom • vomiting • attention is diverted from child • adult is occupied with a task • attention was briefly removed • a more high quality attention can be gained • another individual enters who has diverted attention in the past • some change occurs in the environment which signals the child that attention is about to be diverted • it has resulted in attention in the past • a non-preferred activity is occurring • a task is presented • a request is made • something in the environment leads the child to believe a task or request will be presented • the environment is unpleasant to the child (sensory overload) • a non-preferred activity has occurred in the setting in the past • the behavior has resulted in escape in the past • child is receiving one-onone attention • the environment is free of anything that might lead the child to believe that the attention might be interrupted • high quality attention is as reliably, easily, and quickly available through some other low-effort behavior and the child has used it often in the past • the child is engaged in an activity of his own choosing • the environment is free of anything that might lead the child to believe that a request will be made or a non-preferred activity might occur • there is an alternative way to avoid or escape the setting, activity, or task that is just as reliable, quick, and easy…and the child has used it effectively in the past Nutrition Interventions for Children With Special Health Care Needs 115
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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 4 - Breastfeeding recommend
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Chapter 4 - Breastfeeding Table 4-1
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Chapter 4 - Breastfeeding Assessmen
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Chapter 4 - Breastfeeding 58 Nutrit
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Chapter 5 - Medication-Nutrient Int
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Chapter 5 - Medication-Nutrient Int
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Chapter 14 - 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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