Nutrition Interventions for Children with Special Health Care Needs

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Chapter 10 - Enteral Feeding Other possible physical disadvantages are diarrhea, skin breakdown, or stoma site granulation/infection. Mechanical disadvantages can be a dislodged or occluded feeding tube (1-6). Children who are either malnourished or at high risk for becoming malnourished can benefit from tube feeding. When one or more of the following factors are identified, tube feeding should be considered after other aggressive oral interventions have been tried (1,6): • Inability to consume at least 80% of energy needs by mouth • Total feeding time more than four hours per day • Inadequate growth or weight gain for more than one month (under age 2 years) • Weight loss or no weight gain for a period of three months (over age 2 years) • Weight for length or Body Mass Index (BMI) less than 5th percentile for age/sex • Triceps skinfold less than 5th percentile for age An interdisciplinary team should decide whether or not to begin tube feeding. At a minimum, the team should include the child’s caregivers, the primary physician, the surgeon, and the registered dietitian (RD). If the child has oral motor feeding problems, the team should also include an occupational or speech therapist. Before tube feeding is started, the child needs a medical work-up for the following purposes: • To rule out contraindications for enteral feeding (e.g., malabsorptive disease) • To diagnose possible gastrointestinal problems (e.g., gastroesophageal reflux, risk of aspiration) • To determine the optimal delivery site for the feeding (e.g., stomach, duodenum, or jejunum) • To determine an appropriate program for oral-motor stimulation The feeding tube may be placed through the mouth or nose such as for gavage or nasogastric (NG) feedings. A gastrostomy is placed surgically or by percutaneous endoscopic gastrostomy (PEG). The choice of placement depends on many factors (1-6): • Expected duration of the need for tube feeding (generally, NG feeding tubes are used for short periods of time only) • Local resources for dealing with possible complications • Family’s ability to learn the feeding technique required by the particular placement • Preference of the caregiver(s) Oral-motor problems may improve with development, time, and treatment. All enteral feeding techniques are reversible. Discontinuation of enteral feedings requires the same careful planning and often the same detailed work-up that go into the decision to start it. 122 Nutrition Interventions for Children With Special Health Care Needs
Section 2 - Problem-Based Nutrition Interventions The remainder of this section is presented in two parts: guidelines for determining when enteral feeding is necessary (Table 10-1) and guidelines for evaluating the patient who is being tube-fed (Table 10-2). The details of the enteral feeding process, including possible complications, are discussed in Appendix N. Nutrition Interventions for Children With Special Health Care Needs 123
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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 15 - 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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