Nutrition Interventions for Children with Special Health Care Needs

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Chapter 10 - Enteral Feeding Table 10-1 Guidelines for Determining When to Use an Enteral Tube Feeding Assessment Intervention Evaluation/Outcome Anthropometric * Caregiver(s) and interdisciplinary team decide either to tube feed, or to continue oral feeding alone with reevaluation at later specified date Consider tube feeding if either of the following: Measure and plot on appropriate growth chart: • Height or length for age • Weight for age • Weight for length or BMI for age • Head circumference (under 3 yr) Consistent growth pattern is established • Inadequate rate of growth or weight gain (for 1 month, under age 2 years; for 3 months over age 2 years) OR decreased rate of weight gain such that weight percentile has dropped continuously over past 6-12 months. • Skinfold thickness and arm fat area OR indicators of muscle mass have decreased or are below 5th percentile Measure: • Triceps skinfold • Mid-upper arm circumference • Subscapular skin fold Calculate: • Arm muscle area • Arm fat area 124 Nutrition Interventions for Children With Special Health Care Needs Obtain and plot all previous anthropometrics that are available Compare all current measurements to reference data and previous measurements Clinical/Medical Tube-feeding is initiated, if appropriate, without development of complications Consider tube feeding if any of the following: Obtain the following: • Aspiration pneumonia (g-tube) • Anatomic abnormality in airway, upper intestinal tract, cranium, or face • Medical conditions characterized by hypermetabolic state (e.g., cardiopulmonary diseases) • Neurologic abnormality that prevents efficient oral feeding; feeding video-fluoroscopy swallowing study (VFSS) may document severity • Medical history • Review of body systems • Physical exam • Supportive laboratory work and/or X-ray (individual indications)
Assessment Intervention Evaluation/Outcome Dietary† Intake of fluid, energy, protein, and other nutrients is adequate to support growth Consider tube feeding if either of the following: Assess dietary intake by diet history and food record • Oral feeding providing less than 80% of required energy • Oral feeding not meeting fluid needs Assess adequacy of energy intake based on growth records Estimate energy needs Estimate fluid needs and assess adequacy of fluid intake Feeding Increased time is available for parentchild interaction, without the pressure of oral feeding Consider tube feeding if: Estimate number of hours per day spent feeding child. Assess oral-motor skills to determine ability to take solids and liquids Oral foods offered in addition to tube feeding are appropriate for the child’s swallowing ability • Caregivers spending more than 4 hr/day feeding (less time, if few caregivers) • Oral-motor skills preventing adequate oral intake of foods in a reasonable length of time • Risk of aspiration when eating or drinking Assess ability to swallow to determine risk of aspiration (e.g., VFSS) Section 2 - Problem-Based Nutrition Interventions *For reference data and guidelines for taking accurate measurements, see Chapter 2. †For more information, see Chapter 1 Nutrition Screening and Assessment. Nutrition Interventions for Children With Special Health Care Needs 125
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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 6 - Nutrition Interventions
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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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