Nutrition Interventions for Children with Special Health Care Needs

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Chapter 10 - Enteral Feeding Table 10-2 Guidelines for Evaluating the Patient on an Enteral Tube Feeding Assessment Intervention Evaluation/Outcome Caregiver(s) and all involved medical professionals contribute to decisions regarding feeding route Determine most appropriate feeding route: • Site of formula delivery (i.e., gastric, duodenal, or jejunal) • Tube placement (i.e., nasal or surgical) Once the decision is made to tube feed, have a gastrointestinal work-up done to document intestinal motility, anatomic integrity, and presence/absence of gastroesophageal reflux Patient is receiving a nutritionally adequate feeding Have a medical/surgical assessment done Determine requirements for the following: • Fluid • Energy • Protein • Vitamins • Minerals • Electrolytes Determine most appropriate type of formula and supplements. Before starting tube feeding, do a complete nutrition assessment:* Determine most appropriate method of formula delivery (i.e., bolus, continuous drip or combination) • Anthropometric • Biochemical • Physical • Dietary 126 Nutrition Interventions for Children With Special Health Care Needs Caregiver(s) obtain appropriate formula and supplements Instruct caregiver(s) about the following:† Caregiver(s) demonstrate appropriate techniques for feeding and stoma/skin care Caregiver(s) know when to call MD • Obtaining the formula and supplements • Preparing the formula • Giving feedings and using the pump • Daily skin/stoma care • When to call physician
Assessment Intervention Evaluation/Outcome Child tolerates feeding regimen and formula well (no gastrointestinal disturbances or other signs of formula intolerance) As necessary make changes in: Once tube feeding has begun, monitor closely: • Tolerance of tube feeding; maintain frequent contact with family by phone or clinic visits; check for vomiting, diarrhea, constipation, and other adverse reactions • Growth and indicators of fat and muscle stores, every 1 - 2 months until weight gain has been stable for 2 months Weight gain is stable and adequate • Type of formula • Amount of formula • Method of delivery • Additional supplements • Once child achieves appropriate weight for height (or length), evaluate need for reducing energy intake to compensate for low energy needs due to immobility or paralysis Weight is appropriate for height (or length) Make changes in formula and delivery method as indicated by nutritional status. Once weight gain has been stable for 2 months, re-evaluate every 6 months (more often in periods of rapid growth, such as infancy and adolescence): Formula meets requirements for energy, protein, vitamins, minerals, and electrolytes Section 2 - Problem-Based Nutrition Interventions Fluid intake is adequate • Growth and indicators of fat and muscle stores • Nutrient adequacy of formula • Method of formula delivery • Tolerance of formula *For more information, see Chapter 1 Nutrition Screening and Assessment. †See Appendix N Technical Aspects of Enteral Feeding. Nutrition Interventions for Children With Special Health Care Needs 127
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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 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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