Nutrition Interventions for Children with Special Health Care Needs

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Chapter 11 - Community Monitoring of the Patient on Home Parenteral Nutrition Assessment Intervention Evaluation/Outcome • Triglycerides • Prothrombin time • Zinc, copper, selenium, vitamin B12 • Ammonia • Liver function tests: SGPT, SGOT, GGT, and direct bilirubin • Alkaline phosphatase • Cholesterol • Fat-soluble vitamins (A, E, D) Clinical Observe child for signs of PN-related complications: Complications are identified and treated Immediately alert physician and PN team of signs of complications • Infections (e.g., catheter or line sepsis): indicated by fever, redness at catheter site, elevated triglycerides or glucose levels, lethargy • Mechanical (e.g., catheter occlusion): indicated by clot or thrombus, failure to maintain line patency, formation of fibrin sheath outside catheter, fat deposition or mineral (calcium and phosphorus) precipitates • Metabolic abnormalities (e.g., electrolyte imbalances, glucose instability, elevated triglycerides, elevated liver function tests) indicated by abnormal lab values Dietary/Feeding Assess feasibility of enteral (tube-feeding or oral) trial. Evaluate: Transition to enteral (tube or oral) feedings is begun (or postponed) Make referral to occupational therapist in advance of starting enteral feeding, for oral stimulation, prevention of future feeding aversions • Developmental readiness • Medical readiness • Readiness of family • Level of oral stimulation 132 Nutrition Interventions for Children With Special Health Care Needs Gradually begin oral or tube feeding when feasible
Assessment Intervention Evaluation/Outcome Fluid, energy, protein, and micronutrients provided by parenteral and enteral nutrition meets child’s estimated needs for growth and weight gain As enteral intake approaches 30% of estimated energy needs (and is absorbed), begin decreasing energy provided by PN solution. 7 Consider: Once transition from parenteral to enteral nutrition is begun, assess adequacy of PN and enteral intake: energy, protein, vitamins and minerals. During transition, monitor weight closely. • Reduce rate of PN infusion by 1 mL for every 1 mL tube feeding rate increase • Eliminate lipid infusion when 50-60% energy needs are met enterally and weight is stable • Reduce number of hours of PN infusion • Discontinue PN when 75-80% energy needs met orally or enterally and there is adequate nutrient absorption Section 2 - Problem-Based Nutrition Interventions Nutrition Interventions for Children With Special Health Care Needs 133 *For reference data and guidelines for taking accurate measurements, see Chapter 2
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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 16 - 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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