Nutrition Interventions for Children with Special Health Care Needs

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Chapter 14 - Nutrition Interventions for Failure to Thrive Assessment Intervention Evaluation/ Outcome Dietary Parent/caregiver’s knowledge of child’s nutritional needs. Prioritize nutrition intervention to provide information and recommendations for the family that are non-threatening. Determine parents’ knowledge of child’s feeding development and nutritional needs. Nutrition Counseling: 17 Parents are able to read their child’s cues accurately and provide for their needs in a consistent nurturing manner. Evaluate parents’ perception of child’s intake and daily patterns vs. child’s experience described in diet recall and 3-day diet record. Note parents’ ability to read child’s cues and ease of interactions during office visit. Nutrient intake improves. • Provide unconditional positive regard to establish trust with the parents • Convey empathetic understanding to parent’s fears and frustration by acknowledging the difficulty of the situation • Use initial interview and the parent’s perspective on health and nutrition for the educational starting point. Point out challenges the child brings to the feeding situation • Correlate nutrition education with healthy physiologic feeding cycles and social development • Help parents prioritize efforts to maintain healthy eating habits (meal/snack frequency, limit juice, food/ beverage selection, balance of fluid/solid volume, variety) • Move to new concepts when the parent has experienced success and is confident in their ability to implement recommendations • Revert to initial educational information as needed with setbacks • Avoid using specific numbers for goal weight gain and energy intake; speak in terms of working toward healthy feeding patterns and growth Note parental affect, communication of fear, frustration, and/or hopelessness, and ability to sort family issues and focus on child’s current needs. Frequency of ad-lib feeding and drinking is appropriate. Daily dietary pattern approximates foods offered every 2-3 hour interval about 5-6x/day. Fluid intake is balanced to provide nutrient density and allow for adequate intake of nutrient dense solids (for example, 16-24 oz milk or other nutrient dense fluid plus solids to meet needs for catch up growth). Refer to information gained by other disciplines to prioritize nutritional education and amount of information to be provided (typically 1-3 educational points at one time). 18 158 Nutrition Interventions for Children With Special Health Care Needs Compliment parent on efforts to try new ways and implement intervention
Assessment Intervention Evaluation/ Outcome Energy intake is adequate to meet estimated needs. For infants: Estimate energy requirements: 18 For normal weight gain and proportional linear growth: Growth is appropriate. • Concentrate infant formula to >24 kcal/oz using appropriate guidelines. See Appendix T • Fortify pumped breast milk with infant formula to >24 kcal/oz, and/or supplement breast-feeding with infant formula concentrated to >24 kcal/oz • Add Polycose®, Moducal®, margarine, corn oils, and other high fat additives to strained baby foods as tolerated • Avoid juice in excess of 4 oz/day unless temporarily needed to relieve constipation • Determine basal metabolic rate (BMR) from WHO chart (see below). BMR is expressed in kcal, W is weight (kg). • Calculate estimated daily energy needs (DEE): BMR x 1.5 to 1.8 Estimated BMR Age (years) Females Males Section 3 - Condition-Specific Nutrition Interventions Enhance appetite/satiety awareness for infants >10 months of age: 10,19 0-3 61W-51 60.9W-54 • Encourage gradual change to regular, planned feedings consistent with physiological needs. Emphasize feeding intervals, typically every 2-3 hours 6x/day, rather than rigid times • Optimal feeding period lasts up to 20-30 minutes • Allow the child to determine how much food/beverage is eaten. Offer only slight encouragement after the child expresses satiety • Avoid forceful and other overwhelmingly invasive feeding techniques • If the infant is fearful of food from past experiences, refer to OT/PT or behavior therapist for recommendations and potential positive use of feeding distractions • Introduce new foods one at a time with foods the child enjoys. Food variety is not a primary goal until the child is comfortable and is eating regularly. 3-10 22.5W+499 22.9W+495 Nutrition Interventions for Children With Special Health Care Needs 159 10-18 12.2W+746 17.5W+651 18-30 14.7W+496 15.3W+679 Sample calculation for a 10 year old girl who weighs 26 kg: • BMR = 12.2(26) + 746 = 1063 • DEE = 1063(1.6) = 1700 For catch-up weight gain and growth: • Determine BMR based on ideal body weight (IBW)‡ • Calculate estimated daily energy needs: IBW(BMR) x 1.8 to 2.0
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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 8 - Oral-Motor Feeding Prob
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Chapter 9 - Behavior Issues Related
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Chapter 18 - 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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