Nutrition Interventions for Children with Special Health Care Needs

Section 3 - Condition-Specific Nutrition Interventions
immature maintenance of physiological stability, disorganized suck-swallowbreathing,
decreased strength and endurance, cardiorespiratory compromise, and
neurodevelopmental complications may contribute to alterations in feeding behavior
and ultimately feeding success (16,17). Infants who experience unpleasant feeding
experiences (choking, respiratory distress, GER) may begin to demonstrate aversive
feeding behaviors. Evaluation of preterm infants with growth concerns and/or reports
of feeding difficulties should include a careful history and description of feeding
behaviors and observation. In observing a feeding, attention should be given to
document control, organization, coordination of suck-swallow-breathing, length of
time to consume adequate volume, evidence of distress, signs of choking or changes
in respiratory status. Infants who demonstrate evidence of feeding difficulties should
be referred to the appropriate disciplines for further evaluation and treatment. See
Chapters 8 and 9.
Nutrient Needs
The nutrient needs of preterm infants after hospital discharge and throughout
the first year have not been clearly established. Common practice is to view the
nutrient needs of the preterm infant to be the same as the term infant when the
preterm infant achieves a weight of 2.0-2.5 kg (4.5-5.0 lbs). Some follow-up
studies raise questions about this practice (10-12). Infants fed a nutrient-enriched
formula after discharge show improvements in growth and mineral status. Followup
studies have also demonstrated decreased bone density in VLBW infants one
year after discharge (18-20). Some preterm infants may continue to be at risk
for inadequate bone mineralization after discharge. These infants may need
higher mineral intake and monitoring after hospitalization. Currently there are no
standardized practices to treat these infants and a variety of strategies have been
used without clear identification of an optimal approach (13). Often, the transition to
breastfeeding occurs after discharge from the hospital. These infants may continue
to receive supplemental bottles of formula or breast milk until the transition to total
breastfeeding is complete. To facilitate transition, follow-up is essential. This followup
can be provided by a hospital or community lactation specialist.
Standard infant formulas are designed to meet the DRI for vitamins and minerals for
term infants when the infant consumes approximately 32 oz/day. Infants discharged
from the hospital weighing 4.5-5.0 lbs may only consume 10-12 oz/day. This volume
may be adequate to meet fluid, energy, and protein needs. However, a multivitamin
supplement is needed to meet the DRI for infants until the infant or child consumes
24-30 oz/day. Soy formulas are not recommended for preterm infants, particularly
those at risk for osteopenia, secondary to decreased bioavailability of calcium and
phosphorus (13).
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