Nutrition Interventions for Children with Special Health Care Needs

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Chapter 16 - Nutrition Interventions for Respiratory Diseases infants with BPD experience increased energy needs (7). The reasons for this are not entirely clear, but increased work of breathing, catecholamine release due to stress, increased energy requirements for feeding, and the effects of medications probably all play roles. Energy requirements of 120-160 kcal/kg/d have been reported (8). A number of factors contribute to energy expenditure in individuals, including genetics, activity, and severity of respiratory distress. Correlating growth with energy intake is the best indicator of adequacy. It may be difficult to provide adequate energy to infants and young children with BPD. They may have ongoing fluid restrictions due to concerns about pulmonary edema. They may experience fatigue with feeding. Increasing the energy density of formula or breastmilk using a combination of components may be helpful (see Appendix T). For infants with BPD it is inappropriate to use only carbohydrate to increase energy density. A high carbohydrate load increases production of CO . At the 2 same time, the addition of excess fat may delay gastric emptying. Delayed gastric emptying may contribute to gastroesophageal reflux. The addition of vegetable oils that may separate out from formula or breastmilk may be problematic as they may increase the risk of aspiration pneumonia. Since infants with BPD are at also risk for more frequent and serious illnesses in the first months of life, it is important to teach caregivers how to assess hydration status during illness, especially when infants are receiving an energy-dense formula. Nutritional care for the infant with BPD must be individualized. Feeding concerns, nutrient needs, and growth outcomes are different for each infant. Variables that influence the nutrition care plan include initial severity of BPD, presence of other medical problems, and characteristics the infant and caregiver bring to the feeding relationship. Infants and young children with severe BPD may require ongoing mechanical ventilation and a tracheostomy, medications with nutrition implications such as corticosteroids and diuretics (see Chapter 5), gastrostomy tube feedings (see Chapter 10), and frequent hospitalization. Some infants with milder forms of BPD may continue to require medical/nutritional interventions post discharge including supplemental oxygen, medications, and tube feeding. Some infants with CLD may experience exacerbations of respiratory dysfunction with illness, and have feeding difficulties without ongoing need for oxygen, medications, or tube feeding. FeeDING DIFFICulTIeS Feeding problems are common among infants with moderate or severe BPD. These infants benefit from an interdisciplinary team approach to assess and treat feeding issues. Problems found in infants with BPD include poor coordination of suck, swallow, and breathing, swallowing dysfunction with silent microaspiration, oral- 180 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition-Specific Nutrition Interventions tactile hypersensitivity, and aversive behavior associated with unpleasant oral and feeding experiences. Assessment of feeding problems with feeding observations, swallowing studies, and measurements of oxygen saturation during feeding may be helpful. Infants with BPD may also experience gastroesophageal reflux and/or delayed gastric emptying. The feeding situation may show significant improvement if these conditions are diagnosed and treated with changes in feeding patterns, positioning, or medications (9,14,15,16) (See Chapter 8). The growth and development of infants with BPD is also influenced by family characteristics. Taking care of these infants can present many challenges. Feeding issues may contribute to the stress of caring for an infant with BPD. Feeding infants with moderate and severe BPD may require several hours each day (9,11,14). Nighttime feedings may last for several months. Health care professionals and the families themselves may put excessive emphasis on weight gain increments and establish problematic feeding behavior patterns. Infants with BPD are often rehospitalized. They are at high risk of serious illness during the respiratory syncytial virus (RSV) season from November through March, and families are usually told to keep their babies at home. Many caregivers report a sense of social isolation. Assuring that family needs for social, emotional and financial support are met is an essential component of good care for these infants and young children. The remainder of this chapter presents guidelines for nutritional assessment, intervention, and evaluation/outcome for children with broncopulmonary dysplasia. Nutrition Interventions for Children With Special Health Care Needs 181
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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 10 - Enteral Feeding Other
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Refere
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Chapter 20 - 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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