Nutrition Interventions for Children with Special Health Care Needs

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Chapter 1 - Nutrition Screening and Assessment Table 1-1: Nutrition Screening Screening Activities Nutrition Risk Indicators 3-7 Repeat screening in 6 to 112 months if no nutritional risk factors are identified. Refer for nutrition assessment if any of the following exist: Anthropometric Measure and weigh using standardized techniques and appropriate equipment* • Height or length for age less than 10th percentile • Weight for age less than 10th percentile • Weight for length (or height) less than 10th percentile • Weight for length (or height) greater than 90th percentile • BMI less than 10th or greater than 90th percentile • Change in weight or length of 2 or more percentile channels • Inadequate growth or weight gain for more than one month (under age two) Plot on standard growth charts† • Height or length for age • Weight for age • Weight for height (or length) • Head circumference (under age 3 years) • Body Mass Index (BMI) (over age 2 years) Compare current measurements to reference data and to previous measurements available. If signs of neglect or physical abuse are noted, contact Child Protective Services (CPS). When doing anthropometrics, observe for signs of neglect or physical abuse. Refer for nutrition assessment if abnormal lab values of nutritional significance. Biochemical Laboratory Data Obtain lab data from medical record, WIC program, or primary care provider: • Hematocrit (Hct) or hemoglobin (Hgb) • Other pertinent lab data: serum albumin, serum prealbumin, if available Clinical/Medical History Review past medical history and current health status and diagnosis 4 Nutrition Interventions for Children With Special Health Care Needs Refer for nutrition assessment if any of the following: • Anemia • Anorexia and/or bulimia nervosa • Autism or Pervasive Developmental Disorder • Cardiac, pulmonary, or renal disease (See Chapters 16, 18,19) • Chronic constipation or diarrhea (See Chapters 6 and 7) • Chronic diseases such as diabetes, cancer, HIV/AIDS • Cystic fibrosis (See Chapter 17) • Feeding problems, poor appetite or refusal to eat (See Chapters 8 and 9) • Fetal alcohol syndrome or fetal alcohol effects • Food allergies or intolerances • Frequent or recurring infections
Screening Activities Nutrition Risk Indicators • Gastrointestinal disorders, reflux, vomiting • History of poor growth or excessive weight gain (See Chapters 13 and 14) • Long-term use of laxative, diuretic, anticonvulsant, steroid, or stimulant medications (See Chapter 5) • Malabsorption syndromes • Metabolic disorders, ie, PKU, galactosemia (See Chapter 21) • Myelomeningocele (spina bifida) • Neurological conditions, ie, cerebral palsy, anoxia, trauma • Oral or facial anomalies that affect nutrition (See Chapter 8) • Prader-Willi syndrome (See Chapter 13) • Significant dental problems • Special or therapeutic diet • Tube feeding (See Chapter 10) Refer for nutrition assessment if: Dietary Interview caregiver(s) to determine Section 1 - Determination of Nutrition Status • Inadequate or inappropriate dietary intake, i.e., NPO or hypocaloric intake for more than 3 days • Alternative or special diet: vegan, macrobiotic, or other restricted diet • Consumes only liquid, pureed, or ground food after age 2 • Pica (intake of non-food items, ie, clay, dirt, starch) • Use of supplements, including vitamin / minerals exceeding 100% of the DRI without physician recommendation • Concerns about food intake, feeding, and nutrition • Child’s typical feeding pattern (types of foods eaten and how often, aversions, and preferences) • Use of oral supplements • Use of vitamin/ mineral supplements • Use of herbal products or alternative nutrition or other therapies Developmental Feeding Skills‡ Interview caregiver(s) to determine child’s feeding skills: • Oral-motor control • Frequency and duration of feedings • Consistency of foods eaten • Self-feeding skills • Typical fluid intake by breast, bottle, and/ or cup • Concerns about progression of feeding skills Nutrition Interventions for Children With Special Health Care Needs 5 Refer for nutrition assessment if: • Abnormal sucking pattern (arrhythmic, disorganized, lack of initiation) • Swallowing difficulties (gagging, choking, coughing, noisy breathing after feeding) • Difficulty with chewing • Inability to drink from a cup at appropriate age • Lack of progression in food textures • Not self-feeding after two years of age • Feeding routinely takes longer than 45 minutes per meal Review health records for signs of delays or abnormalities in the development of feeding skills.
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Page 6 and 7: Kay Kopp, OTR/L Occupational Therap
Page 8 and 9: Appendices Appendix A Sample Screen
Page 10 and 11: Nutrition Interventions for Childre
Page 12 and 13: ii Nutrition Interventions for Chil
Page 14 and 15: Population “Children with special
Page 16 and 17: vi Nutrition Interventions for Chil
Page 18 and 19: Chapter 1 - Nutrition Screening and
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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 11 - Community Monitoring o
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Chapter 12 - Accommodating Special
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Chapter 13 - 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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