Nutrition Interventions for Children with Special Health Care Needs

Chapter 16 - Nutrition Interventions for Respiratory Diseases
aSSeSSmeNT INTeRveNTIoN evaluaTIoN/ouTCome
Growth and laboratory
values improve in response
to intervention.
Assess dietary intake, feeding skills, and
feeding interactions. Plan interventions based
on assessment. Possibilities include increased
energy density of breastmilk or formula
and foods (see Appendix T), initiation of
tube feedings (see Chapter 10), referral for
caregiver counseling and support, and referral
for therapies and treatment of problems such
as reflux, aspiration, and compromised oxygen
status.
protein status: If long-term growth is poor, consider monitoring for
protein status with measures of serum albumin, prealbumin, or
transferrin.
Clinical
Growth is appropriate. SaO2
remains >92%.
Provide oxygen therapy as needed. This may
include oxygen support only at feeding and
sleeping or increased flow rates at these times.
Oxygen status: Periods of hypoxemia or marginal hypoxemia
should be suspected whenever infants with BPD fail to grow. 1,5,6
Previously undetected hypoxemia has been reported during sleep
and during and after feeding. 8,16,
Oxygen status should be assessed with pulse oxymetry during
feeding, sleeping, and crying. SaO2 >92% during feeding,
sleeping, and crying is recommended. 1,6 Values in the range of
95% have been reported to increase growth. 1
184 Nutrition Interventions for Children With Special Health Care Needs
Growth is appropriate.
Plan diet that provides adequate energy and
nutrients with limited fluid intake. May need to
concentrate formula. See Appendix T.
Fluid restriction: Fluid restriction may be prescribed for infants
with severe BPD in first months of life.
Meal times and post-prandial
period are pleasant and pain
free. Respiratory symptoms
improve.
If symptoms indicate need for further
assessment, refer to primary care provider
for arrangements for diagnostic tests.
Interventions for GER include:
Gastroesophageal reflux (GER): Assess presence of GER
symptoms: regurgitation with gagging/coughing/repeated
swallowing between meals, red and teary eyes, excessive
vomiting, esophagitis (post prandial pain, anemia), respiratory
symptoms (pneumonia, wheezing), neurobehavioral symptoms
(irritability, crying, feeding refusal, seizure-like attack).
• medication
• positioning
• dietary (e.g.smaller more frequent
feedings)
• surgical (reflux unresponsive to above
treatments may require surgical
intervention)