Nutrition Interventions for Children with Special Health Care Needs

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Chapter 17 - Nutrition Interventions for Cystic Fibrosis referred for a sweat chloride by their pediatrician. Infants with a positive sweat chloride are sent to a CF Clinic. All patients should be followed by an interdisciplinary team at a Cystic Fibrosis Center. The clinical practice guidelines for Cystic Fibrosis, published by the Cystic Fibrosis Foundation, require a coordinated, interdisciplinary approach for the diagnosis and management of patients with CF who have diverse needs and complex treatment plans (4). Typically, the treatment involves professionals in the following areas: • medicine • nursing • nutrition • physical therapy • respiratory therapy • social service • psychologist The nutrient needs of a person with CF are often difficult to meet because of both increased nutrient requirements and decreased food intake. The energy requirement is increased because of hypermetabolism intrinsic to the genetic defect, increased losses of nutrients attributable to pancreatic insufficiency and chronic pulmonary infection, as well as in some instances, sinusitis. Decreased intake is the result of emesis due to coughing, increased work of breathing, anorexia from both GI and pulmonary symptoms and psychosocial issues (2,5). Pancreatic insufficiency is controlled with the use of pancreatic enzymes containing lipase, protease, and amylase. There are several brands and doses of products available. Generic enzymes are not approved for patients with CF. Powdered enzymes are also no longer recommended. Enzymes are administered via capsules with acid resistant coated microspheres released in the alkaline pH of the duodenum. It is recommended that the enzymes be taken prior to meals, snacks and enteral feedings either in the intact capsule form or with the enteric-coated microspheres mixed with an acidic food (2,6,7). Recommendations from the Cystic Fibrosis Foundation are to limit the amount of lipase to 2500 IU lipase per kg per feeding or meal. Because of the increased median age of survival of patients with CF today, secondary illnesses are more common. These include CF-related diabetes, liver disease, and osteoporosis, which require specific interventions as well (2). The effects of the disease on growth are more noticeable. Adequate health care for these patients requires close attention to their nutritional needs. The goal of nutrition intervention is to promote normal growth and development and optimal resistance to infection. 192 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition-Specific Nutrition Interventions Current research is showing that deterioration of pulmonary function can be reversed and catch-up growth achieved by means of nutrition support (8,9). The remainder of this chapter presents guidelines for nutrition assessment, intervention, and evaluation/outcome for children with cystic fibrosis. Nutrition assessment for CF includes the components listed in the table four times per year and is performed by the registered dietitian (RD) in the Cystic Fibrosis Center. The following is included to clarify the information to community RDs who concurrently see patients with CF who are managed at a designated CF center. The community RD and CF Center RD will need to work together to coordinate care and avoid duplication of services. Nutrition Interventions for Children With Special Health Care Needs 193
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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 11 - Community Monitoring o
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Chapter 12 - Accommodating Special
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Chapter 12 - Accommodating Special
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Chapter 21 - 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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