Nutrition Interventions for Children with Special Health Care Needs

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Chapter 17 - Nutrition Interventions for Cystic Fibrosis Assessment Intervention Evaluation/Outcome Clinical Assess for Fewer stools (2/day) and normal consistency Fewer stomach aches Adjust pancreatic enzyme dose to achieve optimal absorption and prevent constipation without the risk of fibrosing colonopathy (sometimes associated with an excessive dose or abrupt discontinuation of pancreatic enzymes). No rectal prolapse • stool (frequency, consistency, size, and color) • abdominal cramping or pain • use of pancreatic enzymes (product name, dose, and frequency) • use of over-the-counter medications as alternative nutrition therapies Re-evaluate pancreatic enzyme dosage at each clinic visit. Rule out distal intestinal obstruction syndrome (DIOS), which has similar symptoms to obstipation or constipation. (Patient needs to be seen in a CF center.) 10 Rule out dehydration. Medication-nutrient interactions are identified and addressed. Address medication-nutrient interactions. (See Chapter 5) Identify possible medication-nutrient interactions, including nausea, vomiting, or diarrhea, possibly attributed to antibiotic therapy. Therapy does not interfere with adequate intake. If chest physio-therapy causes vomiting, complete meals at least 1 hour before therapy or delay Assess effects of chest physio-therapy on intake (can cause vomiting). meals until ½ hour after. Consider energy-dense liquid supplement. Difficulty with breathing does not interfere with adequate energy intake. Patient is tolerating a nutritionally adequate diet without experiencing gastrointestinal symptoms. Assess effects of difficulty with breathing on energy intake (difficult breathing can interfere with ability to chew and swallow). Nutrition Assess intake by diet history. Determine intake of energy, protein, carbohydrate, fat, vitamins, and minerals with 24 hour recall or food record. Specific guidelines are provided below. Determine use of supplements, enteral products, calorie additives, vitamins, and minerals. Identify product name, amount, and frequency. Obtain exact formula recipe used by the family. 196 Nutrition Interventions for Children With Special Health Care Needs Provide recommendations for adequate nutrient intake. Specific guidelines are provided below. Diet should have no limitations for fat, carbohydrate, or protein.
Assessment Intervention Evaluation/Outcome Intake provides an adequate amount of energy for growth. If energy intake is lower than estimated needs, increase energy intake. 5 Caloric intake is estimated to be at 130%-150% of the RDA for age and Ideal Body Weight. RDA is continued to be used by most CF centers as the DRI for energy does not meet the needs for people with CF. Caregiver and/or patient increase energy in usual diet by selecting energy-dense foods. For infants: Energy-dense products are used appropriately to supplement regular diet. Increase energy intake by concentrating formula to >24 kcal/oz. (or higher if necessary) When strained baby foods started, add Moducal ® , Polycose ® , Scandical ® , or margarine Avoid foods and drinks that have a low ratio of nutrients to energy (e.g., commercial dinner combinations and fruit drinks) Section 3 - Condition-Specific Nutrition Interventions For children, increase energy intake by the following means, used in combination: Increase the energy density of usual foods as much as possible without increasing the volume of food Nutrition Interventions for Children With Special Health Care Needs 197 Identify and encourage intake of readily available energy-dense foods enjoyed by the patient Formulate recipe for homemade milkshakes, according to individual preference. Include ingredients such as milk, powdered milk, halfand-half, cream, breakfast powders, corn oil, fruits, and/or syrups Use commercial supplements; ie, complete enteral products such as Scandishake ® , Ensure ® , Ensure Plus ® , or Boost ® . if acceptable to patient or modular products; i.e., Polycose ® , Moducal ® , or Scandical ®11
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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 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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