Nutrition Interventions for Children with Special Health Care Needs

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Chapter 18 - Nutrition Interventions for Congenital Heart Disease and/or modification of dietary sodium. When a child’s fluid intake is limited, it becomes difficult to provide adequate energy intake (4,5). See Appendix T for information about increasing the energy density of formula. CHF can affect either side of the heart. In children with CHD, right-sided CHF is the most common. Children with right-sided failure may have gastrointestinal malabsorption, vomiting, and diarrhea mimicking the common symptoms of milk allergy or formula intolerance. Children with left sided failure may have tachypnea (rapid breathing), tachycardia (rapid heart beat), and/or diaphoresis (sweating) (4). Infants with both types of failure tend to tire easily and may not be able to breastfeed or bottle-feed without developing shortness of breath (4, 5). Malabsorption has been suggested as a cause for growth failure. Some studies report fat and/or protein malabsorption in infants with CHF while others report varying degrees of fat malabsorption in infants with all types of CHD (2,4). Protein losing enteropathy is a condition reported in patients with increased right-sided heart pressures, especially those young children who have undergone the Fontan or Bidirectional Glenn procedure (6). Decreased perfusion to the gastrointestinal (GI) tract often leads to delayed gastric emptying, vomiting and gastroesophageal reflux (GERD) in infants and children with moderate to severe heart failure (6). Reflux can be managed with medications and/or an adjustment to the infant’s feeding (6). Surgical intervention (gastric fundoplication) is effective in managing severe reflux in order to promote weight gain in children with severe congenital heart defects (7). Reduced blood flow to intestinal tract may occur when the body shunts blood away from the gut to preserve heart and brain function in the child with moderate to severe heart failure (6). This reduction in blood flow can cause early satiety, nausea and vomiting which in turn may result in decreased nutrient absorption (6). Often, complications can arise after cardiac surgery. One such complication is the formation of a chylothorax. When the thoracic duct or tributaries are injured during extra pericardial operations, chyle can accumulate in the pleural spaces. This is especially common in surgeries involving mobilization of the aortic arch or coarctation of aorta as well as with a Blalock-Tausig shunt. A chylothorax can also occur spontaneously due to increased pressures within the heart itself (8,9). Conservative nutrition treatment of a chylothorax includes the use of very low fat diet. Infants and young children may require specialized formulas containing high amounts of medium chain triglycerides (MCT) (6). Medium chain triglycerides bypass the lymphatic system and are directly absorbed into the bloodstream via the portal venous system; therefore, reducing chyle production and slowing/eliminating 204 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition-Specific Nutrition Interventions the chylous drainage (8). Depending on the long chain fat content of the diet or formula used, it may be necessary to supplement long chain fatty acids to prevent essential fatty acid deficiency. Nutrition goals for infants/children with CHD (6): • Provide adequate calories and protein, taking into account potentially increased needs. • Promote normal weight gain and growth velocity. • Promote oral feeding as able. Chronic illness or extended hospitalization may result in oral feeding challenges. • Maintain normal/near normal electrolyte levels. Watch closely for abnormalities if the child is on highly concentrated enteral feedings or certain medications. If a child has documented growth failure or is having difficulty meeting nutrition needs with an oral diet, supplemental tube feedings may be considered for additional energy and protein (4,10). There are several factors to consider before deciding if a temporary or permanent feeding tube should be placed. These factors include the length of time, ease of care, appearance and the risks of nasogastric versus gastrostomy tube feeding. A percutaneous endoscopic gastrostomy tube (PEG) is a safe and reliable technique to support enteral nutrition in children with severe CHD (10). This technique allows enteral nutrition support without the disadvantages related to long term nasogastric tube feeding (10). The remainder of this chapter presents guidelines for nutrition assessment, intervention, and evaluation/outcome for children with CHD (Table 18-2). Nutrition Interventions for Children With Special Health Care Needs 205
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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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Page 170 and 171: Chapter 14 - 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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