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Nutrition Interventions for Children with Special Health Care Needs

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Chapter 18 - <strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> Congenital Heart Disease<br />

Assessment Intervention Evaluation<br />

Concerns about medication-nutrient<br />

interactions are addressed<br />

If concerns about medications-nutrient interactions exist, consult<br />

<strong>with</strong> primary care physician; also see Chapter 5<br />

Clinical/Medical<br />

Evaluate possible medicationnutrient<br />

interactions (e.g. diureticinduced<br />

potassium, magnesium,<br />

and/or calcium excretion).<br />

Monitor weight gain and edema<br />

Excessive weight gain and edema are<br />

minimized<br />

If sodium restriction is indicated:<br />

Evaluate water retention (need <strong>for</strong><br />

fluid and/or sodium restriction)<br />

• For infants, evaluate sodium content of infant <strong>for</strong>mula Low<br />

sodium infant <strong>for</strong>mula such as Similac ® , Similac PM60/40 ® , or<br />

Good Start ® may be needed<br />

• For infants, commercial baby foods or homemade baby foods<br />

<strong>with</strong>out added salt should be used<br />

• For children, diet <strong>with</strong> no added salt should be used<br />

Counsel caregivers on:<br />

• Measurement of liquids<br />

• No added salt diet<br />

If malabsorption, vomiting or diarrhea is evident:<br />

Evaluate malabsorption (diarrhea,<br />

or ›0.5% reducing substances in<br />

stool)<br />

• Decrease concentration of <strong>for</strong>mula<br />

• Try small, frequent feedings and/or continuous nasogastric drip<br />

feedings<br />

If malabsorption, vomiting, or diarrhea persist change to hydrolyzed<br />

protein <strong>for</strong>mula (e.g., Alimentum ® , Nutramigen ® , Pregestimil ® ) or<br />

semi-elemental <strong>for</strong>mula (e.g., Peptamen Jr. ® , Vital ® ) or elemental<br />

<strong>for</strong>mula (e.g. Elecare ® , Neocate ® , Vivonex Pediatric ® ) or “fat free”<br />

<strong>for</strong>mula (e.g., Tolerex ® ) or high MCT <strong>for</strong>mula (e.g., Lipistart ® ,<br />

Portagen ® ,) or added MCT oil to diet in place of other fat<br />

210 <strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> <strong>Children</strong> With <strong>Special</strong> <strong>Health</strong> <strong>Care</strong> <strong>Needs</strong><br />

Malabsorption, vomiting, or diarrhea<br />

improved<br />

note: MCT oil can cause diarrhea, start <strong>with</strong> very small amounts and<br />

increase slowly

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