Nutrition Interventions for Children with Special Health Care Needs

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Chapter 19 - Nutrition Interventions for Chronic Renal Failure Although difficult to measure, psychosocial factors can be major contributors to poor growth and malnutrition. Chaotic home life, poverty, poor coping function of parents, as well as low self esteem, and/or depression in the child with CKD all compromise ability to comply with the complex medical and nutrition therapies necessary for successful treatment of CKD (1). The registered dietitian (RD) must work closely with the social worker to optimize family compliance with regimens to meet nutrition needs. The remainder of this chapter presents basic guidelines for nutrition assessment, intervention, and evaluation/outcome for children with CKD. It is impossible to give guidelines for every situation one could see in an infant or child with CKD; it is critical that clinical judgment be used in providing nutrition intervention for these children. Due to the complexities of CKD, regular assessment and monitoring by a pediatric renal team (nephrologist, nurse, RD, and social worker) is essential for comprehensive care of a child with CKD. 218 Nutrition Interventions for Children With Special Health Care Needs
Table 19-2 Nutrition Interventions for Chronic Kidney Disease in Children Assessment Intervention Evaluation/Outcome Anthropometric* Weight for stature between 25th and 75th percentiles If weight for stature and/or rate of weight gain is low, increase energy intake. Measure and plot on appropriate growth chart: Weight and height (or length) increase appropriately. (Expect much higher rate of growth if patient receiving growth hormone and is getting adequate nutrition). If weight for stature is high and rate of weight gain is high, decrease energy intake. • Height or length for age • Weight for age • Weight for length or BMI • Head circumference (under 3 years) If length or height is 25th percentile for age Use arm muscle and fat calculations, together with weight, length or height, and OFC in determining nutritional status and developing intervention plan. Measure: Nutrition Interventions for Children With Special Health Care Needs 219 • Triceps skinfold • Mid upper arm circumference Arm fat area between the 10th and 75th percentiles for age. Calculate: Note: Arm anthropometry is limited by differences of intra-operator measures and fluid overload and is not routinely recommended for children with CKD. However, serial measurements by the same clinician performed on children without fluid issues may provide useful information. • Arm muscle circumference • Arm fat area Repeat mid upper arm circumference and triceps skinfold at least every 3 to 6 months Obtain all available previous measurements. Compare all current measurements to reference data for chronological age and to previous measurements. Biochemical All changes in diet, or medications, based on labs should be done in coordination with physician managing patient’s care. Monitor all blood values every 3 to 6 months for CKD patients, monthly for ESRD patients on dialysis.
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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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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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Nutrition Interventions for Children with Special Health Care Needs

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