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.