Nutrition Interventions for Children with Special Health Care Needs

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Chapter 19 - Nutrition Interventions for Chronic Renal Failure Assessment Intervention Evaluation/Outcome Normal serum sodium: ≠ 135 145 mEq/l Sodium (Na) High or low serum Na, indicates fluid balance problems and/or high or low sodium intake. Determine dietary responses in consultation with physician. Normal serum potassium: ≠ Potassium (K) If serum K is high, restrict K intake: 1-3mEq/kg/day (1meq = 39mg) 3.5-5.5 mEq/l Consider K supplement if K is low. Normal serum creatinine: ≠ Cr is a measure of kidney function. Normal values increase with increased skeletal muscle. Cr will be high in CKD. Knowing Cr helps the RD to know how advanced the CKD is. Creatinine (Cr) 0 - 1 week 0.2 - 1.1 1 week - 2 months 0.1 - 0.6 2 month - 2 years 0.1 - 0.4 2 years - 10 years 0.1 - 0.6 10 years - 14 years 0.2 - 0.9 >/= 14 years 0.2 - 1.1 220 Nutrition Interventions for Children With Special Health Care Needs Normal BUN: 6-20 mg/dl ≠ BUN is a measure of protein waste products in the blood. If BUN is very high (>80-100), it may be a major indication for initiation of dialysis. Protein intake may need to be reduced to the DRI for age or slightly less if BUN is high and dialysis cannot be immediately started. Blood urea nitrogen (BUN) BUN >80-90 on dialysis may indicate need for decrease in protein intake, or change in dialysis regimen. BUN
Assessment Intervention Evaluation/Outcome Normal serum albumin: ≠ • Newborn, infant: 2.9-5.5 gm/dl • Child and adult: 3.8-5.4 gm/dl Albumin Serum albumin may be low in patients “spilling” protein in urine, with elevated C-reactive protein (CRP) and in setting of fluid overload. Evaluate albumin and BUN together to determine need for increased protein intake. Normal serum phosphorus: ≠ If serum P is high and serum Ca is within normal limits or low: Phosphorus (P) • Newborn: 4.5 - 9.0 mg/dl • Child: 4.0-6.0 mg/dl • Adult: 2.5-4.9 mg/dl • Restrict phosphate intake by limiting dairy to 1-2 servings per day (1 serving = 1 cup milk, which provides ~230 mg phosphorus) • Use a phosphate binder such as calcium carbonate or calcium acetate taken with meals (e.g., Tums, Oscal 500, PhosLo) Calcium (Ca) Normal serum total calcium: ≠ Section 3 - Condition-Specific Nutrition Interventions • Infant (full term): 7.5 - 11.0 mg/dl • Child - Adult: 8.7-10.7 mg/dl If serum Ca is low: • Provide supplemental Ca as calcium carbonate • Evaluate calcitriol (activated vitamin D), consider increasing Nutrition Interventions for Children With Special Health Care Needs 221 If serum P is low and serum Ca is low: • Increase P in diet, allow more milk products, alter tube feeding formula to increase P, or provide P supplements (e.g., Neutra-Phos or IV form of Na PO4, given enterally/orally) • Evaluate calcitriol, consider increasing • Decrease calcium carbonate or calcium acetate and replace with calcium gluconate or calcium glubionate (have less of a P-binding effect), give calcium apart from meals
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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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