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Nutrition Interventions for Children with Special Health Care Needs

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Assessment Intervention Evaluation/Outcome<br />

Normal serum albumin: ≠<br />

• Newborn, infant: 2.9-5.5 gm/dl<br />

• Child and adult: 3.8-5.4 gm/dl<br />

Albumin Serum albumin may be low in patients<br />

“spilling” protein in urine, <strong>with</strong> elevated<br />

C-reactive protein (CRP) and in setting of<br />

fluid overload. Evaluate albumin and BUN<br />

together to determine need <strong>for</strong> increased<br />

protein intake.<br />

Normal serum phosphorus: ≠<br />

If serum P is high and serum Ca is <strong>with</strong>in<br />

normal limits or low:<br />

Phosphorus (P)<br />

• Newborn: 4.5 - 9.0 mg/dl<br />

• Child: 4.0-6.0 mg/dl<br />

• Adult: 2.5-4.9 mg/dl<br />

• Restrict phosphate intake by limiting<br />

dairy to 1-2 servings per day (1<br />

serving = 1 cup milk, which provides<br />

~230 mg phosphorus)<br />

• Use a phosphate binder such as<br />

calcium carbonate or calcium acetate<br />

taken <strong>with</strong> meals (e.g., Tums, Oscal<br />

500, PhosLo)<br />

Calcium (Ca)<br />

Normal serum total calcium: ≠<br />

Section 3 - Condition-Specific <strong>Nutrition</strong> <strong>Interventions</strong><br />

• Infant (full term): 7.5 - 11.0 mg/dl<br />

• Child - Adult: 8.7-10.7 mg/dl<br />

If serum Ca is low:<br />

• Provide supplemental Ca as calcium<br />

carbonate<br />

• Evaluate calcitriol (activated vitamin<br />

D), consider increasing<br />

<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> 221<br />

If serum P is low and serum Ca is low:<br />

• Increase P in diet, allow more milk<br />

products, alter tube feeding <strong>for</strong>mula to<br />

increase P, or provide P supplements<br />

(e.g., Neutra-Phos or IV <strong>for</strong>m of Na<br />

PO4, given enterally/orally)<br />

• Evaluate calcitriol, consider increasing<br />

• Decrease calcium carbonate or calcium<br />

acetate and replace <strong>with</strong> calcium<br />

gluconate or calcium glubionate (have<br />

less of a P-binding effect), give calcium<br />

apart from meals

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