Nutrition Interventions for Children with Special Health Care Needs

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Chapter 1 - Nutrition Screening and Assessment Assessment Activities Indicators for Nutrition Intervention • Nutrition intervention indicated if any unresolved nutrition concern. • Refer to primary care provider for follow-up and referral to appropriate medical and pediatric feeding specialist(s). Clinical/Medical History Complete a health history by interviewing caregiver(s) and reviewing medical records. Pay special attention to nutrition risk factors identified in nutrition screening. Include the following in data collection: • Medical diagnosis • Frequency of infections • Reflux/ vomiting not able to be managed with routine precautions (medications, positioning, etc.) • Elimination patterns ‡ • Maturation stage, age of onset of puberty • Possible medication-nutrient interactions ∫ • Family history of diseases • Family growth history • Dental health Physical observation of hair, skin, nails, eyes, oral (tongue and gums), lips and mucus membranes, overall musculature, and adipose stores for signs of deficiencies or excesses. (See Reference 7, Table 4-18) Dietary Assess dietary intake by a 3 to 7-day food record and diet history. When requesting a food record, provide both oral and written instructions. When interviewing for a diet history, include both the child and caregiver(s) if possible. 8 Nutrition Interventions for Children With Special Health Care Needs For nutrient recommendations for specific conditions and disorders, refer to appropriate section in this manual. Obtain the following data: • Type, brand name, and amount of food, beverage, or formula eaten or tube-fed • Preparation method for cooking foods and for mixing formula • Time of each meal, snack, or feeding • Cooking facilities available • Location of feedings (e.g., daycare center, school, home, restaurant) • Dietary supplements (e.g., vitamins, minerals, energy dense liquids) • Complementary and alternative therapies/supplements • Intake of non-food items (pica) Adequacy of food intake may be determined by comparison with age-appropriate food group plan or by computer analysis and comparison with DRIs for age and sex.
Assessment Activities Indicators for Nutrition Intervention Consider: • Level of physical activity or ambulation. • Cultural and familial food practices. • Pertinent historical data related to feeding: breastfeeding, amount of formula milk used, age of introduction of solid foods, variety of solids provided. • Influences on the validity of food record (e.g., illnesses, meals eaten away from home, losses from reflux). Multi-disciplinary intervention with pediatric feeding specialists such as speech pathologist, occupational therapist, registered dietitian (RD), public health nurse, behaviorist, and/or social worker indicated if any of the following: Feeding Skills ** and Behavior†† Complete a feeding history by interviewing caregiver(s) and reviewing health, therapy, and assessment records. Observe child while eating or being fed. Consider the following factors: • Delayed or abnormal feeding skills • Neurological or oral-motor problems • Behavior problems interfering with feeding • Suboptimal scores on feeding assessment tools • Positioning of child • Appropriateness of feeding environment • Oral-motor development and coordination • Self-feeding skills • Behavior problems related to feeding Section 1 - Determination of Nutrition Status Nutrition Interventions for Children With Special Health Care Needs 9 • Child-caregiver interactions during feeding ‡‡ *See Chapter 2 †Correct for prematurity up to 36 months. See Chapters 2 and 15. ‡ See chapters 6 and 7 ∫ See Chapter 5 ** See Chapter 8 ††See Chapter 9 ‡‡ 9 Assessment tools for documenting inappropriate or at-risk child-caregiver interactions during feeding are the NCAST Feeding Scale (up to age 1) and the CHATOOR Feeding Scale 10 (up to age 3).
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Page 6 and 7: Kay Kopp, OTR/L Occupational Therap
Page 8 and 9: Appendices Appendix A Sample Screen
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Page 12 and 13: ii Nutrition Interventions for Chil
Page 14 and 15: Population “Children with special
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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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Chapter 22 - Ketogenic Diet for Sei
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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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