Nutrition Interventions for Children with Special Health Care Needs

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Chapter 20 - Nutrition Interventions for Short Bowel Syndrome Long-Term Nutritional Concerns in Short Bowel Syndrome Micronutrient Deficiencies Once a child is on full enteral or oral feeds and parenteral nutrition has been discontinued, adequacy of micronutrient absorption becomes a concern. This is especially important when a significant portion of the ileum is missing. Ileal resection can result in fat and fat-soluble vitamin malabsorption; it is frequently necessary to give fat-soluble vitamins in a water-soluble form. These are available in individual vitamin preparations or in multivitamin preparations (e.g., ADEK’s ® ), which contain water and fat-soluble vitamins, all in a water-soluble form. Additionally, children with ileal resection may need vitamin B12 injections every 1 to 3 months. It can take from several months to several years for a vitamin B12 deficiency to develop; therefore, long-term, regular monitoring of B12 status is necessary. Vitamin B12 is often given routinely to prevent deficiency when the terminal ileum has been resected (4). Minerals that may be malabsorbed include calcium (often due to vitamin D malabsorption), iron, magnesium, and zinc. These nutrients need to be monitored periodically, especially in the months just after parenteral nutrition is discontinued, and whenever a patient develops a prolonged diarrheal illness or has bacterial overgrowth (4). Bacterial Overgrowth Children with short bowel syndrome often have poor intestinal motility and dilated segments of the small intestine. This, plus absence of the ileocecal valve, contributes to the development of bacterial overgrowth (3). Bacterial overgrowth is present when the bacteria in the small bowel exceed normal levels. Bacterial overgrowth results in malabsorption by causing inflammation of the bowel wall and deconjugation of bile acids. This results in rapid reabsorption of bile, leaving very little bile for fat absorption. Symptoms include very foul smelling stools and flatus, bloating, cramps, severe diarrhea, gastrointestinal blood loss, and accumulation of D-lactic acid in the blood. Bacterial overgrowth can be diagnosed by breath hydrogen test either fasting or after an oral glucose load, by aspiration and culture of small bowel contents or by blood test for D-lactic acid. Bacterial overgrowth is treated with oral antibiotics. In many cases it is necessary to give cyclic antibiotics for the first five days of every month. For some patients continuous antibiotics are necessary; in these cases, 230 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition-Specific Nutrition Interventions antibiotics are rotated every two to three months to avoid overgrowth of resistant bacteria (3,5). Liver Disease Parenteral nutrition-associated liver disease (PNALD) is a common complication for children with short bowel syndrome who depend on long term TPN. PNALD affects 40-60% of infants with prolonged PN and it has a significant effect on mortality. Risk factors for development of PNALD include premature birth, extremely short bowel (
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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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Page 292 and 293: Appendix A Please list any other nu
Page 294 and 295: 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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