Nutrition Interventions for Children with Special Health Care Needs

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Chapter 22 - Ketogenic Diet for Seizure Disorders Assessment Intervention Evaluation/Outcome Blood glucose levels remain within acceptable limits without symptoms of hypoglycemia. Hypoglycemia Hypoglycemia is common and does not require treatment. Symptomatic hypoglycemia is very rare when initiating the diet without a fasting period. Hypoglycemia may not occur until the second or third day of the diet initiation when using a non-fasting start. Symptoms include: • Pallor and fatigue • Nausea • Excess drowsiness • Diaphoresis • Confusion • Seizures • Jitteriness • Tachycardia Symptomatic hypoglycemia should be treated. 11 Usually 15-30 mLs of orange juice is given. Effects of medications Some anticonvulsants (especially barbiturates, e.g., phenobarbital) can have an increase in medication level when a state of ketosis is present. 15 254 Nutrition Interventions for Children With Special Health Care Needs Medication levels remain within the therapeutic ranges. Chronic Effects Serum triglyceride and cholesterol in acceptable range. Slight elevation is acceptable. Evaluate if trending upward if previously stable. Hyperlipidemia No long-term cardiovascular side effects are known. If triglyceride levels are constantly rising and do not subside, the risk of complications versus the benefit of the diet must be considered. Phenobarbitol can increase serum triglycerides. Child receives adequate amounts of vitamins and minerals. Vitamin or mineral deficiency All patients should be given a sugarless multivitamin/ mineral and calcium supplement. The diet is inadequate for most vitamins and minerals. Anticonvulsant medication-nutrient interactions are common. See Chapter 5 for specific assessment and intervention guidelines. Growth should be plotted at each follow-up visit. Growth Some slowing in growth may occur on the diet. Catch-up growth is likely when the diet is discontinued.
Assessment Intervention Evaluation/Outcome Bowel movements should be achieved at least every 1-2 days. Due to the lack of fiber in the diet, many children require intervention. Miralax, Dulcolax, Colace, glycerine suppository, Benefiber and milk of magnesia may be used. Use of lower carbohydrate fruits and vegetables (10% fruits and group A vegetables)‡ should be encouraged in order to maximize the serving size of fiber-containing foods. Constipation • Determine pre-diet bowel pattern • Intervene if child is constipated before start of diet Evaluation by a renal specialist is preferred. Continuation of the diet may be possible with increase in fluid intake. Calcium intake greater than the DRI is discouraged. 2,4,8 Kidney stones Increased risk if family history or use of AED Topamax or Zonegran Strict adherence to the diet for at least 3 months for adequate evaluation of diet success on seizure control. Continued strict adherence to the diet is necessary to maintain seizure control. Section 3 - Condition Specific Nutrition Interventions Noncompliance This is the most common problem. It is more prevalent in older children and poorly organized families. Decreased k betahydroxybutyrate and increased seizures are typical. Diet calculations should be rechecked for miscalculation or excessive energy. Possible errors in food preparation should be discussed. More often than not, family has added an extra snack or meal. Sometimes they change the ratio by giving additional protein or carbohydrate which changes seizure control. Not giving all of the fat in meal plan can also cause increased seizures. Caregivers must be encouraged to be “sleuths” in looking for possible mistakes or extra carbohydrate in the diet (medications, toothpaste, and “sugar-free” beverages). Nutrition Interventions for Children With Special Health Care Needs 255 Dietary Review intake. Intake is appropriate, with consideration of nutrients discussed below. Obtain diet history and/or 3 day food record, including all food preferences. Follow medication list at each clinic visit. Make sure nothing has been used or added that is not on the approved list. Breakthrough seizures can occur. 16 For example, three teaspoons of liquid augmentin yields 1914 mgs of carbohydrate. Families have reported breakthrough seizures with use of high sugar formulations such as this. Medications should be converted to lowest carbohydrate-containing form. Nutritional supplements should be evaluated and coverted to the lowest carbohydrate form. In general, no pediatric formulations, chew tabs or liquids should be used. Contribution of carbohydrate from medications and supplements should be under 1000 mgs. Otherwise, values greater than 1000 mgs. should be calculated into the meal plans. 11 Review all medications and nutritional supplements currently used. Assess amount of carbohydrate provided by supplements and medications. Ketocalculator contains the carbohydrate content of many common supplements and medications.
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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 220 and 221: Chapter 18 - 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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Page 298 and 299: Appendix C 282 Nutrition Interventi
Page 300 and 301: Appendix D 284 Nutrition Interventi
Page 308 and 309: Appendix E 292 Nutrition Interventi
Page 314 and 315: Appendix E Table 3: Parent-Specific
Page 316 and 317: Appendix F Percentiles of Upper Arm
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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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