Nutrition Interventions for Children with Special Health Care Needs

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.