Nutrition Interventions for Children with Special Health Care Needs

Assessment Intervention Evaluation/Outcome
Ketogenic diet ratio sufficient to
maintain consistently high ketosis,
and optimum seizure control.
Betahydroxybutyrate within
consistent range.
Establish ratio (defined as grams of fat to grams of protein and
carbohydrate combined). Consult with KD Epileptologist to determine
starting ratio, and best plan for KD start. This will be dependent on
age of child, and overall caloric need. Some programs start with a
24-hour fast or longer, some only fast after midnight the day before
the diet start.
Develop diet prescription and meal
plans
1. Caloric needs based on three-day
diet history
Start:
2. Dietary preferences based on
preference survey
1. Consistent ratio, increase calories over three days, 1/3, 2/3, then
full calories.
2. Progressive ratio ramp-up, 1:1, 2:1, 3:1 for example.
3. Outpatient diet initiation program - start with the lowest ratio,
then ramp up the ratio every 3-5 days until the desired ratio is
achieved.
Section 3 - Condition Specific Nutrition Interventions
Lower ratios may be necessary for children with very low energy
needs in order to maintain adequate protein in the diet.
Recommend using Ketocalculator or Stanford calculator. Computer
programs give more accurate information and are faster. Both
programs are free. Families can be trained to calculate meal plans
when appropriate.
Nutrition Interventions for Children With Special Health Care Needs 257
Families should be given at least 10-
15 meal plans to initiate diet.
Caloric needs are met, providing
weight maintenance or slight gain
to maintain BMI percentile. Big
fluctuations can cause hyperketosis,
with symptoms, or hypoketosis
resulting in decline in seizure control.