Nutrition Interventions for Children with Special Health Care Needs

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Chapter 22 - Ketogenic Diet for Seizure Disorders Assessment Intervention Evaluation/Outcome Caregivers plan, prepare, and measure meals with 100% accuracy as demonstrated in class and follow-up visits. Ketosis is stable as demonstrated by stable betahydroxybutyrate. Weight gain consistent with defined parameters. Determine education needs Ketogenic Diet education—caregivers come with different levels of understanding and preparation regarding the diet. Education program should include: • History of the diet • Theoretical basis • Expectations of the diet • Possible complications • Expectations of the program • Resources needed • Ketone testing • How to handle illness • Importance of compliance • Monitoring requirements • Nutritional guidelines—energy, protein, carbohydrate, fat, fluids, vitamins, and minerals • Meal planning—eating consistently, using a gram scale, careful measuring, recipe suggestions, and meal preparation Give caregivers as much written information as possible in an organized format for home reference. Education on an outpatient basis may be achieved with a one-day class. The outpatient approach allows an education environment that is lower in stress and free from interruptions common with hospital admissions. Ideally, a child will remain on the diet for 2 years or for one year after becoming seizure-free. This is individualized based on the child’s needs as determined by the KD Epileptologist. The diet is then weaned over a one-year time period, with decreasing ratio every 3-6 months. If seizures increase, the diet can be reversed. Not all children have total seizure control, or become medication-free. 258 Nutrition Interventions for Children With Special Health Care Needs Seizure control remains during and after weaning from the diet. Assess appropriate time and regimen for weaning the diet *For reference data and guidelines for taking accurate measurements, see Chapter 2. †Ideal weight is the weight that would place the child at the 50th percentile for weight for height (or length). ‡See Freeman JM. The Epilepsy Diet Treatment: An Introduction to the Ketogenic Diet, 2nd Edition, p.39 for more information.
References Section 3 - Condition Specific Nutrition Interventions 1. Hori A, et al. Ketogenic diet: effects on expression of kindled seizures and behavior in adult rats. Epilepsia. 1997; 38(7):750-758. 2. Kinsman SL, et al. Efficacy of the ketogenic diet for intractable seizure disorders: review of 58 cases. Epilepsia. 1992; 33(6):1132-1136. 3. Schwartz RH, et al. Metabolic effects of three ketogenic diets in the treatment of severe epilepsy. Dev Med Child Neurol. 1989; 31:152-160. 4. Phelps SJ, et al. The ketogenic diet in pediatric epilepsy. Nutrition in Clinical Practice. 1998; 13(12):267-282. 5. Wilder RM. The effect of ketonuria on the course of epilepsy. Mayo Clinic Bulletin. 1921; 2:307. 6. Kossoff Eh et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia. 2006; 47:421-424. 7. Prasad AN, et al. Alternative epilepsy: the ketogenic diet, immunoglobulins, and steroids. Epilepsia. 1996; 37(l):S81-S95. 8. Amorde-Spalding K. Today’s ketogenic diet revisited. Nutrition Focus. 2006; 21(6):1-8. 9. Nordli Jr. DR, De Vivo DC. The ketogenic diet revisited: Back to the future. Epilepsia. 1997; 38(7):743-749. 10. Wheless JW: The ketogenic diet: fact or fiction. J Child Neurology. 1995; 10(6): 419-423. 11. Freeman J et al. The ketogenic diet. A treatment for children and others with epilepsy. Fourth edition. New Your: Demos medical publishing; 2007. 12. Vining EP, et al. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol. 1998; 55 (11):1433-1437. 13. Livingston S: Comprehensive Management of Epilepsy in Infancy, Childhood and Adolescence. Springfield, IL: CC. Thomas, 1972; 378-404. 14. Amorde-Spalding K, Woch MA. Rediscovering the benefits of ketogenic diet therapy for children (letter). J Am Diet Assoc. 1996; 96 (11): 1134-1135. Nutrition Interventions for Children With Special Health Care Needs 259
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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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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
Page 318 and 319: Appendix F 302 Nutrition Interventi
Page 320 and 321: Appendix G 304 Nutrition Interventi
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Appendix G 308 Nutrition Interventi
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Appendix G 310 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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