Nutrition Interventions for Children with Special Health Care Needs

Assessment Intervention Evaluation/Outcome
Dietary
Subsequent re-evaluation
or food records indicate
appropriate energy and
nutrient intake from a variety
of foods
Assess:
Caregivers report dietary practices
consistent with nutrition care plan.
• If child is overweight or underweight, adjust energy intake
by altering portion sizes, increasing or decreasing snacks,
and changing beverage volume and/or energy-density.
Plan should accommodate child’s food limitations and
preferences as much as possible. See chapter 13 or 14.
• For nutrient inadequacies, collaborate with family to find
alternative food sources that might be acceptable, i.e. for
those on GFCF diet consider calcium-fortified soy milk and
cheese
• Provide vitamin-mineral supplements if needed; work
with family regarding form (chewable, liquid, crushed),
color, taste, etc. Treat supplements as “medicine” or using
behavior approach to increase compliance
• Provide family education and counseling regarding ULs
for supplements, evidence-based effectiveness, and any
dangers of toxicity or negative side effects
• Discourage use of food as a reward in all environments;
work with family and professionals to identify other
reinforcers
• Support family meals and regularly-scheduled meals and
snacks
• Typical food intake, timing of snacks and
meals, and eating environment
• Methods of preparation, preferences,
i.e. brands, presentation, color, shape,
temperature
• Early feeding development history
• Food aversions, refusals
• Use of food as a reward
• Feeding behaviors -- current and past
• Previous dietary interventions
• Use of special diets, i.e. GFCF, SCD, and
nutrients at risk, i.e. calcium, Vit D, folic
acid
• Vitamin and/or mineral supplements,
herbals, etc
• Other complementary and alternative
medicine (CAM), i.e. enzymes, probiotics
• Determine usual energy and nutrient intake
Section 3 - Condition Specific Nutrition Interventions
Nutrition Interventions for Children With Special Health Care Needs 269
Obtain a 3- to 7-day food record.†
Family/Social
Child makes slow, but
consistent progress with food
acceptance and improvement in
feeding behaviors.
Determine:
Periodic re-assessment of
family’s concerns and goals
• Nutrition counseling for caregivers, educators and others
to set small goals, with expectation that progress will
be slow. 6 Food exposures should be step-wise, i.e. child
tolerates, smells or touches food, but does not eat. See Fig.
23-1
• Refer for feeding therapy by OT, SLP, and/or behavior
specialist at early intervention, school, or other program
(with consultation from RD)
• Consider feeding group therapy for preschool children
• Family’s concerns about child’s nutrition and
feeding, and current goals for change
• Child’s behaviors that limit or alter food
intake
• Previous attempts to improve diet and
intake, and their outcomes
• Use of CAM therapies and family’s
expectations
*For reference data and guidelines for taking accurate measurements, see Chapter 2.
† For more information about dietary assessment, see Chapter 1.