Nutrition Interventions for Children with Special Health Care Needs

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Appendix A Please list any other nutrition concerns you have: Ethnicity: (circle one) Community Programs currently enrolled in: (circle all that apply) Black/African American CSHCN WIC Hispanic Food Stamps Medicaid Caucasian SSI Private Insurance Native American CHAMPUS Foster Care Asian/Pacific Islander DDD Other Thank you for providing this important information about your child. Please return this form to For office use only: Evaluation by therapists: __________________Completed by _________________ Describe child’s feeding skill level:_________________________________________ Observations of parent-child interaction_____________________________________ Additional comments: __________________________________________________ Nutritionist: ______________________Completed by ________________________ Weight ____________ Height ____________ Head Circumference _____________ Weight/age ______% Height/age _____% Weight/Height ______% OFC_______% COMMENTS: ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Action taken: _____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 276 Nutrition Interventions for Children With Special Health Care Needs .
nutrition Screening Questionnaire Today’s date ______________ Parent ________________________ Home Phone Address How is your Child Eating and Growing? (Please circle yes or no in response to the following questions) 1. Is it easy to tell when your child is hungry or thirsty? Yes No 2. Do you worry about his/her eating or growing? Yes No 3. Have you received any special directions for feeding your child? Yes No 4. Does he/she take vitamins or minerals? Yes No If yes, what? 5. Does he/she take medications? Yes No If yes, what? 6. Does your child eat anything that is not food, such as paint or dirt? Yes No 7. Do you have trouble buying or making your child’s food? Yes No 8. Is your child on the WIC program? Yes No If yes, where? 9. Does your child go to a daycare or school? Yes No If yes, where? 10. Is your child fed by any other people? Yes No If yes, who? What Does Your Child Eat and Drink? 11. Where do you usually feed your child? 12. How many meals and snacks does he/she eat most days? Meals Snacks 13. How long does it take your child to eat? Minutes 14. Please check what your child eats: Appendix A Breastmilk Baby Cereal Ground Meats/Finely Ground Table Foods Formula Strained Baby Foods Cut Up Meats/Soft Table Foods Cow’s Milk Junior Foods Finger Foods 15. Circle the foods that you feel your child does not eat enough of: 1. milk and milk products 2. meat, beans, eggs 3. fruit and vegetables 4. breads and cereals 16. How much does your child usually drink in one day (24 hours): Water Sweet drinks Juice Cow’s milk Nutrition Interventions for Children With Special Health Care Needs 277
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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 242 and 243: Chapter 19 - Nutrition Intervention
Page 264 and 265: Chapter 22 - Ketogenic Diet for Sei
Page 294 and 295: Appendix A Baby formula What kind o
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Page 298 and 299: Appendix C 282 Nutrition Interventi
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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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Page 336 and 337: Appendix I 320 Nutrition Interventi
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Appendix I 326 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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