Nutrition Interventions for Children with Special Health Care Needs

Appendix N
Table N-1: Water, Energy and Protein Requirements for Children 9
STEP 1
For first 10 kg or 22
lbs, provide:
STEP 2
For second 10 kg or
22 lbs, provide:
STEP 3
For weight over 20
kg or 44 lbs, add to
the amount above an
additional:
Energy
Water Energy Protein
cc/kg cc/lb kcal/kg kcal/lb gm/kg gm/lb
100 45 105 48 2.0 0.9
50 24 50 23 0.9 0.4
20 10 20 9 0.3 0.2
The only way to accurately evaluate an individual’s energy needs is to regularly
monitor weight gain, growth, and actual energy intake. If energy intake is
inadequate weight gain will be poor. If energy intake is excessive, weight gain will
be higher than that desired for linear growth. Factors that may change energy needs
include illness, increased seizures, surgery, increase in therapy or return to school, or
changes in medication.
Children who have been chronically underweight while on oral feedings often gain
excessive weight when tube feedings are initiated, sometimes to the point of obesity.
For these children, two factors may come into play: oral-motor problems that
interfere with adequate energy intake by means of oral feeding, and energy needs
that are lower than expected. Cases such as these illustrate the necessity of routinely
monitoring weight and energy intake in children who are tube-fed, especially after
the tube feeding is initiated.
Older children with delayed growth due to inadequate intake may have delayed
puberty. With adequate energy provided by tube feeding along with increased body
fat, they may begin to experience pubertal growth and body changes into their
twenties. These changes need to be assessed when determining energy needs so
weight gain is appropriate.
Nutrition Interventions for Children With Special Health Care Needs 351