Nutrition Interventions for Children with Special Health Care Needs

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Appendix N his family, and the home care provider. Children on enteral feeds are a high-risk group that requires closer monitoring. What works best for the child and family is a team of health professionals who work together. In Washington State, nutrition assessment and monitoring is reimbursable for children with Medicaid services. However, for many children with private insurance, enteral formula or assessments may not be reimbursable benefits because enteral feeding is considered food. Medications and Tube Feedings The goal for children on enteral feeds is to optimize nutrition therapy and maximize therapeutic response to medications administered through the feeding tube. Children on enteral feedings often have extensive medication regimens; a benefit of tube feeding is delivery of medication by tube. The child does not refuse to swallow, drool or vomit medication, so he receives all of prescribed medication with better efficacy. Feeding tubes may be a convenient avenue for medications, but some medicine may be incompatible, causing the tube to clog, interact negatively with specific nutrients or affect feeding tolerance. Formula or its components can interfere with the absorption, distribution, metabolism or elimination of medication (see Chapter 5). It is important for the pharmacist and physician to know that the child is receiving medication via his gastrostomy tube. The pharmacist and RD can review his medication list for compatibility with enteral feeds. Medications should not be added to enteral formulas. Avoid mixing medications together. Each medication should be administered separately. Families should be encouraged to give medicine in a liquid form. Elixirs and suspensions can usually be delivered through the feeding tube without a problem. Simple compressed tablets can be crushed and mixed with water or the formula or added to a syringe with water until they dissolve (about 30-60 minutes). In contrast, syrups are incompatible with tube feedings because they tend to clog the tube unless diluted with water. Solid medicines such as sustained-action tablets or capsules or enteric-coated tablets should not be crushed and delivered through the tube; once crushed, their action may be altered or they may cause gastrointestinal distress. Check with the child’s physician for another medication preparation. Medications are a common case of tube occlusion. To maintain patency of feeding tubes, flush regularly with water, before, after, and in between giving medications. Another common side effect with medications is feeding intolerance or GI discomfort. Review medications to determine when it is best to administer each one. Adjustments to the feeding and medication schedules may be needed to improve tolerance and comfort. Table N-2 covers common tube feeding complications. For more information on medications and drug-nutrient interactions, see Chapter 5. 358 Nutrition Interventions for Children With Special Health Care Needs
Daily Care of Tube Contact health care provider regarding care instructions. See Table N-2 for some common complications of tube feeding. Appendix N Before feeding: • Wash hands with soap and water before feeding • Gather supplies needed for tube feeding; formula should be at room temperature • Inspect site for skin irritation or leakage • Check the tube for inward/outward migration • Clean site with plain water or simple soap and water in circular motion away from stoma site • Dry site • If needed, stabilize tube with gauze and tape Typical Gastrostomy Feeding Position child with head higher than stomach, upright, or on his side. An infant seat, high chair or propping with pillow or wedge may be helpful. Check residuals if recommended by physician. Residuals may need to be checked with new tube feedings or when switching to a new formula. Residuals may also be checked if the child appears to be, or complains of nausea/fullness before next feeding. To check residuals, attach syringe to feeding tube and “pull back” stomach contents. Return residual contents to the stomach. If residual is okay, flush tube with 10 cc water (10 cc is typical but may vary based on the child’s condition). If residual is greater than 50% of previous feeding, wait one hour and recheck. Return residuals to stomach. If there is still residual, contact MD. If residual is okay, flush tube with 10 cc water. Bolus feeding A feeding should take 15-30 minutes. If given too quickly, the child may experience sweating, nausea, vomiting, or diarrhea. • Syringe: Attach syringe to feeding tube, pour formula into syringe. You may need to push with plunger to start flow and fill tubing. You do not want air in tubing. Connect filled tubing to gastrostomy. Control rate of feeding by raising or lowering syringe. Continue adding formula to syringe until total feeding is given. • Feeding Bag: Clamp tubing, fill bag and tubing with formula. You may need to squeeze bag to start feeding. Control rate of flow with clamp. Hang bag from IV pole. Nutrition Interventions for Children With Special Health Care Needs 359
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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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Chapter 22 - Ketogenic Diet for Sei
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Appendix A Please list any other nu
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Appendix A Baby formula What kind o
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Appendix B Manufacturer Description
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Appendix C 282 Nutrition Interventi
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Appendix D 284 Nutrition Interventi
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Appendix E 292 Nutrition Interventi
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Appendix E Table 3: Parent-Specific
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Appendix F Percentiles of Upper Arm
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Appendix F 302 Nutrition Interventi
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Appendix G 304 Nutrition Interventi
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Appendix G 306 Nutrition Interventi
Page 324 and 325: Appendix G 308 Nutrition Interventi
Page 326 and 327: Appendix G 310 Nutrition Interventi
Page 328 and 329: Appendix H 312 Nutrition Interventi
Page 336 and 337: Appendix I 320 Nutrition Interventi
Page 344 and 345: Appendix J 328 Nutrition Interventi
Page 352 and 353: Appendix K 336 Nutrition Interventi
Page 354 and 355: Appendix K 338 Nutrition Interventi
Page 356 and 357: Appendix L 340 Nutrition Interventi
Page 358 and 359: Appendix M 342 Nutrition Interventi
Page 360 and 361: Appendix M 344 Nutrition Interventi
Page 362 and 363: Appendix N Gastrostomy Tube Feeding
Page 364 and 365: Appendix N activities. When feeding
Page 366 and 367: Appendix N Feeding Sets/Extensions
Page 368 and 369: Appendix N Fluid and Electrolytes W
Page 370 and 371: Appendix N osmolality of full-stren
Page 372 and 373: Appendix N Modular Products Modular
Page 376 and 377: Appendix N • The feeding tube may
Page 378 and 379: Appendix N equipment. The Special S
Page 380 and 381: Appendix N Table N-2: Common Compli
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Page 386 and 387: Appendix O Some conditions increase
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Page 392 and 393: Appendix P Diet Prescription for Me
Page 394 and 395: Appendix Q Goals Considerations for
Page 396 and 397: Appendix R Condition Description Nu
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Page 400 and 401: Appendix R References 1. Ekvall SW
Page 402 and 403: Appendix S Table S-1: Infant Formul
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Page 408 and 409: Appendix S Table S-3: Modular Produ
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Page 414 and 415: Appendix T Powdered Formulas Accura
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Page 420 and 421: Appendix U Nutrition Strategies for
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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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