Nutrition Interventions for Children with Special Health Care Needs

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Appendix N • The feeding tube may be left in place, unclamped to allow the child to burp, after about 10-30 minutes. If the child has a button gastrostomy, he will need a decompression tube to vent air. To prevent reflux, the child may need to remain with head elevated 30-60 minutes after feeding. • After formula and burping are finished, flush tubing with 10-30 cc water. Close tube. Tuck gastrostomy under clothing. • Wash feeding set with hot, soapy water, rinse well and air dry. Feeding sets may be reused. Continuous drip • Clamp tubing on feeding bag and fill with formula. Unclamp tubing and fill drip chamber 1/3 full, then fill remaining tubing with formula to minimize air into stomach and clamp. Thread tubing through pump. Connect to gastrostomy tube. Unclamp feeding tube and start pump. The home care supply company will have instructions on how to use pump. Feedings should not hang for more than 4-8 hours. On hot days, ice can be slipped into the pocket of a feeding bag to keep formula cool. • Children can be cuddled or held during feeding. Include the child at family mealtimes. To distract the child while feeding or doing skin care, play games or music, tell a story, offer toys, etc. Oral motor stimulation is recommended. • You may want to secure tube connections with tape so they do not come apart. Securing tube to clothing, out of reach of the child is helpful. Tubing can be tucked under clothing (onesies, overalls, tube tops and bandnets are helpful). • The feeding tube may be left in place, unclamped to allow the child to burp, after about 10-30 minutes. If the child has a button gastrostomy, he will need a decompression tube to vent air. To prevent reflux, the child may need to remain with head elevated 30- 60 minutes after feeding. • After formula and burping are finished, flush tubing with 10-30 cc water. Close tube. Tuck gastrostomy under clothing. • Wash feeding set with hot, soapy water, rinse well and air dry. Feeding sets may be reused. When to Call the Doctor • If the skin around the gastrostomy is warm, tender, bright red – larger than a quarter • If excess puffy red tissue is building up around stoma site or persistent bleeding around stoma site • If there is excess leaking around stoma site or tube, e.g., soaking 2x2 gauze in
• If child has persistent vomiting, diarrhea or constipation • If the feeding tube is blocked and you cannot remove blockage • If the feeding tube is pulled out • If the child has a temperature >101˚F Common Pump Problems—Check this list if the pump isn’t working correctly • Did the “START” button get pressed? • Are the clamps open? • Is the tubing kinked? • Is the drip chamber too full or not positioned correctly? • Is the “Pause” button on? • Is the feeding tube plugged? • If none of the above, call home care agency. Social Concerns with Tube Feeding Appendix N An important consideration in tube feeding is the family’s ability and willingness to carry out the tube feeding program. Concerns include the availability and cost of equipment and formula, home sanitation and family hygiene, family support systems, and other psychosocial factors. Many families have a difficult time deciding to use a tube for feeding their child. When families are asked about tube feeding, their concerns include finding a caregiver to tube feed their child, public ignorance about tube feeding, planning their social life around feeding schedules, and sadness over depriving their child of the pleasure of eating. Reviewing the benefits of tube feeding and allowing them to talk with other parents may help decrease their anxiety. Insurance coverage for formulas and feeding equipment should be determined before the child is hospitalized for tube placement. Before the child is discharged from the hospital, the caregiver(s) must be prepared for tube feeding. More than one family member or caregiver should be taught about the tube feeding to ensure continuity of the child’s feeding program and to prevent isolation of the primary caregiver. Caregivers should be thoroughly instructed on the following aspects of tube feeding: formula preparation, use and care of equipment, insertion of the tube, stoma care and emergency procedures. The caregivers should be encouraged to keep the following records in a notebook, which they should bring to each clinic visit: formula intake, stooling pattern, activity, behavior, medications, and instructions from medical staff. Identify who will provide formula, supplies, and nutrition follow-up. A home care company can provide feeding supplies and Nutrition Interventions for Children With Special Health Care Needs 361
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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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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
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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
Page 404 and 405: Appendix S Comments Osmolality (mOs
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Page 408 and 409: Appendix S Table S-3: Modular Produ
Page 410 and 411: Appendix S Comments Energy (kcal) P
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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
Page 422 and 423: Appendix U ADA Pocket Guide to Nutr
Page 424 and 425: 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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