Nutrition Interventions for Children with Special Health Care Needs

Appendix N
equipment. The Special Supplemental Nutrition Program for Women, Infants and
Children (WIC) may provide some formulas to eligible infants and children.
The caregiver(s) should be contacted daily for the first week the child is home, or
until they feel secure with the tube feeding regimen. The follow-up can be provided
by home visit, clinic visit or telephone. The caregiver(s) should be given a phone
number for 24-hour assistance regarding problems with tube feeding.
Family meals offer important learning experiences for children who are tube fed. It is
important for the child to associate the satisfying feeling of fullness with the pleasant
time of family meals, including social interactions, good smells and appearance of
food. Even if the child does not experience the tastes and textures of oral feeding,
the social experience can be provided. This is important if the child is to eventually
transition from enteral to oral feeding.
Feeding Behaviors
Negative or atypical feeding behaviors may be present before a child is tube fed and
additional behaviors may develop while the child is tube fed. See Chapter 9.
School and Tube Feeding
Children with feeding tubes are eligible for expanded nutrition services in schools
through Public Law 99-457 and the Americans with Disabilities Act. Tube feedings
can be given as a routine activity at school. This presents understandable concern for
educators. A team, including the RD, a special educator, a nurse and the family can
help facilitate feeding in the school. The objective is to use the same feeding routine,
positioning, and oral-motor stimulation at home and at school. Physician’s orders,
an individualized education plan (IEP) and instruction on when to call the family or
physician may be required. See Chapter 12.
Transition to Oral Feeding
Transition to eating by mouth starts when the tube is first placed. All children on tube
feeding require oral stimulation for development of feeding skills. (See Chapter 8)
The child may need to “re-learn” that food in his mouth can satisfy hunger plus keep
his mouth “awake” and ready to accept foods. Transition is generally most successful
when the process involves a team; a team might include a pediatrician, RD, feeding
therapist, and a nurse. Successful treatment addresses the following questions:
362 Nutrition Interventions for Children With Special Health Care Needs