Nutrition Interventions for Children with Special Health Care Needs

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Appendix N Table N-2: Common Complications of Tube Feeding Complication Possible Cause Intervention Rapid administration of feeding • For continuous drip feeding, return infusion rate to previous tolerated level, then gradually increase rate • For bolus feeding, increase length of time for feeding; allow short break during feeding; offer smaller and more frequent feedings Nausea/Vomiting and Diarrhea • Switch to isotonic formula • Dilute current formula to isotonic, and gradually increase to full strength • Check that formula is mixed properly • Avoid adding other foods to formula, i.e. baby food, powdered formula Hyperosmolar solution (energydense and/or high protein formulas) Medication • Do not add medication to formula; give between feeding with water or juice • Medications that may cause diarrhea include antibiotics, GI neurologic stimulants, beta blockers, stool softeners, liquid medications with sorbitol • Review medication profile and make recommendations for changes Air in stomach/intestine • Burp child during feedings or allow for short breaks • Use medication to decrease gas, ie, simethicone • Elevate child’s head during feeding and for 30 minutes after meal 364 Nutrition Interventions for Children With Special Health Care Needs • Pull on tube to reposition against stomach wall Tube migration from stomach to small intestine Cold formula • Warm formula to room temperature Rapid GI transit • Select fiber enriched formula Bacterial contamination • Refrigerate open cans of formula, keep only as long as manufacturer suggests • Clean tops of formula cans before opening • Hang only a 4 hour amount of formula at a time • Be sure feeding sets are cleaned well Allergy / lactose intolerance • Try a lactose-free formula • Try soy formula; if allergic to soy, try elemental or semi-elemental formula Excessive flavorings • Stop using flavorings Excessive fat • Decrease fat in formula or use MCT oil • Refer to physician
Complication Possible Cause Intervention Constipation * Inadequate fiber/bulk or fluid • Try formula with added fiber • Increase water • Supplement with prune juice • Try stool softeners, suppositories or enema, as indicated • Refer to physician Delayed gastric emptying • Refer to physician • Recommend medication to stimulate movement of GI tract • Elevate child’s head (30-45°) during feeding and for 1 hour after meal • Check for residuals before feeding • Try smaller, more frequent bolus feedings or continuous drip feeding • Consider jejunal feeding Gastroesophageal reflux Large residuals Decreased gastric motility • Elevate child’s head during feeding • Use gastric stimulant to promote gastric emptying • Consider continuous feeds Hyperosmolar formula • Switch to isotonic formula Medications • Do not add medications to formula; give between feeding with water or juice. • Refer to physician • Refer to physician • Decrease protein • Increase fluids. Monitor fluid intake and output Tube feeding syndrome (dehydration, azotemia, and hypernatremia) Appendix N Nutrition Interventions for Children With Special Health Care Needs 365 Excessive protein intake with inadequate fluid intake • Refer to physician • Replace sodium losses • Restrict fluids Hyponatremia Inadequate serum sodium may be related to excessive water intake, excessive fluid loss (e.g., vomiting and/ or diarrhea), medications, tracheostomies, or fluid retention related to renal or cardiac problems
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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 H 312 Nutrition Interventi
Page 330 and 331: Appendix H 314 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 374 and 375: Appendix N his family, and the home
Page 376 and 377: Appendix N • The feeding tube may
Page 378 and 379: Appendix N equipment. The Special S
Page 382 and 383: Appendix N Complication Possible Ca
Page 384 and 385: Appendix N 368 Nutrition Interventi
Page 386 and 387: Appendix O Some conditions increase
Page 388 and 389: Appendix O Table O-3: Recommended P
Page 390 and 391: Appendix O 374 Nutrition Interventi
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
Page 398 and 399: Appendix R Condition Description Nu
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
Page 406 and 407: Appendix S Table S-2: Pediatric For
Page 408 and 409: Appendix S Table S-3: Modular Produ
Page 410 and 411: Appendix S Comments Energy (kcal) P
Page 412 and 413: Appendix S Contact Information Abbo
Page 414 and 415: Appendix T Powdered Formulas Accura
Page 416 and 417: Appendix T Table T-1: Liquid Concen
Page 418 and 419: Appendix T 402 Nutrition Interventi
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
Page 426 and 427: Glossary Early intervention service
Page 428 and 429: 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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