Nutrition Interventions for Children with Special Health Care Needs

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Appendix N Complication Possible Cause Intervention • Use correct formula • Flush tubes with water after giving formula or medication • Flush every 3-4 hours with continuous drip feeds • Do not mix formula with medication • Irrigate with air, using syringe • Gently “milk” tubing • Dissolve ¼ tsp. meat tenderizer in 10 cc water and flush to dissolve clot • Replace tube Clogged feeding tube • Formula residue or coagulated protein • Inadequate flushing of tube • Medication • Place child upright for feeding • Make sure gastrostomy tube is firmly in place • Stabilize tube with gauze pads, adjust crosspiece • If stoma is too large for tube, insert new tube • Keep skin around stoma clean and dry; use protective ointments and gauze • If leaking out of button gastrostomy, may need to replace device • Refer to physician • Improper positioning • Tube migration • Increased size of stoma Leakage of gastric contents • A small amount of bleeding is normal • Tape tube securely in place to avoid irritation from movement • Secure tube under child’s clothing • Refer to physician • Excessive movement or pressure on tubing Bleeding around stoma • Correct cause of leakage • Carefully cleanse and protect stoma • If stoma site is irritated, use plain water or change soap used • Refer to physician for culture and medication Infection of stoma • Gastric leakage around tube • Stoma site not kept clean • Allergic reaction to soap • Keep area clean and dry • Adjust snugness of PEG tube with crosspiece • Stabilize tube using tape, bandnet, ace bandage, tube top • Prevent child from pulling on tube • Apply silver nitrate as directed by physician Granulation tissue • Body rejecting foreign body • Poorly fitting tube causing friction • Use of antiseizure medication such as Dilantin 366 Nutrition Interventions for Children With Special Health Care Needs * See Chapter 6.
References 1. Bankhead R et al. A.S.P.E.N. Enteral Nutrition Practice Recommendations. J Parenter Enteral Nutr. 2009; 33:122-167. 2. Axelrod D. Pediatric enteral nutrition. J Parenter Enteral Nutr. 2006; 30(1s):S21-S26. 3. Davis A. Rehabilitating a malnourished infant: A case presentation. PNPG Post. Appendix N Pediatric Nutrition Practice Group of the American Dietetic Association. Summer 2002. 4. A.S.P.E.N. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr. 2002; (26):1SA-138SA. NOTE – A process was described for updates of these guidelines in J Parenter Enteral Nutr. 2009; 33:255-259. Future updated guidelines will be published as separate chapters and will be available at the A.S.P.E.N. website (www.nutritioncare.org) with access to all. 5. Charney P and Ainsley M. ADA Pocket Guide to Enteral Nutrition. Chicago, IL: American Dietetic Association. 2006. 6. Ponsky A et al: Food Medication Interactions. 15 th Edition. Birchrunville, PA. 2007. 7. Rolandelli RH, Bankhead R, Boullata J, Compher C. Clinical Nutrition: Enteral and Tube Feeding, 4th Edition. Philadelphia, PA: WB Saunders Company. 2004. 8. Frederick A. Practical tips for tube feeding. Nutrition Focus. Seattle, WA: University of Washington. 2003; 18(1);. 9. Pederson A. Tube feeding update. Nutrition Focus for Children with Special Health Care Needs. Seattle, WA: University of Washington. 2002; 17(6). 10. Klein MD and Morris SE: Homemade Blended Formula Handbook. Tucson, AZ: Mealtime Notions, LLC. 2007. 11. Pediatric Nutrition Practice Group of the American Dietetic Association. Infant Feedings: Guidelines for Preparation of Formula and Breast Milk in Health Care Facilities. Chicago, IL: American Dietetic Association. 2004. 12. Glass R and Nowak-Cooperman K. Helping children who are tube-fed learn to eat. Nutrition Focus. Seattle, WA: University of Washington. 2003; 18(2). Nutrition Interventions for Children With Special Health Care Needs 367
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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
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Appendix H 314 Nutrition Interventi
Page 332 and 333: Appendix H 316 Nutrition Interventi
Page 334 and 335: Appendix H 318 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 380 and 381: Appendix N Table N-2: Common Compli
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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
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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
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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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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