Nutrition Interventions for Children with Special Health Care Needs

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Appendix O Some conditions increase fluids needs: • Fever (any degree of fever above normal (37.0-37.4 C) needs immediate medical attention. Fevers are often indicators of line sepsis.) • Hypermetabolism • Diarrhea (high ostomy outputs) Some conditions decrease fluid needs: • Heart disease • Renal failure with low urine output Energy Parenteral energy needs vary depending upon the activity and stress of the individual child. Because PN requires less energy for digestion and absorption, energy needs may be up to 15 % lower in stable (renourished and not stressed), parentally fed children than for those who are fed enterally. Conversely, an individual’s energy needs may be higher than the DRIs during periods of catch-up growth, hypermetabolism, and illness (2,3). The dietitian must monitor the child’s rate of weight gain to ensure appropriate growth. Only by tracking monthly plots on the child’s growth chart can the dietitian determine whether to increase energy to maintain the growth pattern or decrease calories to prevent excessive weight gain. Other Nutrients Amino acids (AA) provide 4 kcal/g and should provide 6-16% of total energy depending upon the child’s energy needs and disease state. For infants and children, AA are typically started at 1.5 g/kg/day and increased by 0.5 g/kg/d increments until the final protein goal is reached (2). Intravenous (IV) lipids provide a concentrated, isotonic source of energy by which fat is used to supply approximately 30-40% of the child’s total calories. The minimum amount of lipid required to prevent essential fatty acid deficiency is 4 – 8% of total calories, while the maximum amount of lipid that may be administered is 60% of total calories. Such IV lipids are available as 20% or 10% emulsions. 20% emulsions provide 2 kcal/ml and is the exclusive solution used in pediatric PN. 10% emulsions are no longer used in the pediatric population due to increased phospholipid content and inferior clearance. Carbohydrate (dextrose) is typically the major source of non-protein energy and provides 3.4 kcal/g. In general dextrose should provide 40-50% of total energy (3). 370 Nutrition Interventions for Children With Special Health Care Needs
Appendix O Electrolytes and minerals are adjusted in PN solutions based on serum lab values. The team managing the child’s PN solution will determine the amounts of electrolytes and minerals to be included in the solution. Vitamins are added to each bag of PN solution prior to administration. The PN solution is clear until the vitamins are added; the vitamins change the color of the PN solution to yellow. Recommended parenteral vitamin and mineral intake levels are provided in Tables O-2 and O-3 (4). Trace elements included in the PN solution will vary, depending on the child’s age, size, and medical condition. For example, patients with large stool and ostomy outputs may require additional zinc. Again, in general, children are not discharged from the hospital until their medical conditions are stable and PN solutions are firmly established. Recommended trace element intake levels are provided in Table O-4 (4). Table O-2: Recommended Parenteral Vitamin Intakes for Term Infants and Children 1,4 Nutrient Recommended intake Vitamin A (μg RE/d) 700 Vitamin E (mg α-tocopherol/d) 7 Vitamin K (μg/d) 200 Vitamin D (IU/d) 400 Ascorbic acid (mg/d) 80 Thiamin (mg/d) 1.2 Riboflavin (mg/d) 1.4 Pyridoxine (mg/d) 1.0 Niacin (mg/d) 17 Pantothenate (mg/d) 5 Biotin (μg/d) 20 Folate (μg/d) 140 Vitamin B12 (μg/d) 1.0 Nutrition Interventions for Children With Special Health Care Needs 371
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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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Page 336 and 337: Appendix I 320 Nutrition Interventi
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Page 352 and 353: Appendix K 336 Nutrition Interventi
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Page 356 and 357: Appendix L 340 Nutrition Interventi
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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
Page 382 and 383: Appendix N Complication Possible Ca
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Page 388 and 389: Appendix O Table O-3: Recommended P
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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
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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
Page 426 and 427: Glossary Early intervention service
Page 428 and 429: Glossary Length (recumbent length)
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Page 432 and 433: Index specialist 98 target 108 Bink
Page 434 and 435: 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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