Nutrition Interventions for Children with Special Health Care Needs

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Chapter 2 - Anthropometricss measure. BMI is expressed as a ratio of weight in kilograms to height in meters squared: BMI = weight in kilograms (height in meters)2 OR BMI = (weight in kilograms) ÷ (height in meters) ÷ (height in meters) BMI can also be calculated using English units (8): BMI = [Weight (pounds) ÷ Height (inches) ÷ Height (inches)] x 703 The calculated BMI adds a useful dimension to the assessment of body composition if accurate stature (length or height) and weight measurements are obtained. This index of weight relative to length or stature can be used to monitor changes over time. With this addition, clinicians can compare a child’s BMI to the BMI of her peers. Because growth parameters change, no single BMI is ideal during childhood and adolescence. Incremental Growth Charts Incremental growth charts used with charts for weight and stature can be helpful in assessing deviations in growth and response to intervention (9,10). These charts show changes in growth velocity over a 6 month period and are more sensitive to deviations in growth than charts with length or height and weight attained. For example, a child weighing 7 kg at 12 months of age and 8.8 kg at 18 months plots below the 5th percentile for weight for age on the CDC charts, but shows a growth velocity near the 90th percentile. This child, although below the 5th percentile for weight for age, is demonstrating rate of weight gain that is faster than the mean. Copies of incremental growth charts are provided in Appendix D (13). Specialty Growth Charts Growth charts for premature infants that attempt to reflect intrauterine growth rates have been produced by several different researchers; each set has benefits and drawbacks. However, instead of premature infant charts, many practitioners use the CDC growth charts and correct for the child’s prematurity. It is important to document that measurements of age are corrected for prematurity. It is best to continue to correct for prematurity until the child’s growth is plotted on the charts for 2-20 year olds. 24 Nutrition Interventions for Children With Special Health Care Needs
Section 1 - Determination of Nutrition Status Other growth charts that are useful in assessing growth are those for children with Down syndrome, William’s syndrome, cerebral palsy (quadriplegia only), Turner syndrome, achondroplasia and charts for measuring crown rump and sitting height. (See Table 2-2). These charts should be used as an additional tool for interpretation of growth after data have been plotted on the CDC charts. They are based on the growth of small groups of children with specific disorders and do not necessarily reflect ideal rates of growth. Many children with Prader Willie syndrome now receive growth hormone beginning as early as 6 months of age. The Prader-Willi growth charts do not reflect growth patterns in those children with PWS who receive growth hormone. Charts and tables available for interpretation of growth of children with special health care needs, as well as the advantages and limitations of these charts and tables are summarized in Table 2-2. Copies of these charts are included in Appendices G-M. Midparent Height Adjustment of length or height to reflect parental stature may help to explain unexpected growth. These adjustments help remove the influence of genetics from the child’s measurement and make it easier to recognize potential growth problems. Tables of adjustment have been developed based on the research of Himes, Roche, and Thissen (14). Midparent height adjustments should be applied when the child is below the 5th percentile or above the 95th percentile in length or height for age and both parents are very tall (mother taller than 5’9” and father taller than 6’4”) or very short (mother shorter than 5’ and father shorter than 5’5”) (3,15). The technique for parent-specific length or height adjustment is recorded on the table included in Appendix E. “Ideal” Body Weight Because children grow at different rates, it is impossible to quantify an absolute “ideal” weight based solely on age. Obviously, the desirable weight for a 108 cm, 6 year old girl is not the same as for a 120 cm, 6 year old girl, although both children’s growth rates can be described as typical. Some sources suggest using the weight that would place the child at the 50th percentile for weight for stature as an “estimated desirable weight” or “ideal” body weight. This may help to make identification and classification of malnutrition more quantifiable, but must be carefully considered. Many children are more satisfactorily described in terms of “degree of malnutrition.” However, classifications are generally arbitrary and thus may not be consistent. Nutrition Interventions for Children With Special Health Care Needs 25
Page 1: Nutrition Interventions for Childre
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Page 6 and 7: Kay Kopp, OTR/L Occupational Therap
Page 8 and 9: Appendices Appendix A Sample Screen
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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 Refere
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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 I 320 Nutrition Interventi
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Appendix J 328 Nutrition Interventi
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Appendix K 336 Nutrition Interventi
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Appendix K 338 Nutrition Interventi
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Appendix L 340 Nutrition Interventi
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Appendix M 342 Nutrition Interventi
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Appendix M 344 Nutrition Interventi
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Appendix N Gastrostomy Tube Feeding
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Appendix N activities. When feeding
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Appendix N Feeding Sets/Extensions
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Appendix N Fluid and Electrolytes W
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Appendix N osmolality of full-stren
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Appendix N Modular Products Modular
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Appendix N his family, and the home
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Appendix N • The feeding tube may
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Appendix N equipment. The Special S
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Appendix N Table N-2: Common Compli
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Appendix N Complication Possible Ca
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Appendix N 368 Nutrition Interventi
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Appendix O Some conditions increase
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Appendix O Table O-3: Recommended P
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Appendix O 374 Nutrition Interventi
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Appendix P Diet Prescription for Me
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Appendix Q Goals Considerations for
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Appendix R Condition Description Nu
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Appendix R Condition Description Nu
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Appendix R References 1. Ekvall SW
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Appendix S Table S-1: Infant Formul
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Appendix S Comments Osmolality (mOs
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Appendix S Table S-2: Pediatric For
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Appendix S Table S-3: Modular Produ
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Appendix S Comments Energy (kcal) P
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Appendix S Contact Information Abbo
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Appendix T Powdered Formulas Accura
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Appendix T Table T-1: Liquid Concen
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Appendix T 402 Nutrition Interventi
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Appendix U Nutrition Strategies for
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Appendix U ADA Pocket Guide to Nutr
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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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