Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
for each infant and mother should be done in a manner that ultimately leads to full
breastfeeding and/or use of the mother’s milk supported by methods to preserve
the mother’s supply. The energy density of a mother’s expressed breast milk (EBM)
can be increased by the use of powdered formula and/or additional modules. See
Appendix S. The increased energy dense breast milk can be given by a supplemental
nursing system (SNS) or by use of the bottle for 1 or 2 feedings a day with the goal
of full breastfeeding and/or use of all breast milk. Careful evaluation of the infant’s
growth will be needed. Merely taking the fully breastfed baby off of the breast,
having mother pump her milk, fortifying it and then giving it by bottle can quickly
lead to the cessation of breastfeeding, and possibly a severe reduction in breast milk
supply.
Even babies who require nasogastric or gastrostomy tube feedings can gain
breastfeeding benefits. They may breastfeed for a portion of their nutrition, with tube
feeding volumes adjusted to account for intake (as measured by pre-post weights).
Optimally, as much EBM as possible will be provided during tube feedings. Babies
who take low volumes from the breast or who are unsafe to breastfeed can still nurse
at a “dry” breast or participate in skin-to-skin care. These feeding experiences can
have a beneficial influence on milk production.
Contraindications for breastfeeding and/or use of human breast milk are present in
children with special health care needs. The most obvious is that for infants identified
with galactosemia or other inborn errors of metabolism (See Chapter 21). For other
contraindications to breastfeeding and/or the use of breast milk see The American
Academy of Pediatrics Pediatric Nutrition Handbook (6).
For the infant with special health care needs, breastfeeding may look differently for
each mother/baby pair. The primary goal is for the baby to receive as much breast
milk as possible, with the secondary goal of achieving at least some feeding at the
breast. Treatment strategies must support the mother in maintaining her milk supply,
and support the mother and baby in moving toward breastfeeding. The intensity
of the physical and emotional experience for the mother beginning breastfeeding
with an infant with special health care needs should be acknowledged. The team of
professionals working together can help balance competing medical goals, provide
emotional support, and offer practical guidance to ensure the baby’s optimal growth.
In the process, we may redefine “breastfeeding” in a way that is unique to each
mother/baby pair.
Table 4-1 presents guidelines for the assessment, intervention, and outcome/
evaluation for several breastfeeding concerns.
Nutrition Interventions for Children With Special Health Care Needs 53