Nutrition Interventions for Children with Special Health Care Needs

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Chapter 5 - Medication-Nutrient Interactions Table 5-1: Medication—Nutrient Interactions Assessment Intervention Evaluation/Outcome See the intervention below for each type of medication In addition to the Nutrition Assessment described in Chapter 1, complete the assessment indicated below ANTICONVULSANTS Examples: Any of the following alone or in combination with other anticonvulsants: phenobarbital; phenytoin (Dilantin); carbamazepine (Tegretol); primidone (Mysoline); valproic acid (Depakene/Depakate) Dietary intake of all nutrients is adequate If intake of any nutrient is less than the DRI/RDA: • Counsel caregiver/patient about food sources of nutrients • Recommend multivitamin/mineral supplement at DRI/RDA levels • Monitor for weight changes Assess diet for overall nutrient intake. Check specifically vitamin D, folic acid, other B vitamins, vitamin C, Vitamin K, and calcium Monitor for weight gain, weight loss, diarrhea, and constipation Assess indicators of bone mineralization: Indicators of bone mineralization are within normal limits If vitamin D is low, supplement with pharmacologic doses of vitamin D3 until it is well within normal limits While pharmacologic doses of vitamin D are being given, monitor for vitamin D toxicity weekly or bimonthly by checking serum Ca level (High serum Ca may indicate vitamin D toxicity) • Serum 25 (OH) vitamin D • Serum calcium (Ca) • Serum phosphorus (P) • Serum alkaline phosphatase (Alk Phos) 64 Nutrition Interventions for Children With Special Health Care Needs If vitamin D is normal, give up to 2000 IU/day of vitamin D to maintain stores If Ca or P is low, and vitamin D is normal, supplement with Ca or P. If Ca or P is low and vitamin D is low, insure DRI levels of Ca and P while vitamin D is being repleted If serum Ca, P, and Alk Phos are normal, re-assess 1-2 times per year STIMULANTS Examples: methylphenidate (Ritalin); dextroamphetamine (Dexedrine, Adderall); pemoline (Cylert) Dietary intake of all nutrients is adequate If diet is low in any nutrient, counsel appropriately. Instruct caregiver(s) to offer meals before giving the medication and later in the day when the medication action is minimal or absent. Collaborate with school to make sure child gets meal or snack before medication at school, if appropriate (see Chapter 12) Assess dietary intake when medication first prescribed
Assessment Intervention Evaluation/Outcome Weight and height (or length) are increasing in appropriate percentiles If rate of growth (height/length, or weight) is slowing, re-assess dietary intake and counsel appropriately Assess growth (height or length and weight) every 3 months Reassess dietary intake with a 3-to-7- If diet is adequate, but growth rate continues to slow, refer to physician day food record (if possible) and a diet to evaluate need for a change in medication or dose history DIURETICS Examples: furosemide (Lasix); spironolactone (Aldactone); triamterene (Dyrenium*); thiazides (Diuril, Hydrodiuril, Naqua, Hygroton, Hydromox, and Diamox) Consider effect of diuretic on excretion If intake of K, Ca, or Mg is lower than the DRI counsel regarding dietary Dietary intake of all nutrients of potassium (K), magnesium (Mg), and sources. Consider mineral supplements, especially K is adequate calcium (Ca) Assess diet for K, Ca, and Mg Lab indicators of electrolyte and mineral status are within normal limits If mineral deficiency is evident, counsel on dietary sources and provide mineral supplement If use of diuretics has been long-term, assess electrolyte and mineral status Section 2 - Problem-Based Nutrition Interventions CORTICOSTEROIDS Examples: Systemic-dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone Inhaled - triamcinolone acetonide (Azmacort) Assess for indigestion or mild GI Administer oral or inhaled dosage forms with food GI distress is decreased intolerances that may occur Consider need for sodium restriction and/or potassium supplementation Fluid retention and electrolyte Assess if patient receiving prolonged disturbances are minimized therapy with pharmacologic doses Assess protein intake to ensure Ensure adequate intake of protein and encourage physical activity Muscle catabolism is adequacy minimized. Assess vitamin and mineral intake Supplement any vitamins and minerals that are deficient in diet. Supplement Calcium to insure intake of 150% DRI22 Intake of vitamins, calcium, and phosphorus is adequate and 400 to 2000 IU vitamin D Assess linear growth Discuss possibility of decreased dose and/or alternate days on/off Effect on growth is minimized medication with physician. Assess bone density—use bone If condition permits, exercise or physical therapy will reduce risk of Bone loss is prevented/ densiometry to diagnose osteoporosis if osteoporosis minimized long term corticosteroid treatment Nutrition Interventions for Children With Special Health Care Needs 65
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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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Page 30 and 31: Chapter 2 - Anthropometricss needs,
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Page 54 and 55: Chapter 3 - Physical Activity for C
Page 68 and 69: Chapter 4 - Breastfeeding recommend
Page 70 and 71: Chapter 4 - Breastfeeding Table 4-1
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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 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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