Nutrition Interventions for Children with Special Health Care Needs

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Chapter 6 - Nutrition Interventions for Constipation Brand/Common Name Action Comments Site of Action Onset of Action (hours) Laxative Type Glycerin Sodium stearate in preparation causes the local irritation, can moisten suppository in water to reduce irritation Local irritation; hyperosmotic action 0.25-0.5 colon Miscellaneous Glycerin Lactulose Cephulac® Chronulac® Also indicated in portal systemic encephalopathy Delivers osmotically active molecules to colon Lactulose 24-48 colon Miralax® Osmotic agent, causes Polyethylene glycol 1-4 colon stool to retain water Compiled from Drug Facts and Comparisons, 1999 Edition, J.P. Lippincott Company. 76 Nutrition Interventions for Children With Special Health Care Needs
Table 6-2 - Nutrition Interventions For Constipation Assessment Intervention Evaluation/Outcome Clinical Regular toileting is established and followed. Obtain stool history. Differentiate between acute and chronic conditions. Determine: Re-evaluate frequently until regular bowel movements are occurring every 1-2 days, with a normal consistency. Work with family to establish regular toileting schedule and appropriate positioning. Include a physical or occupational therapist to assist with appropriate positioning techniques, and assess the need for any special equipment. • Stool frequency and consistency • Toileting techniques • Primary diagnosis (e.g. Down syndrome, cerebral palsy, Hirschsprung’s disease) Work with child’s primary care physician or a medical consultant to rule out anatomic or neurologic disorder. Medical contributors to constipation are controlled. Provide medical management for physiologic disorders (e.g. a child with myelomeningocele who has a neurogenic bowel, which may require surgery) 1 Obtain the following as needed: Section 2 - Problem-Based Nutrition Interventions When a potentially correctable underlying cause of constipation exists, re-evaluate need for medications on a regular basis. If possible, discontinue and manage with other methods. (Children who have neurogenic bowel or who are immobile often need medications indefinitely.) Use the following treatments with care: laxatives (including prunes and prune juice), stool softeners, suppositories, and enemas. Certain treatments may be hazardous with long-term or excessive use, or if there is impaction or megacolon. 1,3 Some of these may result in dependency. See Chapter 5 for more information or see reference 9. • Rectal exam • Abdominal x-ray • Barium enema • Intestinal biopsy/rectal manometrics • Colonoscopy (From early infancy, children with spinal cord anomalies, e.g. myelomeningocele, need close medical assessment and monitoring for bowel problems.) Nutrition Interventions for Children With Special Health Care Needs 77 Recommended activity schedule is followed. Appropriate massage occurs. Increase physical activity as tolerated. Obtain OT/PT consult for instruction on infant/child massage. 10 Assess level of physical activity. Dietary Intake of fluid and fiber is increased. Counsel caregivers regarding appropriate dietary changes. 11 Advise the following as needed: Assess fluid and fiber intake. Re-evaluate diet frequently until stools are of normal consistency and frequency. Use food record and/or interview. Increase fluids, especially water and juice. For the child who cannot easily swallow thin liquids, try the following: Determine food textures that are well-tolerated.
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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 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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Nutrition Interventions for Children with Special Health Care Needs

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