Nutrition Interventions for Children with Special Health Care Needs

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Chapter 7 - Nutrition Interventions for Diarrhea abdominal pain. Types of infection include: 1. viral: (e.g., Rotavirus, enteric adenovirus). In the United States, viruses account for at least 3040% of episodes of acute gastroenteritis. 2. parasitic: (e.g., Giardia) 3. bacterial: (e.g., E. coli 0157, Salmonella, Shigella, Campylobacter) 4. non-gastrointestinal infection: Diarrhea can accompany otitis, pneumonia or urinary tract infection • Medication side-effect (frequent with some antibiotics) • Food intolerance Nutritional Complications Nutritional complications from acute diarrhea may not always be evident. Nutrient deficits are uncommon among previously healthy children with self-limited gastroenteritis. Dehydration is the most concerning complication of acute diarrhea. In the literature there are multiple different definitions of degrees of dehydration. Table 7-1 describes one approach to the assessment of dehydration for those with acute diarrhea. Table 7-1: Assessment of Dehydration (1,2,5,6) Percent Body Water Signs and Symptoms Lost Minimal dehydration 1 to 2%, subclinical Increased thirst and mild oliguria (decreased urine output) Mild dehydration 3 to 5% Increased thirst, oliguria, mucous membranes slightly dry Moderate dehydration Severe dehydration 6 to 9% Marked thirst, urine output
Section 2 - Problem-Based Nutrition Interventions digestive enzymes, and increased permeability of the mucosal barrier. All of these effects can lead to decreased ability of the gut to absorb nutrients (7,8). Some children who have chronic illnesses or who are medically fragile may suffer nutrition deficits from repeated bouts of mild acute diarrhea even when appropriately managed. Treatment Mild acute diarrhea requires no special treatment. Adequate fluid intake should be a priority, but a strict clear liquid diet is no longer the treatment of choice. Recent data indicates that feeding with the usual diet is appropriate for most cases of acute diarrhea (1-3, 5-9). If an infant is breastfed, this should be continued on demand and other fluids given if needed for supplementation. Breast milk contains substances which may stimulate and protect the gastrointestinal mucosa (7). Formula-fed infants also should be continued on their routine formula. Milk and milk-based formulas have historically been avoided during episodes of diarrhea. There may be mucosal damage during the illness that creates temporary lactase deficiency. However, at least 80% of children do not have worsening of diarrhea from this temporary lactase deficiency and can safely be continued on milkbased formula or milk (7,8). Change to a lactose-free formula is only recommended if stool output increases on a milk-based formula (3). Previous recommendations for treatment of acute diarrhea were for a period of “bowel rest” with clear liquids only, then gradual re-introduction of first diluted, then full strength formula or milk along with a very limited diet of solid foods. Diluted formula is no longer recommended. Current information has demonstrated that early feeding of a routine diet leads to a better overall outcome. Specific beneficial effects are decreased duration of illness, improved weight gain, and improved nutritional state (5,7,8). There is discussion in the medical literature as to what constitutes the most appropriate mixed diet for feeding during acute diarrhea. Historically, the BRAT diet (banana, rice, applesauce and toast/tea) was recommended. This very restricted diet is high in carbohydrates but very low in calories, fat, fiber, protein, calcium, and Vitamins A and B12 (8). Current broad guidelines for an appropriate mixed diet are for food that is palatable, inexpensive, culturally acceptable, and easily digested (5,7). This may include complex carbohydrates (rice, wheat, potatoes, bread, cereal), lean meats/poultry, eggs fruits, vegetables, and yogurt (5). Nutrition Interventions for Children With Special Health Care Needs 83
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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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Page 110 and 111: Chapter 8 - Oral-Motor Feeding Prob
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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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