Nutrition Focus

30(4) Tube Feeding Basics

Posted on July 21, 2015 by nutrfoc

Enteral or tube feeding refers to the delivery of liquid feedings through a tube. Tube feedings are used for the infant or child with a functioning gastrointestinal tract who is unable to meet nutrition needs or safely consume food by mouth. The role of tube feeding may range from supportive therapy where only part of the child’s nutrition is provided by tube plus oral food intake, to a primary therapy where all of the nutrition needs are provided via the feeding tube. Feeding tubes may be used to provide medication, hydration, or to release air or stomach contents. Most children who receive tube feedings can continue to receive oral feedings to fulfill pleasurable and social aspects of eating. If children are totally fed via a tube feeding, offering some feedings at the same time the family is eating meals will engage these children in the social aspects of feeding.

Tube feeding benefits the child by improving growth, nutritional status and frequently, their primary condition. By ensuring the child’s nutrient needs are being met, tube feeding can free the family from anxiety and improve the child’s quality of life.

30(3) Practical Tips for Tube Feeding

Posted on May 1, 2015 by nutrfoc

The goal of this newsletter is to share ideas for successful use of a feeding tube to meet the nutrition needs of a child in a family-friendly manner. Most of the practical tips shared are those from parents who have a variety of experiences with their children who have used a tube feeding. The suggestions provided are designed for day to day life including school and vacations. The use of the tips and information should be evaluated for each individual child based on their tube feeding experiences and family needs. Table 1, on page 2, describes some items a mother has now learned, but would have appreciated knowing earlier in her child’s tube feeding experience.

All pediatric patients with tube feedings will need to maintain close contact with their primary care provider and a registered dietitian nutritionist (RDN) with experience managing children of all ages who have tube feedings. Families may also work closely with an infusion company for formula and equipment supplies. These companies may employ health care professionals including registered nurses and RDNs. Some families may receive formula from WIC (the Women, Infants and Children Supplemental Nutrition Program). In addition, some children may also require oral-motor feeding therapy in preparation for eventual weaning from the feeding tube. Previous issues of Nutrition Focus Newsletter have described various methods of weaning children from tube feedings.

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Practical Tips for Tube Feeding

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Posted in Nutrition-related Issues | Tagged assessment, calories, CSHCN, enteral nutrition, failure to thrive, family centered care, feeding, fluid, growth, infants, intervention, nutrition management, oral-motor, team members, tube feeding | Comments Off

30(2) Nutrition Issues for Children with Down Syndrome

Posted on March 1, 2015 by nutrfoc

Within the community, many health care professionals who work with children with special health care needs have seen families with children who have Down syndrome (DS). Over the last 5 decades individuals with DS have moved out of institutions and benefitted from services beginning within the early intervention system, and continuing with educational and community programs with an emphasis on healthy activities in the school years. Adults with DS have moved into employment/vocations and living arrangements in group or individual settings. From an early age, physical activity and a healthy weight are encouraged, with appropriate consideration given to each child’s health and developmental capabilities.

As the National Down Syndrome Society (NDSS) web site notes, “The NDSS envisions a world in which all people with Down syndrome have the opportunity to enhance their quality of life, realize their life aspirations, and become valued members of welcoming communities”

This issue of NUTRITION FOCUS will update the reader about DS and discuss concerns related to growth, nutrient adequacy, and feeding that often occur in children with DS. The article will also describe how the Registered Dietitian Nutritionist (RDN) works in collaboration with the family, health care providers, educators, and others to provide information and support to families who have a child with DS. Lastly, the article will review the scientific evidence behind the use of supplements and other complementary therapies.

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Posted in Specific Conditions | Tagged complementary therapies', down syndrome, education, energy, enteral nutrition, failure to thrive, family centered care, feeding, fluid, genetics, growth, growth charts, intervention, nutrition management, team members, transition | Comments Off

30(1) Assessing Fluid Requirements in Infants and Children

Posted on January 1, 2015 by nutrfoc

Assessment of fluid requirements is an important component of pediatric nutrition care. Fluid intake provides the water that is necessary as a transportation network throughout our bodies and also provides structural integrity to our cells. Accurate assessment of fluid needs is especially important for children as they are at a greater risk of dehydration than adults. This is because the bodies of children contain proportionately more water and therefore require more fluid intake each day to maintain balance. Although we often think of fluid requirements as a goal volume for water consumption, children may meet their fluid requirements through intake of breastmilk, formula, milk, other beverages and even foods. Children with special health care needs require close monitoring of fluid status because their needs may be greater or less than expected and these children may not be able to compensate for inadequate or excessive fluid intake.

This issue of Nutrition Focus will discuss the issue of fluid in children, especially those with special health care needs. The assessment of fluid status will be reviewed. Several cases provide illustrations of fluid assessment and intervention.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, CSHCN, feeding, fluid, growth, infants, intervention, nutrition management | Comments Off

29(6) Fetal Alcohol Spectrum Disorders

Posted on November 1, 2014 by nutrfoc

Fetal alcohol syndrome (FAS) is a permanent birth defect caused by maternal alcohol consumption during pregnancy. In the United States, prenatal alcohol exposure is one of the leading known preventable causes of intellectual disabilities. Not all individuals with prenatal alcohol exposure have the birth defect known as FAS. Most present with lifelong neurocognitive and behavioral problems, without the facial features of FAS. This occurs because the window of vulnerability for alcohol to cause the unique facial features is very narrow, perhaps as narrow as the second and third weeks of pregnancy. The window of vulnerability for neurocognitive problems, in contrast, extends throughout pregnancy. The damage caused by prenatal alcohol exposure presents along a continuum. This continuum is called Fetal Alcohol Spectrum Disorders (FASD).

There are 4 diagnoses that fall under the umbrella of FASD. They include FAS, partial FAS (PFAS), Static Encephalopathy/Alcohol-Exposed (SE/AE) and Neurobehavioral Disorder/Alcohol-Exposed (ND/AE). See Figure 1 on page 2. Individuals with FAS have growth deficiency, unique facial features (See Figure 2 on page 2), and severe structural and/or functional CNS abnormalities. Individuals with PFAS have FAS without the growth deficiency. Individuals with SE/AE have severe structural/functional CNS abnormalities without the facial features of FAS. Individuals with ND/AE have moderate CNS dysfunction without the facial features. FASD is diagnosed by an interdisciplinary team using a rigorous FASD diagnostic system like the FASD 4-Digit Diagnostic Code.

In the United States, the estimated prevalence of FAS in the general population is 1-to 3- per 1,000 live births. The prevalence of FAS in high risk populations like foster care is ten-fold higher (1/100). The prevalence of all other diagnoses under the umbrella of FASD is 5 to 10 times higher than the prevalence of FAS.

This volume of the NUTRITION FOCUS newsletter updates an article published in 2006. The current article describes new terminology and knowledge related to the full spectrum of outcomes called FASD. Nutrition issues related to alcohol use by pregnant and lactating women are presented. In addition, nutrition concerns for children, exposed to alcohol inutero, are reviewed.

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Fetal Alcohol Spectrum Disorders

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Posted in Specific Conditions | Tagged fas, fasd, feeding, fetal alcohol, growth, sensory | Comments Off

29(5) A Focus on Family-Centered Care from the Parent’s Perspective

Posted on September 1, 2014 by nutrfoc

The term “family-centered care” (FCC) was coined in the 1980’s to describe a philosophy of care for children with special health care needs and their families. It was a radical paradigm shift from the previous philosophies of “systemcentered care” in which the needs of, or benefit to, the system drive the delivery of services and “child-centered care” in which the strengths and needs of the child, apart from the family, drive the delivery of services. The definition of FCC has since evolved from a philosophy of care to a philosophy of care and a standard of practice.

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Posted in General Topics Related to CSHCN | Tagged ABA, autism, CSHCN, enteral nutrition, family centered care, feeding, prematurity, resources, school, team, team members, transition, tube feeding | Comments Off

29(4) Weaning from tube feedings: many different pathways Part 2B – Case Study Illustrations

Posted on July 1, 2014 by nutrfoc

These detailed and comprehensive case studies complement Part 1 of this topic published in November/December 2013. Due to the depth of information shared within the case studies which contributed to many pages we have decided to publish the case studies as two separate Nutrition Focus articles – i.e., Part 2A and Part 2B. These will be published as May/June (Vol 29, #3) and July/August 2014 (Vol 29, #4). We are giving credit to all four authors in both issues. Please see page 2 for a glossary. The authors represent the feeding therapists involved with each case. However, each therapist was supported by a Registered Dietitian/Nutritionist (RD/N) and other team members. It is essential that the RD/N be a part of the process, whether a slow, gradual wean or a more intense experience, to ensure an appropriate energy, nutrient, and fluid intake.

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Posted in Nutrition-related Issues | Tagged assessment, behavior, calories, constipation, CSHCN, education, energy, enteral nutrition, failure to thrive, family centered care, growth, hunger, intervention, nutrition management, oral-motor, resources, team members, transition, tube feeding, weaning | Comments Off

29(3) Weaning from tube feedings: many different pathways Part 2A – Case Study Illustrations

Posted on May 1, 2014 by nutrfoc

This article is Part 2 of the series. Part 1 was published in November/December 2013. It can be accessed by those who have a current subscription to the Nutrition Focus newsletter (https://depts.washington.edu/nutrfoc). Part 1 describes several models of treatment for weaning from a feeding tube. They included gradual controlled weaning programs and intensive feeding programs, both hospital based and community based. The goal in this issue is presentation of two (A and B) of the four case studies that illustrate the models below. The July/August 2014 issue will present the other two cases (C and D).

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, behavior, calories, CSHCN, energy, enteral nutrition, family centered care, feeding, growth, intervention, nutrition management, oral-motor, team members, transition, tube feeding | Comments Off

29(2) Nutrition Issues in Children with Asthma

Posted on March 1, 2014 by nutrfoc

Asthma is a chronic inflammatory disorder of the airways that can cause wheezing, shortness of breath, chest tightness, and coughing. The inflammatory responses associated with asthma can cause airway narrowing and excessive secretions. Over time, these responses result in injury of epithelial cells in the respiratory system, airway remodeling, and pulmonary dysfunctions. Genetic as well as environmental factors play an important role in the development of asthma.

Asthma, one of the most common chronic diseases in the pediatric population, affects approximately 7.1 million children (9.3% prevalence) from birth to 18 years of age. The prevalence of asthma in both adults and children has been increasing since the 1980s, becoming a major public health concern. Asthma is a chronic condition with periodic exacerbations, causing children to miss an estimated 14 million school days per year. Undiagnosed and poorly controlled asthma can lead to serious outcomes, even death. In 2009, asthma attacks led to 774,000 emergency room visits by children under 15 years of age. In the same year, about 160 children in this age group died from asthma. The total direct cost (health care related) and indirect cost (such as loss of productivity) of asthma is estimated to be as high as 56 billion dollars annually.

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Posted in Specific Conditions | Tagged assessment, asthma, calories, CSHCN, development, family centered care, fluid, growth, intervention, medication interactions, medications, nutrition management, pulmonary, resources, team members | Comments Off

29(1) Selected Pediatric Nutrition Questions and Answers

Posted on January 1, 2014 by nutrfoc

This issue is a compilation of various questions we have received from our Pediatric Nutrition Listserve. This listserve is designed for members to submit questions and receive an evidenced based answer. Subscribers to Nutrition Focus who are Registered Dietitians can also become members of the listserve (see page 9 for information). These questions were submitted to the Pediatric Nutrition Consultation Online listserve between November 2011 and January 2014. We felt the responses were still accurate, but please note there may be more current references for some of the questions.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues, Specific Conditions | Tagged calcium, enteral formula, epidermolysis bullosa, growth hormone, infancy, iron, lactose intolerance, medications, obesity, prader-willi syndrome, soy formula, tube feeding, xylitol | Comments Off

Nutrition Focus

30(2) Nutrition Issues for Children with Down Syndrome

29(6) Fetal Alcohol Spectrum Disorders

29(2) Nutrition Issues in Children with Asthma

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