Nutrition for Children with Special Health Care Needs

Module 4: Evaluating Nutrition

Care Plans
 Pacific West MCH
Distance-Learning Curricula
 Nutrition for Children with Special Health
Care Needs - 6 self-study modules
 Nutrition for Children with Special Health
Care Needs - 4 group study modules
(this presentation is one of them)
 Nutrition and Oral Health Curriculum
all available (free) on-line at
www.pacificwestmch.org
 Group Study Curriculum
Module 1: Providing Family-Centered Care
Module 2: Participating in the
Interdisciplinary Approach to
Feeding Interventions
Module 3: State and Local Nutrition
Resources
Module 4: Improving Nutrition Interventions
 Module 4:
Evaluating Nutrition Care Plans
Activities:
 Video example of interdisciplinary intervention
 Review process of nutrition assessment and
intervention planning
 Evaluate appropriate intervention plans and
outcome measures
 Discussion regarding follow up and measurement
of intervention outcomes
 Learning Objectives
After completing the module, participants
will have the knowledge and skills to:
 Critically evaluate the development of
nutrition interventions
 Develop alternative strategies for weak
nutrition intervention plans
 Determine appropriate mechanisms for
nutrition follow-up
 The Process of Developing a
Nutrition Care Plan
 Decide on Nutrition Outcomes
(assessment to identify problems)
 Develop Nutrition Interventions
(to address identified problems)
 Determine Outcome Measures
(appropriate to specific interventions)
 The Process
 Screening
 Assessment
 Anthropometrics
 Biochemical
 Clinical/Medical
 Dietary/Feeding
 Intervention
 Evaluation
 The Process: How does the condition
affect:
Assessment •Growth potential?
•Body composition
 Anthropometrics
•Risk of over/under- weight
 Biochemical
Are the effects on growth
 Clinical/Medical nutrition-related or non-
nutritional?
 Dietary/Feeding
Do any medications have
the potential to affect
growth? Weight gain?
 The Process:
Assessment Does the condition affect
biochemical markers?
 Anthropometrics
Do medications affect
 Biochemical biochemical markers?
 Clinical/Medical Does the condition require
 Dietary/Feeding special biochemical
monitoring?
 The Process:
Assessment
 Anthropometrics Are there any secondary
 Biochemical conditions that might affect
nutritional status (e.g.,
 Clinical/Medical constipation,
malabsorption)?
 Dietary/Feeding
 The Process:
Assessment Does the condition affect
nutrient needs?
 Anthropometrics (Energy, other macronutrients;
 Biochemical vitamins, minerals; fluid)

 Clinical/Medical Does the condition affect

ability to eat?
 Dietary/Feeding (Positioning, oral-motor skills,
coordination, need for different
portion size, acceptance of food,
meal duration, social interaction)
 The Process:

Intervention = ACTION = What will be done differently?

Individualized
Specific
Outcome-based
Family centered

Example: Family will offer energy-dense foods at meal and

snack times
 Interventions
Effective interventions specify:
 What will be done
 How it will be carried out
 Who will do it
 When it will happen
 Where it will happen (when appropriate)

Family will offer 2 foods with crunchy textures at each meal

 Evaluation
Outcome = RESULTS = What will happen as a result of the
intervention?
Measurable
Specific
Evaluated

Example: Weight-for-age between the 10th and 50th

percentiles
 Evaluation
Outcome = RESULTS = What will happen as a result of
the intervention?
 Long-term (adequate calcium intake)
 Short-term (re-gain of weight lost during an acute
illness)
Examples
Sheldon
Sheldon is a 9-month old with Prader-Willi
syndrome.
Assessment identifies that:
 Wt/age, length/age, weight/length are <5th %ile
 Wt/age was ~10th %ile until 6 weeks ago, when
he was ill
GOAL (desired outcome):
 Sheldon’s weight-for-age will increase.
Sheldon
Sheldon is a 9-month old with Prader-Willi
syndrome.

IMPROVED GOAL:

Sheldon’s weight-for-length will increase

to 5-10th percentile in 6 weeks.
Sheldon
GOAL: Sheldon’s weight-for-length will increase
to 5-10th percentile in 6 weeks.

INTERVENTION (action):
 Sheldon’s family will offer infant formula that
is concentrated.
Sheldon
GOAL: Sheldon’s weight-for-length will increase
to 5-10th percentile in 6 weeks.

IMPROVED INTERVENTION:
 Sheldon’s family will offer infant formula that
is concentrated to provide 24 kcal/oz.
Sheldon’s family will receive a written recipe
for this special formula.
 Carla: Desired outcomes
Carla is a 2-year old with cerebral palsy
Assessment indicates that:
- Oral-motor delays interfere with eating
- Weight gain has slowed over past few months
- Labs indicate that she is malnourished

 Carla will be well-nourished

 Carla’s feeding problems
will be addressed
 Carla: Measurable Outcomes
Carla is a 2-year old with cerebral palsy
–Oral-motor delays interfere with eating
–Weight gain has slowed over past few months
–Labs indicate that she is malnourished

 Carla will be well-  Carla’s prealbumin will be in

nourished the normal range in 6 weeks
 Carla’s feeding  Carla’s weight-for-length will
problems will be be >10th percentile in 6
addressed months
 Carla: Measurable Outcomes
Carla is a 2-year old with cerebral palsy
–Oral-motor delays interfere with eating
–Weight gain has slowed over past few months
–Labs indicate that she is malnourished

 Carla will be well-

nourished
 Carla’s feeding  Carla will be referred
problems will be to a feeding therapist
addressed by her next clinic visit
 Carla: Designing Interventions
Outcomes:
 prealbumin will be in the normal range in 6 weeks
 weight-for-length will be >10th percentile in 6 months
 Referral to feeding therapist by next clinic visit

Interventions: need to be designed to achieve the

measurable outcome
 Carla: Specific Interventions
Outcomes:
 prealbumin will be in the normal range in 6 weeks
 weight-for-length will be >10th percentile in 6 months
 Referral to feeding therapist by next clinic visit

Interventions:
 One food with added energy and protein will be offered
at each meal and snack
 RD will contact Carla’s PCP to initiate referral
 Carla: Evaluating Progress
 Prealbumin will be in the normal range in 6 weeks
 Blood drawn: prealbumin was in the normal range
 Outcome modified: prealb, albumin WNL in 6 mos
 Weight-for-length >10th percentile in 6 months
 Weight-for-length 10th percentile
 Outcome modified: weight/age 5th-25th %iles, length/age10th-
50th %iles, weight/length 10th-50th %iles
 Referral to feeding therapist by next clinic visit
 Carla’s mother reported that referral made
 Outcome modified: Carla will receive feeding therapy
 Aaron: Desired Outcomes

Aaron is an 8-year old with Down syndrome. In

9 months, Aaron has gained 7 kg. BMI-for-age is
at the 95th %ile

 Aaron will maintain a healthy weight

 Aaron: Measurable Outcomes
Aaron is an 8-year old with Down syndrome. In 9
months, Aaron has gained 7 kg. BMI-for-age is at
the 95th %ile
 Aaron will maintain
his current weight
 Aaron will maintain (32 kg) until his
a healthy weight BMI-for-age is at
the 75th %ile
 Aaron: Interventions
Aaron will maintain his current weight (32 kg)
until his BMI-for-age is at the 75th %ile

 Aaron will eat foods with fewer kilocalories

 Aaron: Improved Interventions
Aaron will maintain his current weight (32 kg) until
his BMI-for-age is at the 75th %ile

 Aaron’s family will substitute foods with fewer

kilocalories for energy-dense foods (specific
information provided to Aaron’s family).
 Aaron will walk to school with his older brother 3
days each week
Justin
 18-month old with
trisomy 21 (Down
syndrome)
 Growth is appropriate
 Feeding skills are
delayed
 Receives OT, SLP
services
Justin: Feeding skills
 Give mother a handout
about feeding skill
development
 Suggest the family be
seen by a feeding
therapist
 Suggest that the OT
and SLP also work on
feeding skills
 Justin: Improved Interventions
 Review feeding skill  Give mother a handout
development handout about feeding skill
with mother development
 Identify where Justin is  Suggest the family be
and what skills to seen by a feeding
reinforce therapist
 OUTCOME: Identify  Suggest that the OT and
desired feeding skills SLP also work on
and strategies family can feeding skills
use
 Justin: Improved Interventions
 Give mother a handout
about development of
feeding skills
 Make a referral to a  Suggest the family be
community feeding team seen by a feeding
at an early intervention therapist
center  Suggest that the OT and
 OUTCOME: appointment SLP also work on
will be scheduled feeding skills
 Justin: Improved Interventions
 Give mother a
handout about
development of
 Contact OT and SLP to discuss
feeding skills
a plan to address Justin’s
feeding skills  Suggest the family be
seen by a feeding
 OUTCOME: RD, OT and SLP
therapist
will develop list of feeding-
related recommendations for  Suggest that the OT
Justin before next nutrition and SLP also work on
appointment
feeding skills
Justin
Goals for nutrition
therapy:
 Maintain adequate
intake and
appropriate growth
 Improve feeding
skills
 Prevent overweight
Further thought…
Conclusion

 Resource sheet
 Post-test and evaluation