Advanced Nutrition Care

Advanced care involves strategies to improve intake and to assess nutritional status beyond the standard nutrition care provided to all patients. Advanced care is needed to address malnutrition (i.e., patients identified as SGNA moderate or severe). The objective of this care is to provide more nutrient dense food/formula to children at meals and between meals to optimize oral intake, while still providing all components of standard care. A clinical dietitian should be consulted and a comprehensive nutritional assessment completed.

RECOMMENDATIONS TO OPTIMIZE ORAL INTAKE

1. A variety of activities can be undertaken to improve intake including identification of barriers related to food intake and/or etiology of malnutrition.  Patient specific strategies need to address these barriers or etiologies. For example, higher energy and protein food offerings can be provided at and between meals and/or oral supplements in small amounts frequently can be provided. 

Other specific examples may include:

Suboptimal caloric intake:

Infants

• Increase number of feeding times per day
• Use of hypercaloric formula/supplementing expressed breast milk with formula
• Recommend lactation consultant if breastfed infant <6 months of age
• High calorie purees or other appropriate texture (examples: infant cereal, banana, avocado, sweet potato, full fat dairy)

Children >2 years of age:

• Family counseling on high calorie, high fat diet
• Oral nutrition supplements
• Preferred foods from home

Behavioral: (feeding relationship)

• Reduce parental anxiety
• Return control of feeding to the child
• Enjoyable mealtimes and positive experience

Education

• Provide education to families for related knowledge deficits

Feeding difficulties

• Feeding and/or swallowing assessment by OT/ SLP if concerns arise

Food intake should be monitored at least one meal per day to determine effectiveness of nutrition interventions.

If oral intake continues to be suboptimal, Specialized Care, including enteral or parenteral nutrition should be considered