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

Canadian Malnutrition Awareness Week, our annual campaign, aims to enhance learning of clinicians, healthcare providers and consumers around malnutrition. CMAW 2024 dates to follow.

In primary care, 1 dollar spent on nutrition interventions can save up to 99 dollars by reducing medication use, hospitalizations and freeing up physician time.

Nutrition risk screening is the first step in identifying patients at risk for malnutrition.

Up to 1 in 3 hospitalized children are malnourished upon admission to hospital and at risk of further deterioration.