Standard Nutrition Care

Standard care in the P-INPAC pathway refers to the minimum level of nutrition care that should be received by all children, regardless of their nutritional status.

PRINCIPLES OF STANDARD CARE

The following are a variety of strategies to promote food intake for all patients:

1. Breastfeeding mothers should be supported to maintain lactation.

• Challenges to breastfeeding should be addressed. Helpful resources include support from a registered lactation consultant, health professionals who specialize in the clinical management of breastfeeding. Click here for help finding a lactation consultant in your area
• Separation of mothers from their infants should be minimized wherever possible. Consider institutional strategies for mothers to “room-in” with infants, or regularly scheduled mother-baby times to optimize lactation and breastfeeding.

2. Infants and young children should always be supervised during feeding.

• While infants and young children should be encouraged to explore their food independently, supervision is required to ensure nutritional adequacy and appropriate intake
• Appropriate seating is required (high-chair, booster-chair, or positioned upright in bed; depending on age and ability)
• Supervision to ensure adequate, age-appropriate volumes are consumed safely

3. Ensure that foods appropriate for age, diet and texture are available at and outside of mealtimes

• Children should be offered multiple meals and snacks throughout the day

4. Assistance with opening packages and eating is required and families should be supported to bring preferred foods from home.

• Appropriate refrigerated storage and re-heating services should be available to families with guidance around general principles of food-safety.  
• This includes safe storage and re-heating options for pumped breastmilk

The following recommendations are strategies to identify patients at risk of malnutrition or those that have worsening nutritional status during admission:

5. Food intake monitoring should be provided where possible

• A minimum of 3 meals per week should be monitored
• Parents or patients may be able to report food intake, but careful attention must be paid to potential confounders, including: inaccurate self-reporting, food avoidance, or parental consumption of patient meals
• Portion consumed should be recorded in the medical record. This allows for early identification of intake challenges. The Visual Estimation of Food Intake Form may be helpful.
• Electronic apps may be helpful to support the monitoring of food portion size consumption by families
• Children consuming <50% of offered should have an RD consult to better identify risk factors, and causes of insufficient intake
• Careful attention should be paid to NPO/clear fluid times, and any child who has been NPO (through medical directive or inability to tolerate intake) >3 days should have an RD consult

6. After initial screening on admission, rescreen nutritional risk every 7 days of admission using a validated screening tool 

7. Growth measurements should be performed on all children at admission, and serially during admission. Details on this can be found at anthropometric assessment