Theory of Focused Energy Expenditure during Feeding of Infants with CHD Child Feeding Status control: The optimal

state for feeding is an awake, alert, or active state

Note infant's state before, during, and after feeds. If at any point the infant is not in an appropriate state, note if infant can be brought into an appropriate state. Note what techniques are successful and how much assistance the infant needs to maintain appropriate state for feeding.

Detect Cute of feeding: reinforce appropriate cute, recognize negative and stress cute, respiratory distress, heart rate. Environmental, physical, psychological influence factors. Operating Feeding technique: Physiologic adjustment: heart rate, respiratory rate, oxygen saturation, swallowing, sucking. Nutrient supplying: breast feeding, tube feeding, bottle feeding, caloric calculating.
o o o o o o o o

Is this infant's fluid intake adequate to meet fluid needs? Is this infant receiving breastmilk or an appropriate formula? Is this infant offered appropriate foods? Is this infant receiving appropriate vitamin-mineral supplements? Is the diet developmentally appropriate? Is the infant receiving adequate energy? Is the infant receiving adequate nutrients (iron, calcium and vitamin D)? For more information, see the section on nutritional intake.

Interaction behavior

One systematic method for observing infant/caregiver interactions during feeding has been developed by Barnard et al. In the assessment tool devised by this group Caregiver and Infant Responsibilities during feeding are described as follows: Caregiver Responsibilities:

Recognize and respond to the infant's cues and respond in a contingent manner Sooth or quiet a distressed infant Demonstrate warmth and affection toward infant and communicate a positive feeling tone Foster cognitive growth through touch, movement, and talking Delay stimulating or responding until the infant signals readiness

Feeding Observation
o o o o

Is the infant positioned correctly for feeding? Does the infant have effective nippling skills? Can the infant coordinate suck-swallow-breathe? Does the infant appear to choke, gag, regurgitate, have apnea/bradycardia/cyanosis or have other signs of respiratory distress with feeding? Does the caregiver/infant interaction appear appropriate? Does infant show appropriate cues for hunger and satiety? Is the length of feeding appropriate? Is the volume of feeding adequate? Are there environmental distractions that cause stress during feeding?

o o o o o

Medical Factors Do any of the following impact the nutritional or feeding status of this infant?
o

Chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD)

2

o o o o o o o o

Short gut or other malabsorptive conditions Reflux (GER) Neurological impairment Motor problems Cardiac conditions Renal conditions Hepatic conditions Medications

Other Risk Factors

o o o o

Small for gestational age On TPN more than 4 weeks during early hospitalization? Anemia Osteopenia

Theory of Focused Energy Expenditure during Feeding of Infants with CHD

Appropriate Feeding Caregiver Caregivers Knowledge of Energy Expenditure Caregivers Expectations

Perception of Elements in Current Situation Comprehension of Current Situation Projection of Future Status

Intake Calorie Growth and Developme nt

Awareness Child Energy Status

Decision

Energy adjustment

Appropriate Energy Expenditure

Caregivers Experiences Caregivers Knowledge of Energy of Children with CHD Caregivers Skills of Energy of Children with CHD Caregivers Expectations of Energy of Children with CHD

Appropriate Feeding Caregiver Awareness Child Energy Status Decision Making Calorie Intake Adjust Perception of Elements in Current Comprehension of Current Situation Projection of Future Status Energy Expenditure Appropriate Energy Growth and Development

Training Intervention