NUTRITION SYMPOSIUM Atlanta,Georgia OCTOBER 24-25, 2014 PROGRAM 1 Table of Contents GENERAL INFORMATION ............................................................................................................ 3 MALNUTRITION ......................................................................................................................... 8 GLUTEN‐FREE DIETS FOR THE NON‐CELIAC PATIENT ................................................................... 24 FIBER IN HEALTH AND DISEASE .................................................................................................. 38 GROWTH CHARTS ...................................................................................................................... 44 NUTRITION OF VERY LOW BIRTH WEIGHT INFANTS .................................................................... 55 BREAKOUT SESSIONS FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES) ....................................... 65 MICRONUTRIENT INTERPRETATION ............................................................................... 72 PEDIATRIC FEEDING DISORDERS: ASSESSING TYPICAL DIETARY FLUCTUATIONS VS. CHRONIC/SEVERE FEEDING PROBLEMS .......................................................................... 87 INTESTINAL FAILURE: MEDICAL MANAGEMENT ............................................................. 96 President’s Welcome I would like to welcome you all to the second annual NASPGHAN Annual Nutrition Symposium for Dietitians. I am honored to write this letter as the president of the inaugural membership of the Council for Pediatric Nutrition Professionals (CPNP). It has been the dream of NAPSGHAN to create a cohort of dietitians and other nutrition professionals within the organization. After the success of last year’s symposium, it was decided that our time had come. I am thrilled that we have more than 100 members that have joined us in just a few short months. We are so excited about what is in store for this council. In order to make the council a success, we will need your help. We are having a short council meeting during lunch at the symposium. We will review the responses from our member survey and discuss our goals. If you are not a CPNP member, we still encourage you to attend the meeting to see what we are all about. We hope you enjoy this symposium. We have worked to include topics that we felt were relevant to your work, but we would welcome any suggestions that you have. We request that you take some time to provide us your feedback at the end of the symposium as it will help us plan next year’s event. Thank you for being here. Sincerely, Jenny Crouse, MS, RD, CD, CDE President, Council for Pediatric Nutrition Professionals 3 NASPGHAN Nutrition Symposium CPNP Founders Thanks to the following companies for their support of this event and the establishment of the Council of Pediatric Nutrition Professionals Abbott Nutrition Mead Johnson Nestlé Nutrition QOL Medical Schar 4 NASPGHAN/CPNP NUTRITION SYMPOSIUM FOR DIETITIANS FRIDAY OCTOBER 24, 2014 5:30 PM RECEPTION & CELEBRATION OF THE “COUNCIL FOR PEDIATRIC NUTRITION PROFESSIONALS” Rooms 309‐312 SATURDAY OCTOBER 25, 2014 7:30 AM ‐ 8:00 AM BREAKFAST Salon D, 2nd Floor 8:00 AM ‐ 8:15 AM INTRODUCTIONS Salon D, 2nd Floor Praveen Goday MD, Chair, NASPGHAN Nutrition Committee 8:15 AM ‐ 9:05 AM MALNUTRITION Beth Smith RD, CNSC, LDN, Children’s Hospital of Philadelphia Learning objectives: 1. Name three diagnostic indicators of Pediatric Malnutrition 2. Explain the advantages of using z scores in identifying malnutrition 3. Identify one alternative growth measurement used in diagnosing malnutrition 9:05 AM ‐ 9:55 AM GLUTEN‐FREE DIETS FOR THE NON‐CELIAC PATIENT Alessio Fasano MD, Center for Celiac Research and Treatment MassGeneral Hospital for Children Learning objectives: 1. To provide insights on the increased popularity of the gluten free diet 2. To discuss facts and myths about the indication of embracing a gluten free diet 3. To review the controversial indications of the gluten free diet 9:55 AM ‐ 10:10 AM BREAK 10:10 AM ‐ 11:00 AM FIBER IN HEALTH AND DISEASE Asim Maqbool MD, Children’s Hospital of Philadelphia Learning objectives: 1. To provide an overview of dietary fiber 2. To discuss: Why is fiber intake important? How much fiber do we need to eat? What types of fiber do I need to recommend to my patients? Are there dangers associated with fiber intake? 11:00 AM ‐ 11:50 AM GROWTH CHARTS Sarah Vermilyea MS, RD, CSP, LD, CNSC, ChildServe, Johnston, IA Learning objectives: 1. Explain design methodology of commonly utilized growth charts 2. Identify limitations and advantages of each chart 3. Integrate extended knowledge of growth charts into daily practice, patient assessment, and education of peers 11:50 AM ‐ 12:30 PM LUNCH Salon A 12:30 PM ‐ 1:20 PM NUTRITION OF VERY LOW BIRTH WEIGHT INFANTS Salon D, 2nd Floor Berthold Koletzko MD, Dr. von Hauner Children’s Hospital President, ESPGHAN Learning objectives: 1. Appreciate the role of early nutrition and growth in very low birthweight infants (VLBWI) for outcome 2. Recognize current recommendations on early initiation of parenteral nutrition in VLBWI on day 1 3. Know current concepts on initiation of enteral nutrition in VLBWI within 48 h after birth 4. Be informed on standards of practice of VLBWI nutrition 1:20 PM ‐ 2:20 PM HANDS–ON PHYSICAL ASSESSMENT 1. Length/height/knee height Room 308 2. Triceps skinfold, mid–arm circumference Room 307 3. Circumference–waist and head Room 306 4. Muscle‐grip measurement and assessment of fat/muscle/edema Room 305 5. Subjective global assessment Room 304 2:30 PM ‐ 3:00 PM BREAKOUT SESSION #1 (PICK FROM 4 TOPICS BELOW) 3:00 PM ‐ 3:30 PM BREAKOUT SESSION #2 (PICK FROM 4 TOPICS BELOW) 3:30 PM ‐ 4:00 PM BREAKOUT SESSION #3 (PICK FROM 4 TOPICS BELOW) SESSION CHOICES 1. FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES) Room 301 Karen Freedle MD and Alexia Beauregard MS, RD, LD, Children’s Healthcare of Atlanta Learning objectives: 1. Participants will be able to identify how FPIES is diagnosed 2. Participants will be able to identify the most common trigger foods 3. Participants will be able gain a better understanding of the elimination diet and how to make it nutritionally complete 2. MICRONUTRIENT INTERPRETATION Room 302 David Suskind MD, Seattle Children’s Hospital Learning objectives: 1. To describe the clinical signs, symptoms and laboratory findings in deficiencies of the fat soluble vitamins A, D, E, and K. 2. To describe the clinical signs, symptoms and laboratory findings in deficiencies of the water soluble B vitamins and C 3. PEDIATRIC FEEDING DISORDERS: ASSESSING TYPICAL DIETARY FLUCTUATIONS VS. CHRONIC/SEVERE FEEDING PROBLEMS Room 303 William Sharp PhD and Rashelle Berry MPH, MS, RD, CSP, The Marcus Autism Center, Children’s Healthcare of Atlanta Learning objectives: 1. Define pediatric feeding disorders and discuss the different types of feeding disorders 2. Compare feeding disorders and typical dietary fluctuations 3. Discuss the nutrition issues associated with feeding disorders and ASD 4. INTESTINAL FAILURE: MEDICAL MANAGEMENT Room 304 Conrad Cole MD, Cincinnati Children’s Hospital Medical Center Learning objectives: 1. Defining Intestinal failure 2. Update on changing epidemiology 3. Review principles of management for both parenteral and enteral nutrition The New Definition of Pediatric Malnutrition in Clinical Practice Beth Smith, RD, CNSC, LDN NASPGHAN Nutrition Symposium October2014 Learning Objectives 1. Name three diagnostic indicators of pediatric malnutrition 2. Explain the advantages of using z scores in identifying malnutrition 3. Identify one alternative growth measurement validated for the diagnosis of pediatric malnutrition Goals of Malnutrition Classification 1. Define the term “Malnutrition” 2. Identification of standardized diagnostic and documentation criteria 8 Problem: Who is “Malnourished”? Two “Categories” of Malnutrition Pediatric Malnutrition in the US Undernutrition Overweight/ Obese - 14% of children/ adolescents - 17% of children/ adolescents - Hospitalization - Excessive energy - Chronic Illness imbalance - Special Needs Grover, 2009; US Department HHS, 2007 Ogden, 2010 9 Defining Undernutrition Step One: Determining a Realistic Approach to the Defining Characteristics EQUAL Standards for Assessment 10
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