Nutritional Concerns when Managing Pediatric Patients with Functional Abdominal Pain.........

280 Pages·2016·7.16 MB·English

Table of Contents
Pediatric Liver Transplant: An Overview ...........................................................................................................13
Jerome Menendez DNP, MSN Carolinas HealthCare System
Assessment and Management of Barriers to Adherence in Liver Transplant Recipients .................................26
Jamie Ryan PhD, Children’s Mercy, Kansas City
Nutrition in Liver Transplant: A Balancing Act ..................................................................................................36
Kathryn Chambers RD, The Hospital for SickKids Toronto
Manifestations of Gastrointestinal Issues in Cystic Fibrosis ..............................................................................43
Veronique Morinville MD, Montreal Children’s Hospital
GI Nursing Considerations for the Cystic Fibrosis Patient
Sophie Vallee-Smejda RN, Montreal Children’s Hospital
CF Nutritional Managements: Nuts and Bolts
Donna Drury RD, Montreal Children’s Hospital
Psychosocial support for GI symptoms in Patients with CF ...............................................................................71
Brandi Whitaker PhD Arkansas Children’s Hospital
Advances in the Evaluation and Treatment of Functional Abdominal Pain .....................................................78
Samuel Nurko MD, MPH and Elizabeth Burch MSN, CPNP Boston Children’s Hospital
Nutritional Concerns when Managing Pediatric Patients with Functional Abdominal Pain..............................96
Janet Iurilli RD, Phoenix Children’s Hospital
Promoting Resilience in Youth with Functional Gastrointestinal Disorders ......................................................107
Kari Baber PhD Children’s Hospital of Philadelphia
Building an Intestinal Failure Program: NIFYTy Lessons ....................................................................................114
Abigail Martin MD AI DuPont Hospital for Children
Nutritional Assessment in Children with Intestinal Failure ..............................................................................124
Nicole Fragale MPH, RD, CSP, LN, AI DuPont Hospital for Children
Management of Pediatric Intestinal Failure ......................................................................................................135
Margy Miccolis APN, AI DuPont Hospital for Children
Psychosocial Risk and Patient/Caregiver Quality of Life within the Context of Pediatric Intestinal Failure Rehab
Rebecca Johnson PhD ABPP, Children’s Mercy, Kansas City
Update on GI Pharmacology ..............................................................................................................................150
Kathleen M. Gura PharmD, BCNSP, FASHP, FPPAG, FASPEN, Boston Children’s Hospital
IBD, Sexuality and Pregnancy ............................................................................................................................183
Nancy McGreal MD, Duke University Medical Center
Comprehensive Care Considerations in Pediatric Inflammatory Bowel Disease ...............................................191
Amy Donegan MS, APN, Nationwide Children’s Hospital
Sex, Drugs and Rock ‘n’ Roll: Health-Risk Behavior Screening for Adolescent IBD Patients..............................202
Rose Schroedl PhD, Nationwide Children’s Hospital
Tube Wars: A Long Time Ago in a Galaxy Far Away There Was One .................................................................209
Millie Boettcher APN, Children’s Hospital of Philadelphia
Intractable Constipation ....................................................................................................................................224
John T. Boyle MD, Children’s Hospital of Philadelphia
Gastroparesis .....................................................................................................................................................234
Jose Garza MD, Children’s Center for Digestive Healthcare, Children’s Healthcare of Atlanta
The Role of the APN in an Interdisciplinary Feeding Team ...............................................................................258
Robyn Robinson APN, CHOC Children's Specialists
Behavioral Aspects of Feeding Problems............................................................................................................266
Maria Ramsay PhD, Montreal Children’s Hospital
Beyond Vitamins: Managing Nutritional Risk in the Low Appetite Child...........................................................273
Abigail Brodovitch P.Dt. Montreal Children’s Hospital
Letter from the President
Dear APGNN Meeting Participant:
Welcome to the 25th APGNN Annual Meeting, taking place during the World Congress of Pediatric
Gastroenterology, Hepatology and Nutrition in Montreal, Quebec. Maureen Egan, our current Program
Chair, and her committee members have planned a dynamic and informative conference. We hope you
find the program invaluable to your ongoing education. Upon completion of the conference, please take
time to complete the course evaluation. Your feedback is an integral part of ensuring that our meetings
are always of high quality and meeting the unique needs of our members. We also appreciate your topic
suggestions or any other ideas you may have to help our organization evolve and flourish.
In lieu of a keynote speaker this year, you will hear brief updates from the current presidents/chairs of
our physician partner’s organization, NASPGHAN (North American Society of Pediatric Gastroenterology,
Hepatology, and Nutrition); CPNP (Certified Pediatric Nutrition Professionals); and the newly formed
PCG (Psychology Collaborative Group). We hope you find the multidisciplinary module format engaging
will allow you to tailor your experience to your personal and professional interests. All meeting
participants can also attend any of the NASPGHAN and CPNP lectures that are of interest to you.
The Annual Business Meeting will be held at 8:00 on Saturday October 8th. Please make every effort to
attend as the Annual Report will be presented at that time and we will be introducing you to your new
board members. We hope to see many of you stick around for committee meetings on Saturday evening
from 5:15pm-5:45pm. We are always looking to learn from our members and to collaborate on projects
of interest that will ultimately enhance the membership experience. We are sure you will find at least
one APGNN committee that interests you. All levels of knowledge and expertise are welcome. This is a
great way to become involved in APGNN. Our annual APGNN Social Event will be Friday evening.
If you are not an APGNN member, please consider joining. Information about our organization as well as
membership applications can be found at the APGNN Membership booth in the exhibit hall and on our
website www.apgnn.org.
Lastly, a special thank you to the NASPGHAN staff: Margaret Stallings, Kim Rose, Donna
Murphy. We acknowledge the gift of your time and energy, and publicly want to recognize our gratitude
for their assistance.
Best wishes,
Ryan Shonce, FNP-C
Board of Directors 
President  Media 
Ryan Shonce, RN, MSN, FNP‐C  Amy Donegan RN, MS, APN 
Levine Children's Hospital  Pediatric Gastroenterology 
Pediatric Gastroenterology, Hepatology and  Nationwide Children's Hospital 
Nutrition  700 Children's Drive 
1001 Blythe Blvd MCP Suite 200 F  Columbus, Ohio 43205 
Charlotte, North Carolina 28203  Tel: (614)‐722‐3402 
Fax:(704)381‐6851  Email: [email protected] 
Phone:(704)381‐8898 
Email: [email protected]  Patient and Family Education 
Pamela Morgan, RN, BSN 
Past President 
Diane Kocovsky, APRN  Program Chair 
Boys Town National Research Hospital  Maureen Egan, MSN, PNP‐BC 
Omaha, NE 68144  Nemours Alfred I. duPont Hospital for Children 
Work: 402‐778‐6851  Division of Gastroenterology, Hepatology, and 
Fax: 402‐778‐6826  Nutrition 
Email: [email protected]  1600 Rockland Road 
Wilmington, DE 19803 
Secretary /Treasurer  Tel: (302) 651‐5928 
Rosemary Pauley‐Hunter, APRN, MS  Fax: (302) 651‐5838 
14080 Boystown Hospital Road  Email: [email protected] 
Boys Town, NE 68010 
Phone: 402‐778‐6890  Clinical Practice Committee 
Fax: 402‐778‐6807  Kerry Zabriskie‐Reed, RN MS CPNP 
Email: rosemary.pauley‐[email protected]  Pediatric Nurse Practitioner 
Digestive Health Institute 
Membership  Children's Hospital Colorado 
Robyn Robinson, CPNP, MSN  13123 East 16th Avenue, B290 
Pediatric Gastroenterology and Nutrition  Aurora, CO 80045 
CHOC Children's Speciatlists  Tel: (720) 777‐6669 
1201 W. LaVeta Avenue  Fax: (720) 777‐7277 
Orange, CA 92868  Email: [email protected] 
Tel: 714‐509‐4099 
Email: [email protected]  Research and Publications 
Goldie Markowitz, MSN, CRNP 
The Children's Hospital of Philadelphia 
34th and Civic Center Blvd. 
Philadelphia, PA 
Tel: (267) 426‐7899 
Email: markowitzg@ email.chop.edu
The Mission of APGNN  
The formation and ongoing mission of the Association of Pediatric Gastroenterology and 
Nutrition Nurses is to:  
Promote the professional development and recognition of pediatric nurses as experts in their field  
Promote excellence in the care of families with children with gastroenterology and nutritional illnesses  
Our Goals  
The APGNN was founded upon and recognizes the following organizational goals:  
Promote nursing research and publication of findings  
Promote education for patients, families, nurses, allied health professionals, and physicians  
Establish standards of practice  
Create a Pediatric Gastroenterology/Nutrition Network  
Support role development through attendance and participation in conferences and development of 
teaching materials  
The APGNN web site is: 
www.apgnn.org 
A membership application is also available through this web site. 
Please be patient as this site continues to evolve. 
For changes in your membership database go through the 
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition 
NASPGHAN web site: 
www.naspghan.org 
Helpful practice guidelines and patient and family brochures are also accessible through this website
2016 APGNN Educational Conference 
Supported in part through restricted educational grants from:
APGNN Annual Meeting 
October 7 – 8, 2016 
Friday, October 7, 2016 
7:30‐8:00   Registration 
8:00‐8:45   Welcome  
James Heubi, MD President Elect, NASPGHAN 
Ryan Shonce, APN, MSN President, The Association of Pediatric Gastroenterology and 
Nutrition Nurses  
Jennifer Crouse, RD, President, Council of Pediatric Nutrition Professionals  
Amanda Deacy, Psychology Collaborative Group  
8:45‐10:15   Liver Transplant: A Multi‐Disciplinary Approach 
8:45‐9:15 Pediatric Liver Transplant: An Overview   
Jerome Menendez DNP, MSN Carolinas HealthCare System  
Learning Objectives: 
 Identify indication for pediatric liver transplant
 Recognize potential complication following liver transplant
 Discuss the need for post‐transplant immune suppression therapy
9:15‐9:45 Assessment and Management of Barriers to Adherence in Liver Transplant 
Recipients  
Jamie Ryan PhD, Children’s Mercy, Kansas City 
Learning Objectives: 
 List 3 or more barriers to effective self‐management in pediatric transplant recipients
 Describe at least 2 benefits of screening for adherence barriers
 Identify 2 or more strategies for addressing adherence barriers in clinical practice.
9:45‐10:15 Nutrition in Liver Transplant: A Balancing Act  
Kathryn Chambers RD, The Hospital for SickKids Toronto 
Learning Objectives: 
 Discuss main nutritional concern in patient pre‐liver transplant.  Explain a few of the
nutritional strategies to optimize nutritional status in liver patient pre transplant.  
Demonstrate the importance of weekly anthropometric collection pre transplant. 
 Emphasize the importance of balanced healthy nutritional post transplant
10:15‐10:30   Break 
10:30‐12:30   Cystic Fibrosis: A Team Approach 
10: 30‐11:00 Manifestations of Gastrointestinal Issues in Cystic Fibrosis 
Veronique Morinville MD, Montreal Children’s Hospital 
11:00‐11:30 GI Nursing Considerations for the Cystic Fibrosis Patient 
Sophie Vallee‐Smejda RN, Montreal Children’s Hospital
11:30‐12:00 CF Nutritional Management: Nuts and Bolts  
Donna Drury RD, Montreal Children’s Hospital 
Learning Objectives: 
 Recognize the various manifestations of cystic fibrosis involving the gastrointestinal system
 Appreciate how a team approach can help optimize digestive and overall health in a cystic
fibrosis child
12:00‐12:30 Psychosocial support for GI symptoms in Patients with CF 
Brandi Whitaker, PhD Arkansas Children’s Hospital 
Learning Objectives: 
 Overview of common GI issues in patients with CF
 Behavioral/parenting strategies to meet daily calorie needs
 Adherence for taking enzymes
 Non‐pharmacological pain management techniques
12:30‐1:30   Lunch and Poster session 
1:30‐3:00   Functional GI disorders: A Multi‐Disciplinary Approach 
1:30‐2:00   Advances in the Evaluation and Treatment of Functional Abdominal Pain  
Samuel Nurko MD, MPH and Elizabeth Burch MSN, CPNP Boston Children’s Hospital 
Learning Objectives: 
 Understand the pathophysiology of functional abdominal pain
 Understand the multi‐disciplinary treatment of functional abdominal pain
 Understand the different treatment modalities to be used
2:00‐2:30   Nutritional Concerns when Managing Pediatric Patients with Functional Abdominal Pain 
Janet Iurilli RD, Phoenix Children’s Hospital 
Learning Objectives: 
 Understand the current nutritional approaches in managing functional abdominal pain in
pediatric patients 
 Recognize the potential nutritional deficiencies that can be a result of a restricted or
elimination diet in pediatric patients (specifically a low FODMAP diet) 
 Appreciate the essential role of the dietitian to ensure nutritional adequacy for growth in
pediatric patients 
2:30‐3:00 Promoting Resilience in Youth with Functional Gastrointestinal Disorders
Kari Baber PhD, Children’s Hospital of Philadelphia 
Learning Objectives: 
 Identify factor associated with resilience in youths with functional GI disorders.
 Describe the utility of psychological intervention in promoting adaptive functioning and
resilience in youth with functional GI disorders.
3:00‐3:15   Break 
3:15‐5:15  Intestinal Rehabilitation a Team Approach  
3:15‐3:45 Building an Intestinal Failure Program: NIFYTy Lessons 
Abigail Martin MD, AI DuPont Hospital for Children  
Learning Objectives: 
 List intestinal failure team members and discuss their role in caring for these patients.
 Describe at least 2 examples of difficulties that may be encountered when trying to build an
intestinal failure program
3:45‐4: 15 Nutritional Assessment in Children with Intestinal Failure  
Nicole Fragale RD, AI DuPont Hospital for Children 
Learning Objectives: 
 To demonstrate the ability to conduct a nutrition assessment in a child with intestinal failure
 To discuss best practices for feeding patient with intestinal failure
 To identify common nutrient deficiencies in patient with intestinal failure
4:15‐4:45   Management of Pediatric Intestinal Failure  
Margy Miccolis APN, AI DuPont Hospital for Children  
Learning Objectives: 
 Describe the definition and etiology of pediatric intestinal failure
 Explain the pathophysiology of pediatric intestinal failure
 Describe techniques for management for pediatric intestinal failure that improve outcomes
4:45‐5:15   Psychosocial Risk and Patient/Caregiver Quality of Life within the Context of Pediatric 
Intestinal Failure Rehab  
Rebecca Johnson PhD ABPP, Children’s Mercy, Kansas City 
Learning Objectives: 
 Describe child‐ and family‐related stressors common to pediatric intestinal failure
 Describe how pediatric intestinal failure impacts child/caregiver/family quality of life
 Identify how psychosocial risk factors are related to treatment outcomes and how a team
approach can ameliorate risk
5:15   Wrap up 
5:15‐5:45   Committee Meetings 
6:00    APGNN Social Event