Food Plans For Wheelchair Bound or Bedridden Children Who Can Eat

Because the majority of children who are wheelchair or bed bound have a difficult time eating, special emphasis must be placed on how the feeding is accomplished. The difficulties determine the strategies and techniques needed, and they in turn, have a tremendous impact on the foods--even for the child who can eat by mouth.

Standard, grocery shelf foodstuffs are the cheapest and simplest means of providing feedings by mouth. Taste and texture can be varied if oral skills are normal or nearly so. Children who can swallow safely and effectively but cannot chew, may be able to receive the same foods in a pureed consistency (just by putting them through a blender). A child who can tolerate solids but not thin liquids can have thickeners added to his or her fluids, to adapt to the consistency the child needs in order to swallow safely. The modified liquids can then be given at the appropriate temperature, while the child is in his or her optimal feeding posture.

Numerous high calorie beverages and puddings are now available to supplement the calories, proteins and nutrients needed when these kids tire and can't finish their meals. Many parents like the convenience and many children like the taste, especially when they are served cold, but other children lose interest in drinking these on a daily basis. A particular product can be chosen based on the patient's need for fiber in regulating bowel movements and the patient's tolerance of the product's components and taste.

However, the products are expensive and often have a high sugar content to make sure the kids like them; and while they have good nutritional value (because they do contain additional nutrients), they either need to be given in quantity or along with other foods in order to meet the child's complete nutritional needs. A similar beverage (for those who do not have problems with milk) can be made by adding a packet of instant breakfast (which is milk based) to an 8 oz glass of milk. When there is little actual food intake and more complete nutritional supplementation is needed, a cost effective blenderized alternative can be made by the caregiver to achieve similar weight gain and improved nutritional status. Pediatric dietitians can combine foods with a milk (or alternative milk base Milk Alternatives Comparison Guide). They can adapt the beverage adding calories, fluid and fiber content, vitamin and mineral requirements, and allergy restrictions to meet a child's special needs. Potentially, these blenderized feedings or "homebrews" are less expensive and offer the caregiver the perception of providing their child "real food" and "hands on care." 

But whether you buy or make the beverage, it's best to use this early in the evening or after a meal, because these drinks can fill the child, and make them less interested in eating their next meal.

Infants With Developmental Feeding Problems

While breast feeding is encouraged for its various benefits, (see Breastfeeding Benefits both Mother AND Baby or Breastfeeding Can Lessen the Risk of Obesity for Babies or Breastfed Babies Test Higher in IQ or any of our other Breastfeeding articles and posts) many of these children have difficulty latching on or sucking at the breast. That actually provides the opportunity to gradually add extra calories and protein in the forms of easily digested carbohydrates, oils and proteins for the child who is not able to consume enough breastmilk alone (see the table below). The choice of which product and the amount should be discussed with the child's doctor or dietitian in order to lessen the potential for problems developing.

Possible High-Calorie Additions For Infants
AdditionCalories per Gram (cal/g)Calories per Tablespoon (cal/tbs)Nutrient Source
Human Milk Fortifier 3.5 per packetWhey, sodium caseinate, corn syrup solids, lactose
Promod Liquid Protein4.718Glycerine,hydrolyzed beef collagen, water, malic acid, citric acid, L tryptophan, potassium sorbate, sodium benzoate
Beneprotein3.617Whey protein isolate(milk) soy lecithin
Formula powder[5-5.2cal/g]40Variable
Non-fat dry milk8.727Milk
Whole milk powder5.330Milk
MCT oil8.2115Medium Chain Triglycerides
Vegetable oil8.9124Variable
Sol Carb3.823Maltodextrin
Polycal4.029Maltodextrin
Duocal4.942Hydrolyzed corn starch, refined vegetable oils, fractionated coconut oil
Additions5.243Sodium caseinate, whey protein
Benecalorie (liquid)7 kcal/ml110High oleic sunflower oil, calcium caseinates, sodium ascorbate, polysorbate, zinc, etc
Rice (or other) infant cereal4.415Rice flour, soy oil, barley malt
Corn syrup2.961Corn syrup, sugar

a20cal/oz infant formula.

Adapted and updated from Cohen SA, Navathe A, Piazza CC: Feeding and Nutrition, in Rubin IL, Crocker AC, Medical Care for Children and Adults with Developmental Disabilities, Second edition, Baltimore: Brookes, 2005.

These additives can be used with infant formulas as well to increase the calories by up to 50% more, while carefully monitoring for intolerance (showing up as vomiting, diarrhea or a rash). The formulas can also be concentrated an additional ten to twenty percent by altering the amount of water that's added to the powdered versions.

It is possible to make the formula in batches, but this needs to be reviewed carefully with your dietitian. Household measures can vary, so you should bring in the containers and measuring cups to check for accuracy.

Increased calorie concentrations of standard 20-kcal/oz infant formulas
 20 kcal/oz22 kcal/oz24 kcal/oz26 kcal/oz
To make an 8 oz bottle    

Powderb

Water to make

4 scoops

8 oz

4½ scoops

8 oz

4¾ scoops

8 oz

5¼ scoops

8 oz

aConcentrations are approximate.

bScoops should be level, not pressed or packed. Scoop sizes vary for each product. Do not switch.

Adapted and updated from Cohen SA, Navathe A, Piazza CC: Feeding and Nutrition, in Rubin IL, Crocker AC, Medical Care for Children and Adults with Developmental Disabilities, Second edition, Baltimore: Brookes, 2005.

Dr. Stan Cohen13 May 2015

Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr. Stan is an internationally recognized expert in Read more

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