Presentation on theme: "Nutrition Management in Children with Special Health Care Needs (CSHCN) Jackie Maurer MS, RD."— Presentation transcript:
1 Nutrition Management in Children with Special Health Care Needs (CSHCN) Jackie Maurer MS, RD
2 Children with Special Health Care Needs (CSHCN) IntroductionChildren with Special Health Care Needs (CSHCN)Definition:Children with congenital or acquired conditions affecting physical/cognitive growth and development and who require more than the usual pediatric health care; also refers to children who have developmental disabilities, chronic conditions, or health related problems as well as those who are at risk for these conditions(JADA. 1995;95:809)
4 Objectives Understand basic measures of growth & development Acquire fundamental skills in global assessment techniquesAppreciate general medical nutrition therapy for lung diseasesExperience oral supplements that promote nutrition status
5 GROWTH & DEVELOPMENT Weight Growth chart Technique Primary indicator for over-/under- nutritionGrowth chartReflects growth patternTechniqueNeeds to be consistent and accurate (ie no shoes, no diapers)
6 GROWTH & DEVELOPMENT Height Technique: Has slower response to nutrition changesMay indicate chronic under-nutrition if measurements continually trend downTechnique:0-36 months - Recumbent length2-20 years Standing height
7 GROWTH & DEVELOPMENT Head Circumference Last indicator to be affected by undernutrition< 3 yr oldPossible nutritional insult with downtrends, accompanied by decreases in weight and height> 3 yr oldDecreases are generally not nutrition-relatedFOR MORE INFO...See CDC web site, to download charts.
8 ASSESSMENT SKILLS Subjective Global Assessment (SGA) Nutrition History Simple technique for assessing nutritional statusEvaluates body fat and muscle storesInvolves visual review of physical bodyMay be applied by any healthcare workerNutrition HistoryInterview reveals dietary habitsQuick tool for assessing one’s ability to meet, fail, or exceed nutritional needs
9 SGA METHOD Muscle Stores Fat Stores Temple Eye fat pad Clavicle ShoulderScapulaUpper joint areaInterosseus areaFat StoresEye fat padCheek padTricep pinchREFERENCE:Detsky, A, et al. Journal of Enteral and Parenteral Nutrition. 11:8, Jan/Feb, 1987.
11 DIET HISTORY METHOD What is the home life/meal pattern? How much is consumed?Food allergies or intolerances?Who is present at mealtimes?Is the child interested in eating?Any problems with chewing or swallowing? Gagging or choking?Are there any foods or textures that the child has difficulty with?Does the child eat non-foods ?Any weight change perceived?What religious or cultural backgrounds are present?
12 ASTHMA & NUTRITION Malnutrition of excess Cycle of inactivitySteroid inducedPotential food allergy triggersNutrient Medication Interactions
14 ASTHMA & NUTRITION General guidelines 1. No skipping meals (Eat min 3 x day)2. Maintain a “normal”, balanced dietand choose sensible portions3. Lose weight, if needed4. Avoid excessive salt, fat, sweets5. Increase dairy or supplements6. Exercise daily
15 ASTHMA & EXERCISE Tips 20 minutes total 3 times per week Check local pollen, mold, spore levels.Lengthen the time between breaks while conditioning occurs.Wear scarves over mouth and nose in winter to keep heat & moisture in lungs.Warm-up to lessen chances of EIB.Do pursed lip breathing when medication is not readily available.20 minutes total3 times per weekAerobic activityAvoid asthma triggersMay lessen Exercise Induced Asthma (EIB)
16 ASTHMA & FOOD ALLERGIES Food allergies - usually NOT common triggerOccurs in <5% of asthmaticsDifficult to diagnoseSkin tests, Blood test (RAST)Food diary, elimination dietSymptomshives, itching, eczema, sneezing, coughing, swelling of throat, nasal stuffiness, vomiting, diarrhea, cramping, collapse and sometimes death
17 POTENTIAL FOOD ALLERGENS Milk and dairy productsNo link to increasedmucus production or bronchoconstrictionWheatSoyEggsPeanutsTree nutsFish and shellfish ChocolateCornTomatoesCitrus fruitsOther grainsBeefChickenSulfite-containing
18 ASTHMA & FOOD AIDS? Conflicting evidence that foods can prevent asthma Of three scientific papers on asthma & omega-3 fatty acids:1 showed favorable results1 showed no results1 showed negative results w/ worse asthma
19 BPD: Bronchopulmonary Dysplasia Nutrition Concerns?Prenatal undernutrition, premature growth issuesIncreased caloric intake to maintain normal or catch-up growthSuboptimal intake due to increased effort of breathing during eating and appetite suppressing medicationsDelayed development of oral feeding skills
20 BPD & NUTRITION 1. Concentrate infant formula Nutrition Therapy 2. Initiate adjuvant nutrition via enteral route as indicated3. Assess feeding skills4. Occupational therapy/feeding specialist referral
22 CYSTIC FIBROSIS & NUTRITION Multifactorial risks for malnutritionIntakeDecreased appetiteDecreased volume consumedPhysical/mechanical/mental inability to meet nutritional needs orallyOutputIncreased energy output to meet cost of breathing and coughing, higher during pulmonary exacerbations.Malabsorption
23 CF & NUTRITION Basic Nutrition Guidelines Oral Supplementation 1. High calorie diet (moderate fat)2. Snacks 2-3 times/day3. Salt repletion, especially with sweating4. Pancreatic enzymesFat soluble vitamins in water miscible form (ADEK)Oral SupplementationCalorically denseSample tasting
24 Childhood Obesity1980 and 1994, children and adolescents considered to be overweight (BMI-for-age > 95th percentile) increased by 100% in the United States. Thirteen percent of children age 6-11 and 14 percent of adolescents age are estimated to be overweight
25 Childhood Obesity DEFINITION: BMI Percentiles (2 to 20 y.o.) 85-95th %ile = at risk>95th%ile OverweightAssociated risks:Hyperlipidemia, glucose intolerance, hepatic steatosis, cholelithiasis, early maturation. hypertension, sleep apnea