Presentation on theme: "Nutrition Management in Children with Special Health Care Needs (CSHCN) Jackie Maurer MS, RD."— Presentation transcript:
Nutrition Management in Children with Special Health Care Needs (CSHCN) Jackie Maurer MS, RD
Introduction Children 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)
Introduction Nutrition Intervention Critical aspect Critical aspect Interdisciplinary Interdisciplinary Preventive and therapeutic Preventive and therapeutic Family centered Family centered Community based Community based Culturally competent Culturally competent
Objectives Understand basic measures of growth & development Understand basic measures of growth & development Acquire fundamental skills in global assessment techniques Acquire fundamental skills in global assessment techniques Appreciate general medical nutrition therapy for lung diseases Appreciate general medical nutrition therapy for lung diseases Experience oral supplements that promote nutrition status Experience oral supplements that promote nutrition status
GROWTH & DEVELOPMENT Weight Weight –Primary indicator for over- /under- nutrition Growth chart Growth chart –Reflects growth pattern Technique Technique –Needs to be consistent and accurate (ie no shoes, no diapers)
GROWTH & DEVELOPMENT Height Height –Has slower response to nutrition changes –May indicate chronic under-nutrition if measurements continually trend down Technique: Technique: 0-36 months - Recumbent length 0-36 months - Recumbent length 2-20 years - Standing height 2-20 years - Standing height
GROWTH & DEVELOPMENT Head Circumference Head Circumference –Last indicator to be affected by undernutrition –< 3 yr old Possible nutritional insult with downtrends, accompanied by decreases in weight and height –> 3 yr old Decreases are generally not nutrition-related See CDC web site, to download charts. FOR MORE INFO...
ASSESSMENT SKILLS Subjective Global Assessment (SGA) Subjective Global Assessment (SGA) –Simple technique for assessing nutritional status –Evaluates body fat and muscle stores –Involves visual review of physical body –May be applied by any healthcare worker Nutrition History Nutrition History –Interview reveals dietary habits –Quick tool for assessing one’s ability to meet, fail, or exceed nutritional needs
SGA METHOD Fat Stores Fat Stores –Eye fat pad –Cheek pad –Tricep pinch Muscle Stores Muscle Stores –Temple –Clavicle –Shoulder –Scapula –Upper joint area –Interosseus area Detsky, A, et al. Journal of Enteral and Parenteral Nutrition. 11:8, Jan/Feb, REFERENCE:
DIET HISTORY METHOD What is the home life/meal pattern? What is the home life/meal pattern? How much is consumed? How much is consumed? Food allergies or intolerances? Food allergies or intolerances? Who is present at mealtimes? Who is present at mealtimes? Is the child interested in eating? Is the child interested in eating? Any problems with chewing or swallowing? Gagging or choking? Any problems with chewing or swallowing? Gagging or choking? Are there any foods or textures that the child has difficulty with? Are there any foods or textures that the child has difficulty with? Does the child eat non-foods ? Does the child eat non-foods ? Any weight change perceived? Any weight change perceived? What religious or cultural backgrounds are present? What religious or cultural backgrounds are present?
ASTHMA & NUTRITION Malnutrition of excess Malnutrition of excess –Cycle of inactivity –Steroid induced Potential food allergy triggers Potential food allergy triggers Nutrient Medication Interactions Nutrient Medication Interactions
ASTHMA & NUTRITION General guidelines General guidelines 1. No skipping meals (Eat min 3 x day) 2. Maintain a “normal”, balanced diet and choose sensible portions 3. Lose weight, if needed 4. Avoid excessive salt, fat, sweets 5. Increase dairy or supplements 6. Exercise daily
ASTHMA & EXERCISE 20 minutes total 20 minutes total 3 times per week 3 times per week Aerobic activity Aerobic activity Avoid asthma triggers Avoid asthma triggers May lessen Exercise Induced Asthma (EIB) May lessen Exercise Induced Asthma (EIB) Tips 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.
ASTHMA & FOOD ALLERGIES Food allergies - usually NOT common trigger Food allergies - usually NOT common trigger Occurs in <5% of asthmatics Occurs in <5% of asthmatics Difficult to diagnose Difficult to diagnose –Skin tests, Blood test (RAST) –Food diary, elimination diet Symptoms Symptoms –hives, itching, eczema, sneezing, coughing, swelling of throat, nasal stuffiness, vomiting, diarrhea, cramping, collapse and sometimes death
Milk and dairy products Milk and dairy products –No link to increased mucus production or bronchoconstriction Wheat Wheat Soy Soy Eggs Eggs Peanuts Peanuts Tree nuts Tree nuts POTENTIAL FOOD ALLERGENS Fish and shellfish Chocolate Fish and shellfish Chocolate Corn Corn Tomatoes Tomatoes Citrus fruits Citrus fruits Other grains Other grains Beef Beef Chicken Chicken Sulfite-containing Sulfite-containing
ASTHMA & FOOD AIDS? Conflicting evidence that foods can prevent asthma Conflicting evidence that foods can prevent asthma Of three scientific papers on asthma & omega-3 fatty acids: Of three scientific papers on asthma & omega-3 fatty acids: –1 showed favorable results –1 showed no results –1 showed negative results w/ worse asthma
BPD: Bronchopulmonary Dysplasia Nutrition Concerns Nutrition Concerns –?Prenatal undernutrition, premature growth issues –Increased caloric intake to maintain normal or catch-up growth –Suboptimal intake due to increased effort of breathing during eating and appetite suppressing medications –Delayed development of oral feeding skills
BPD & NUTRITION Nutrition Therapy Nutrition Therapy 1. Concentrate infant formula 2. Initiate adjuvant nutrition via enteral route as indicated 3. Assess feeding skills 4. Occupational therapy/feeding specialist referral
BPD & FEEDING SKILLS Feeding Assessment Feeding Assessment –Responses to tactile input irritability, frenzy, drowsy, staring, silent cry –Feeding position –Oral motor control tongue retraction/protrusion, jaw excursion –Physiologic control heart rate –Sucking, swallowing, breathing –Caregiver/infant feeding interactions
CYSTIC FIBROSIS & NUTRITION Multifactorial risks for malnutrition Multifactorial risks for malnutrition –Intake Decreased appetite Decreased volume consumed Physical/mechanical/mental inability to meet nutritional needs orally –Output Increased energy output to meet cost of breathing and coughing, higher during pulmonary exacerbations. Malabsorption
CF & NUTRITION Basic Nutrition Guidelines Basic Nutrition Guidelines 1. High calorie diet (moderate fat) 2. Snacks 2-3 times/day 3. Salt repletion, especially with sweating 4. Pancreatic enzymes 5.Fat soluble vitamins in water miscible form (ADEK) Oral Supplementation Oral Supplementation –Calorically dense –Sample tasting
DEFINITION: BMI Percentiles (2 to 20 y.o.) DEFINITION: BMI Percentiles (2 to 20 y.o.) –85-95 th %ile = at risk –>95 th %ile Overweight Associated risks: Associated risks: –Hyperlipidemia, glucose intolerance, hepatic steatosis, cholelithiasis, early maturation. hypertension, sleep apnea
Childhood Obesity - Factors Familial influence Familial influence –Fat parent = fat child –Model: eating & activity Physical Inactivity Physical Inactivity –TV –Cuts in PE class Heredity Heredity –Fatness –regional fat distribution –response to overfeeding