1. Nutrition Through the Life Cycle
Chapter 11 Toddler and Preschooler Nutrition: Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown

2. Who Are Children with Special Health Care Needs?
Criteria for “chronic condition” or “disability” varies from state to state
Estimates range from 5% to 31% of children
~90% of children with disabilities have a nutrition problem

3. Eligibility for Early Intervention Services are Based on:
Developmental delays:
Cognitive, physical, language & speech, psychological, or self-help skills
Physical or mental condition with a high probability of delay
At risk medically or environmentally for substantial delay without services

4. Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions
DRIs are a starting point for setting protein, vitamin and mineral needs
Specific conditions need adjustments
May cause poor appetite & increased caloric needs
May lead to over- or under-weight
Caloric & nutrient recommendations should be customized for each child

5. Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions

6. Growth Assessment
Nutrition assessment should be first step to determine if nutrition services are needed
Assessment answers the following:
Is child’s growth on track?
Is child’s diet adequate?
Are feeding or eating skills age appropriate?
Does diagnosis affect nutritional needs?

7. Growth Assessment
Interpretation of growth charts should consider special health condition
Growth charts specific to some conditions include:
LBW or VLBW
Special head growth chart

8. Nellhaus Head Circumference Growth Chart Plotted for Girl with Rett Syndrome

9. Feeding Problems
Special health care needs cause feeding problems in young children combined with typical feeding issues of the average toddler or preschooler
Examples include:
Low interest in eating
Long mealtimes
Preferring liquids over solids
Food refusals

10. Behavioral Feeding Problems
Mealtime feeding problems are common with toddlers & preschoolers with behavioral & attention disorders
Behavioral disorders that affect nutritional status
Autism
Attention deficit hyperactivity disorder (ADHD)
May be suspected in preschool years but usually treated in the school years

11. Other Feeding Problems
Excessive fluid intake
Child would rather drink than eat
Feeding problems & food safety
Mashed or pureed foods and tubing or devices for feeding may be contaminated or spoilage may occur
Feeding problems from disabilities involving neuro-muscular control

12. Nutrition-Related Conditions
Failure to thrive (FTT)
Toddler diarrhea & celiac disease
Autism
Muscle coordination problems & cerebral palsy
Pulmonary problems
Developmental delay & evaluations

13. Failure to Thrive (FTT)
What is FTT? Inadequate wt or ht gain with growth declines more than 2 growth percentiles
May result from:
Digestive problems
Asthma or breathing problems
Neurological conditions
Pediatric AIDS

14. Failure to Thrive (FTT)

15. Toddler Diarrhea and Celiac Disease
“Toddler diarrhea” typically caused by sucrose & sorbitol content of fruit juices
Celiac disease results in diarrhea & caused by sensitivity to the protein gluten found in wheat & other grains

16. Autism
No scientifically proven diet is recommended for prevention or treatment
Gluten-free & casein-free diets have been recommended via Internet and support groups but not scientifically shown beneficial

17. Muscle Coordination Problems & Cerebral Palsy
Group of disorders characterized by impaired muscle activity & coordination present at birth or developed during early childhood
Spastic quadriplegia: a form of cerebral palsy
Reduced dietary intake results from child easily becoming tired while eating

18. Meal Pattern & Recommended Foods
Meal pattern may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals
Foods recommended are easy to chew and small

19. Meal Pattern & Recommended Foods

20. Pulmonary Problems
Examples of pulmonary (breathing) problems are brochopulmonary dysplasia & asthma
Breathing problems increase nutrient needs, lower interest in eating & can slow growth
Preterm infants at high risk of breathing problems

21. Developmental Delay & Evaluation
Developmental delay may be suspected when:
Specific nutrients are inadequately or excessively consumed
May result from iron deficiency or lead toxicity
Physical growth may be impacted

22. Food Allergies and Intolerance
True food allergies seen in ~2% to 8% of children
Common food allergies include:
Milk
Eggs
Wheat
Peanuts
Walnuts
Soy
Fish

23. Dietary Supplements and Herbal Remedies
Parents should be cautioned about use of supplements and/or herbs to treat various conditions
Often unproven recommendations come from support groups or the Internet

24. Sources of Nutrition Services
State programs
Early intervention programs
Early childhood education programs (IDEA)
Head Start
Early Head Start
WIC
Low birthweight follow up
Child care feeding programs