1. Margaret McGough KIN 583 Nutrition & Students with Disabilities The Developing Child

2. “Typical” diet provides all nutrients, minerals, vitamins needed for normal growth & development

3. In Children with Disabilities, the “Typical” Diet May Not Be the Case… Difficulty ingesting food Food selectivity Hyperphagia – pathological eating Obese due to inactivity

4. What is the Child’s Environment Like? Food selection Preparation Finances Culture Obesity – family problem

5. Disability or Not, There are Nutritional Struggles with Children! Children without disabilitiesChildren with disabilities Over/underweight Refusing to eat, drink Fighting for control at mealtime Over/underweight Refusing to eat, drink Fighting for control at mealtime Oral motor skills Medical problems

6. A Closer Look at Nutritional Issues in Children with Disabilities Obesity o Increasing worldwide o What is the ideal way to assess risks of obesity in children? o BMI, but may not apply (scoliosis and height) Undernutrition o Increased energy needs in children who are born prematurely, acutely ill, recovering from surgery, medication side effects

7. Nutritional Issues Cont’d Stature o Extra calories won’t “normalize” growth  Down syndrome, turner syndrome, FAS, microdeletion syndromes, etc. o Providing extra calories may result in obesity o In certain disabilities, it’s not that the child is truly undernourished Disability limits eating o Child may not want to eat o May have physical difficulties

8. Comprehensive Care for Children with Disabilities

9. Medical Nutritional Therapy What is it? Manipulation of nutrients and dietary components to affect a disease or condition Idea: Improve child’s health and nutritional status Promote family enjoyment of child at mealtimes

10. MNT: Nutritional Assessment answers 3 questions: 1. Is child being fed a diet that meets his/her age, gender, and condition? 2. Is child growing as expected for his/her age, gender, and condition? 3. Is there a feeding or eating problem?

11. Nutritional Care Plan Recommendations Monitors follow up Addresses the role of food in family (culture, patterns) JUST A FEW of the sample activities in a NCP:  Demonstrate how to determine portion sizes  Select foods to address food texture (avoid choking)  Monitor planned weight gain/loss/catch up

12. What About the Child who Cannot Eat? Enternal feeding (gastrostomy: feeding directly into stomach) complications involved!  Cerebral Palsy, Tay-Sachs Disease, uncontrolled seizures Parenteral feeding: when feeding has to bypass GI tract (nutrients directly into bloodstream) hospital setting Nutritional Support Formulas (food replacements, supplements)

13. Concerns Food Allergies – increase in concern between types of food allergies and chronic illness and disabilities Ex: lactose and gluten free restrictions to treat individuals with disabilities, hypoallergenic infant formulas Constipation Ex: whole wheat instead of white, apple with peel instead of juice *laxatives, daily doses Celiac Disease – sensitivity to gluten  ASD, down syndrome, Turner syndrome, Williams syndrome

14. Concerns Cont’d Dietary Self Restriction – food refusal, selectivity, oral motor motor delay, dysphagia (Color, texture, temperature) OVER 60% OF CHILDREN WITH ASD ARE SELECTIVE EATERS *Vitamins, adding new foods one at a time

15. Just A Few Exs: Disability/DiseaseIssue/Problem/Concern Cerebral Palsy Autism Prader Willi Spina Bifida, Down Syndrome  Ingesting food  Food selectivity  Hyperphagia  Obesity

16. Strategies for Teachers Get to know your students Develop report with parents Give ideas and suggestions for at home Fact Sheets – Handouts – Newsletters – Guest Speakers – Food Days Incorporate nutrition in everyday teaching TEACH that we are all different! COMPREHENSIVE!!!!! Discuss and share these issues and concerns! WHAT ELSE CAN WE DO?