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Introduction Discussion of nutrition needs of children with chronic conditions Cystic fibrosis Diabetes mellitus Cerebral palsy Phenylketonuria Behavioral.

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Presentation on theme: "Introduction Discussion of nutrition needs of children with chronic conditions Cystic fibrosis Diabetes mellitus Cerebral palsy Phenylketonuria Behavioral."— Presentation transcript:

1 Chapter 13 Child and Preadolescent Nutrition: Conditions and Interventions

2 Introduction Discussion of nutrition needs of children with chronic conditions Cystic fibrosis Diabetes mellitus Cerebral palsy Phenylketonuria Behavioral disorders

3 “Children Are Children First” What does that mean?
Expectations that children will become more independent in making food choices, assisting with meal preparation, & participating at meal times with other family members apply to children with special health care needs Expectations are the same for all children with or without special needs

4 Nutritional Requirements of Children with Special Health Care Needs
Children with special health care needs vary in nutritional requirements & health needs: Low energy intake with small muscle size High protein, fluid or fiber Increases or decreases in vitamins or minerals Frequent hospitalizations Nutrient & health guidelines may not apply because of health needs

5 Energy Needs Energy needs vary depending on special health care condition Lower calories needed by children with slow growth or decreased muscles such as in Prader-Willi syndrome Increased calories needed as activity increases such as in ADHD or ASD

6 Protein Needs Protein needs vary by condition
Recovery from burns & cystic fibrosis increases protein needs to 150% DRI PKU and other protein-based inborn errors of metabolism require decreased protein Some conditions may require hydrolyzed or specific amino acids

7 Other Nutrients Adequate vitamins & minerals should be provided in a well-balanced diet Conditions that interfere with adequate nutrient intake include: Chewing or other feeding problems Side effects from prescribed medications Food refusals Treatment of condition that includes restriction of certain foods

8 Growth Assessment CDC 2000 growth charts are a good starting place for assessing the growth of any child Adjustments may need to be made for children with some conditions that affect the rate of growth

9 Growth Assessment Long-term health goals less important for children with life-shortening conditions Warning signs for growth problems: Plateau in weight Pattern of weight gain & then loss Failure to regain weight lost during an illness Unexplained/unintentional wt gain

10 Growth Assessment & Interpretation in Children with Chronic Conditions
Factors that affect growth: Age of condition onset May determine if growth charts will be applicable Secondary conditions May interfere with accurate measurements Activity/inactivity level

11 Body Composition and Growth
Health conditions may alter muscle size, bone structure, fat stores Down syndrome results in short stature, low muscle tone, & low weight Cerebral palsy & spina bifida may reduce muscle tone Spina bifida may impact muscles only in the lower extremities

12 Special Growth Charts Growth charts are available for some special conditions (See Table 13.1) Conditions that do not have growth charts include: Juvenile rheumatoid arthritis Cystic fibrosis Rett syndrome Spina bifida Seizures Diabetes

13 Special Growth Charts

14 Nutrition Recommendations
Assess intake to determine if nutrients and energy are adequate Children with special health needs benefit from same dietary recommendations as other children

15 Methods of Meeting Nutritional Requirements
Most children will be able to eat and drink like everyone else Gastrostomy feeding may be required for: Kidney disease Some cancers Severe cerebral palsy Cystic fibrosis

16 Nutritional Supplements and Formula

17 Feeding and Eating Schedule

18 Vitamin and Mineral Supplements for Chronic Conditions
Supplements may be beneficial for conditions to assure adequate intake Conditions that require supplements: Chewing problems need liquid supplements Diabetes or on ketogenic diets should avoid supplements with added CHO PKU should avoid supplements with certain artificial sweeteners Cystic fibrosis requires fat-soluble vitamins Galactosemia (restricts dairy) requires calcium

19 Fluids Conditions that impact fluid status and increase needs include:
Uncontrollable drooling Constipation from neuromuscular disorders Multiple medication use

20 Eating & Feeding Problems in Children with Special Health Care Needs
Eating and feeding problems are diagnosed when children have difficulty with: Accepting foods Chewing them safely Ingesting enough foods and beverages 70% of children with developmental delays have feeding difficulties

21 Eating & Feeding Problems in Children with Special Health Care Needs-Specific Disorders
Cystic fibrosis Diabetes mellitus Seizures Cerebral palsy Phenylketonuria (PKU) Attention deficit hyperactivity disorder (ADHD) Pediatric HIV


23 Cystic fibrosis One of most common lethal genetic conditions
Interferes with lung function Causes decreased absorption nutrients Malabsorption due to lack of pancreatic enzymes

24 Cystic fibrosis Dietary considerations:
Calories & protein increase 2 to 4 fold Enzymes taken with meals to aid in digestion Frequent meals & snacks Fat-soluble vitamin supplements Gastrostomy feeding at night may be needed to boost energy intake

25 Diabetes Mellitus Disorder in insulin & blood glucose regulation
Type 1—virtually no insulin production Type 2—associated with obesity Treatment includes: Timing & composition of meals & snacks Insulin injections—for type 1 Exercise Summer camps for diabetic children

26 Seizures Uncontrolled electrical disturbances in brain
Seizures = Epilepsy Results of a seizure range from mild blinking to severe jerking Postictal state—time after seizure of altered consciousness

27 Seizures Treatment: Feeding or eating during postictal state not recommended due to chocking risk Medications—may impact growth and/or appetite Ketogenic diets—severely low-CHO diet with increased calories from fat

28 Cerebral Palsy Group of disorders resulting from brain damage with impaired muscle activity & coordination Spastic quadriplegia presents most nutritional problems

29 Cerebral Palsy Nutrition concerns:
Slow growth Difficulty feeding & eating Athetosis (less common form of CP)—uncontrolled movement which increases energy expenditure

30 Growth Chart

31 Phenylketonuria (PKU)
Inborn error of metabolism Body lacks enzyme needed to metabolize phenylalanine Require intervention to manage breakdown of dietary proteins

32 Phenylketonuria (PKU)
Diet is adequate in vitamins, minerals, pro, fat and calories Nutrients are often provided in liquid rather than solid form Dietary treatment includes avoiding meats, eggs, dairy products, nuts & soy beans

33 Attention Deficit Hyperactivity Disorder (ADHD)
Most common neurobehavioral problem (~5% to 8% of children) Chaotic meals & snacks with difficulty staying seated May be given fewer opportunities in the kitchen due to impulsiveness

34 Attention Deficit Hyperactivity Disorder (ADHD)
Nutritional concerns: Medications: May decrease appetite & growth Medication peak activity is aimed at school hours Appetite returns to normal when meds are not given such as on weekends & school holidays No evidence of nutrition as a cause and treatment but families may choose herbal medicines anyway

35 Pediatric HIV Nutrition is important for HIV management
Antiretroviral therapy depresses appetite & food intake Other nutrition concerns: Control food-related infections Access to determine need for complete nutritional supplements Referrals to food banks Dietary approaches have to customized

36 Childhood Celiac Disease
Chronic condition increasing in prevalence Underdiagnosed in children May interfere with learning and growth Once diagnosed, will need gluten free diet for life

37 Dietary Supplements and Herbal Remedies
Use of supplements or herbs has not been shown to improve prognosis for special health needs However, nutritional claims abound Families hear from one another about various nutrient claims May use diet claims for one condition and expect it to work for a different condition

38 Dietary Supplements and Herbal Remedies
Strategies to counter unscientific claims include: Recognize the benefits of supports for families (e.g. advocacy groups) Improve communication with health care providers Provide factual information without endorsing any claim & allow families to make informed choices

39 Sources of Nutrition Services
Supplemental Social Insurance (SSI) Americans With Disabilities Act USDA Child Nutrition Program USDA 504 Accommodation Individuals with Disabilities Education Act (IDEA) Maternal and Child Health Block Grants

40 Nutrition Intervention Model Program
Maternal and Child Health Bureau (MCH) is part of the department of Health and Human Services (HHS) Funds nutrition services for chronically ill children Develops and promotes model programs by funding competitive grants Pediatric Pulmonary Centers Bright Future Guidelines

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