1. Nutrition Through the Life Cycle
Chapter 13 Child and Preadolescent Nutrition: Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown

2. “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

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

4. 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 autism

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Special Growth Charts
Growth charts are available for some special conditions as noted on the next slide (See Table 13.1)
Conditions that do not have growth charts include:
Juvenile rheumatoid arthritis
Cystic fibrosis
Rett syndrome
Spina bifida
Seizures
Diabetes

12. Special Growth Charts

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

14. Methods of Meeting Nutritional Requirements
Oral feeding is preferred method of feeding
Gastrostomy feeding may be required for:
Kidney disease
Some cancers
Severe cerebral palsy
Cystic fibrosis

15. 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

16. Fluids Conditions that impact fluid status and increase needs include:
Drooling from cerebral palsy
Constipation from neuromuscular disorders
Multiple medication use

17. 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

18. 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

20. Cystic fibrosis Common lethal genetic condition
Interferes with lung function
Causes decreased absorption nutrients
Malabsorption due to lack of pancreatic enzymes

21. Cystic fibrosis Dietary considerations:
Calories & protein increase 2 to 4 fold
Enzyme 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

22. 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

23. 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

24. Seizures Treatment: Medications—may impact growth and/or appetite
Ketogenic diets—severely low-CHO diet with increased calories from fat

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

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

27. Growth Chart

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

29. 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

30. Modified Food Pyramid for PKU

31. 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

32. Attention Deficit Hyperactivity Disorder (ADHD)
Nutritional concerns:
Medications:
Ritalin or Adderal
Both 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

33. 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

34. Dietary Supplements and Herbal Remedies
Use of supplements or herbs has not been scientifically 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

35. 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

36. Sources of Nutrition Services
USDA Child Nutrition Program
School breakfasts & lunches must be modified for special needs children
Maternal & Child Health Block Program of the U.S. Department of Health & Human Services (HHS)
Funds for nutrition services such as special formulas or food & nutrition education

37. Public Schools Regulations
504 Accommodation
Requires that school provide a written plan to accommodate for special health care needs
Individuals with Disabilities Education Act (IDEA)
Requires each special needs child to have a written plan that may include nutrition-related goals & objectives as needed

38. 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