1. Chapter 11 Toddler and Preschooler Nutrition: Conditions and Interventions

2. Introduction This chapter discusses children at risk Covers nutrition needs and services for children with: –Food allergies –Breathing problems –Developmental delays –Those needing nutrition support

3. 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

4. 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 developmental delay without services

5. 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

6. Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions

7. 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 food and nutrient intake adequate? –Are feeding or eating skills age appropriate? –Does diagnosis affect nutritional needs?

8. 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

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

10. 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

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

12. 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

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

14. Failure to Thrive (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 Recovery can include catch-up growth

15. Failure to Thrive (FTT)

16. Toddler Diarrhea and Celiac Disease “Toddler diarrhea” typically caused by sucrose & sorbitol content of fruit juices –Limiting juice may be recommended Celiac disease results in diarrhea & caused by sensitivity to the protein gluten found in wheat & other grains –Complete restriction of any gluten- containing foods

17. Autism Spectrum Disorders No specific diet is recommended for prevention or treatment Gluten-free & casein-free diets have been used by parents but not endorsed by professional societies

18. Muscle Coordination Problems & Cerebral Palsy 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 Meal pattern may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals Foods recommended are easy to chew and soft

19. Meal Pattern & Recommended Foods

22. 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 Recommend small, frequent meals with concentrated energy

23. 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

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

25. 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 parent coalitions and advocacy groups

26. 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