9/8/09 1 Chapter 13 Child and Preadolescent Nutrition: Conditions and Interventions 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 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 Protein Needs ??Protein needs vary by condition ??Recovery from burns & cystic fibrosis increases calorie needs to 150% DRI ??Phenylketonuria requires decreased protein 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 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 9/8/09 2 Growth Assessment & Interpretation in Children with Chronic Conditions ??Factors that affect growth surfacing during middle childhood include: ??Age of condition onset ??Secondary conditions ??Activity/inactivity level 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 Special Growth Charts ??Growth charts are available for some special conditions as noted on the next slide ??Conditions that do not have growth charts include: ??Juvenile rheumatoid arthritis ??Cystic fibrosis ??Rett syndrome ??Spina bifida ??Seizures ??Diabetes Special Growth Charts Nutrition Recommendations ??Assess intake to determine if nutrients are adequate ??Children with special health needs benefit from same dietary recommendations as other children 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 9/8/09 3 Examples of Nutritional Supplements and Formula for Children Example of a Feeding and Eating Schedule for an 8-year-old Who Eats by Mouth and Gastrostomy 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 Fluids ??Conditions that impact fluid status include: ??Drooling from cerebral palsy ??Constipation from neuromuscular disorders ??Multiple medication use Eating & Feeding Problems in Children with Special Health Care Needs ??Cystic fibrosis ??Diabetes mellitus ??Seizures ??Cerebral palsy ??Phenylketonuria (PKU) ??Attention deficit hyperactivity disorder (ADHD) ??Pediatric HIV Cystic fibrosis ??Common lethal genetic condition that interferes with lung function & causes decreased absorption ??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 9/8/09 4 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 Seizures ??Uncontrolled electrical disturbances in brain; results ranging from mild blinking to severe jerking ??Postictal state?time after seizure of altered consciousness ??Treatment: ??Medications?may impact growth and/ or appetite ??Ketogenic diets?severely low-CHO diet Sample Menu for a Ketogenic Diet Used to Control Seizures Cerebral Palsy ??Group of disorders with impaired muscle activity & coordination ??Spastic quadriplegia most common form ??Nutrition concerns: ??Slow growth ??Difficulty feeding & eating ??Athetosis?uncontrolled movement which increases energy expenditure Growth Chart for a Boy who has Spastic Quadriplegia and is Fed by Gastrostomy Phenylketonuria (PKU) ??Inborn error of metabolism ??Body lacks enzyme needed to metabolize phenylalanine ??Dietary treatment includes avoiding meats, eggs, dairy products, nuts & soy beans 9/8/09 5 Diet Recall of Child with PKU PKU Food Pyramid Attention Deficit Hyperactivity Disorder (ADHD) ??Most common neurobehavioral problem (~3% to 5% of children) ??Chaotic meals & snacks with difficulty staying seated ??Medications: ??Ritalin or Adderal ??Both may decrease appetite & growth ??Appetite returns to normal when meds are not given such as on weekends & school holidays 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 ??Refer to food banks Dietary Supplements and Herbal Remedies ??Use of supplements or herbs has not been scientifically shown to improve prognosis for special health needs ??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 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 9/8/09 6 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 Example of Nutrition Objectives for an Individualized Education Plan Nutrition Intervention Model Program ??Maternal and Child Health (MCH) Bureau (MCH) is part of HHS & funds nutrition services for chronically ill children ??MCH develops & promotes model program such as: ??Pediatric Pulmonary Centers ??Leadership Education in Neurodevelopment Disabilities Antonio/Jen Vega/Hess 3612 - Chapter13.ppt
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