Child and Preadolescent Nutrition PDF

Child and Preadolescent Nutrition Maymona Al-Hinai, PhD, RDN Children with special health care needs Nutrition services are needed to help children reach their full potential Modified for children with chronic conditions Cystic fibrosis Diabetes mellitus Cerebra...

Child and Preadolescent Nutrition Maymona Al-Hinai, PhD, RDN Children with special health care needs Nutrition services are needed to help children reach their full potential Modified for children with chronic conditions Cystic fibrosis Diabetes mellitus Cerebral palsy Phenylketonuria Behavioral disorders People-first language “A girl with Down’s syndrome” vs. “the Down’s girl” Nutritional Requirements of Children with Special Health Care Needs Children with special health care needs vary in nutritional requirements 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 Nutritional Requirements of Children with Special Health Care Needs Protein Needs Vary by condition Recovery from burns increases protein needs to 150 percent of the DRI PKU and other protein-based inborn errors of metabolism require decreased protein Some conditions may require hydrolyzed or specific amino acids Nutritional Requirements of Children with Special Health Care Needs Other nutrients Start with DRI Some conditions interfere with adequate nutrient intake Eating or feeding problems Side effects from prescribed medications Food refusals Treatment of condition that necessitates restriction of certain foods Calcium is low in general population and for children with special needs Growth Assessment Growth charts Good starting place for assessing the growth of any child In-depth growth assessment required with interpretation based on condition Warning signs for growth problems Plateau in weight Pattern of weight gain and then loss Failure to regain weight lost during an illness Unexplained and unintentional weight gain Growth Assessment Growth interpretation in children with chronic conditions Factors that affect growth Age of condition onset: earlier affects growth more than later Secondary conditions: condition may be cause of growth problem rather than nutritional status Activity level: may be decreased Growth Assessment Body composition and growth Health conditions may or may not alter muscle size, bone structure, and fat stores Down syndrome results in short stature, low muscle tone, and low weight Cerebral palsy, Down syndrome, and spina bifida may alter muscle size Spina bifida may impact muscles only in the lower body Standard body composition assessment needed Growth Assessment Specialized Growth Charts Low number of children with variable disease severity used to develop charts Conditions that do not have growth charts Juvenile rheumatoid arthritis Cystic fibrosis Rett syndrome Spina bifida Seizures Diabetes Nutrition Recommendations Methods of Meeting Nutritional Requirements Parents and caregivers, important to decide type and form Oral nutritional supplements Gastrostomy feeding May be required for kidney disease, some cancers, severe cerebral palsy, or cystic fibrosis Many schedule options May swim, bathe, and be active Can be temporary Nutrition Recommendations Vitamin and mineral supplements Supplements may be beneficial to assure adequate intake Excessive intake can happen inadvertently Special attention to calcium and vitamin D Fluids Some conditions impact fluid status and increase needs Uncontrollable drooling Low intake related to problem behaviors Constipation from neuromuscular disorders Medication use Eating and Feeding Problems in Children with Special Health Care Needs Feeding Challenges for Children with Health Care Needs Example situations: Assistance and supervision due to low self-feeding skills Low food intake due to meal length or food loss Adjustment in timing of meals and snacks Families may use mealtime to help cope Eating and Feeding Problems in Children with Special Health Care Needs Cystic Fibrosis (CF) One of most common genetic conditions Affects all exocrine organs with lung complications causing death in adulthood Causes malabsorption of nutrients due to lack of pancreatic enzymes Slower rate of weight and height Higher energy needs Chronic lung infections Eating and Feeding Problems in Children with Special Health Care Needs Cystic fibrosis Nutrition interventions: Monitoring growth Assessing food and nutrient intake 2-4 times ↑ energy and protein Frequent eating and large, calorie-dense meals Gastrostomy feeding at night to boost energy is sometimes required Must take pancreatic enzymes pills with each meal or snack Vitamin and mineral supplementation Water-soluble forms of vitamins A, D, E, and K Eating and Feeding Problems in Children with Special Health Care Needs Diabetes mellitus Disorder in insulin regulation and glucose metabolism Treatment includes timing and composition of meals and snacks, insulin injections, or other medications Eating and Feeding Problems in Children with Special Health Care Needs Seizures Uncontrolled electrical disturbances in brain Epilepsy and seizures are the same disorder Results of a seizure range from mild blinking to severe jerking No known nutrients bring on seizures Postictal state: time after seizure of altered consciousness Eating and Feeding Problems in Children with Special Health Care Needs Seizure treatment Feeding or eating during postictal state: not recommended due to choking risk Medications: may effect growth and/or appetite Ketogenic diet for uncontrollable seizures: severely limited carbohydrate diet with increased calories from fat Eating and Feeding Problems in Children with Special Health Care Needs Cerebral palsy (CP) Broad range of disorders due to brain damage early in life Spastic quadriplegia presents most nutritional problems Nutrition concerns: slow growth and difficulty feeding and eating, and changes in body composition Athetosis: uncontrolled movement which increases energy expenditure  Eating and Feeding Problems in Children with Special Health Care Needs Cerebral palsy treatment Recommendations for energy needs are difficult to determine No specific vitamins or minerals are known to correct CP Nutrition interventions may include the following: Stimulating oral feeding Adjusting menus and timing of meals Assessing and adjusting the child’s dietary plan over time Using adapted self-feeding utensils or other types of feeding equipment Eating and Feeding Problems in Children with Special Health Care Needs Inborn errors of metabolism Require interventions to manage breakdown products from foods and beverages metabolized incompletely or inadequately Phenylketonuria PKU, defective or absent enzyme needed to metabolize phenylalanine, an amino acid Eating and Feeding Problems in Children with Special Health Care Needs Attention deficit hyperactivity disorder (ADHD) Most common neurobehavioral problem Medication can decrease appetite, resulting in weight loss or slow growth Effect of ADHD medications on appetite is variable Children with ADHD who are not on medication may have a chaotic meal and snack pattern and inability to stay seated for a meal Eating and Feeding Problems in Children with Special Health Care Needs Pediatric HIV Most children with HIV were infected at around the time of birth Nutrition is important for HIV management Family education and financial support referrals Food-related infection-control Access to determine need for complete nutritional supplements Customize intervention to behavioral and developmental realities Eating and Feeding Problems in Children with Special Health Care Needs Childhood celiac disease Underdiagnosed in children May interfere with learning and growth Most effective treatment: avoiding gluten for life Eating and Feeding Problems in Children with Special Health Care Needs Food Allergies Milk and egg allergy often outgrown when entering school Peanut allergy usually persists to middle childhood Anaphylactic reactions to peanuts are 60% of death from food allergens Food allergy diagnosis effects life significantly Potential for exposure at school is concerning Eating and Feeding Problems in Children with Special Health Care Needs Reduce food allergen exposure at school: Read all food labels carefully Avoid cross-contamination Clean surfaces and hands with soap and water or disinfecting wipes Develop and implement policies about use of allergens in school Teach child and staff how to recognize symptoms of a reaction Develop emergency action plans Keep an unassigned epinephrine autoinjector in school Train staff to recognize and respond to allergic reactions Dietary Supplements and Herbal Remedies No herbal remedy or nutritional supplement are effective to treat or prevent conditions Nutritional claims abound for various chronic conditions Strategies to counter unscientific claims Recognize benefits of supports for families (e.g., advocacy groups) Improve communication so that family asks more questions Provide factual information without endorsing any claim and allow families to make informed choices