Maternal chapter11

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Transcript Maternal chapter11

Chapter 11
Toddler and Preschooler Nutrition:
Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown
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
• ~90% of children with disabilities have a
nutrition problem
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 delay without services
Nutrition Needs of Toddlers &
Preschoolers with Chronic
• 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
Nutrition Needs of Toddlers &
Preschoolers with Chronic
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 diet adequate?
Are feeding or eating skills age appropriate?
Does diagnosis affect nutritional needs?
Growth Assessment
• Interpretation of growth charts should
consider special health condition
• Growth charts specific to some conditions
– Special head growth chart
Nellhaus Head Circumference
Growth Chart Plotted for Girl
with Rett Syndrome
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
Behavioral Feeding Problems
• Mealtime feeding problems are common with
toddlers & preschoolers with behavioral &
attention disorders
• Behavioral disorders that affect nutritional status
– Autism
– Attention deficit hyperactivity disorder
• May be suspected in preschool years but usually
treated in the school years
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
Nutrition-Related Conditions
Failure to thrive (FTT)
Toddler diarrhea & celiac disease
Muscle coordination problems & cerebral
• Pulmonary problems
• Developmental delay & evaluations
Failure to Thrive (FTT)
• What is FTT? Inadequate wt or ht gain with
growth declines more than 2 growth
• May result from:
Digestive problems
Asthma or breathing problems
Neurological conditions
Pediatric AIDS
Failure to Thrive (FTT)
Toddler Diarrhea and Celiac
• “Toddler diarrhea” typically caused by
sucrose & sorbitol content of fruit juices
• Celiac disease results in diarrhea & caused
by sensitivity to the protein gluten found in
wheat & other grains
• No scientifically proven diet is
recommended for prevention or treatment
• Gluten-free & casein-free diets have been
recommended via Internet and support
groups but not scientifically shown
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 & Recommended
•Meal pattern may be changed to provide
small, frequent meals, and snacks to prevent
tiredness at meals
•Foods recommended are easy to chew and
Meal Pattern & Recommended
Pulmonary Problems
• Examples of pulmonary (breathing)
problems are brochopulmonary dysplasia &
• Breathing problems increase nutrient needs,
lower interest in eating & can slow growth
• Preterm infants at high risk of breathing
Developmental Delay &
• Developmental delay may be suspected
– Specific nutrients are inadequately or
excessively consumed
– May result from iron deficiency or lead toxicity
• Physical growth may be impacted
Food Allergies and Intolerance
• True food allergies seen in ~2% to 8% of children
• Common food allergies include:
Dietary Supplements and Herbal
• Parents should be cautioned about use of
supplements and/or herbs to treat various
• Often unproven recommendations come
from support groups or the Internet
Sources of Nutrition Services
State programs
Early intervention programs
Early childhood education programs (IDEA)
Head Start
Early Head Start
Low birthweight follow up
Child care feeding programs