Transcript Chapter 13

Chapter 13
Child and Preadolescent Nutrition:
Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown
“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
Nutritional Requirements of
Children with Special Health
Care Needs
• Children with special health care needs vary
in nutritional requirements & health needs:
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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 protein needs to 150% DRI
• Phenylketonuria and other protein-based
inborn errors of metabolism requires
decreased protein
Other Nutrients
• Adequate vitamins & minerals should be
provided in a well-balanced diet
• Conditions that interfere with adequate
nutrient intake include:
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Chewing or other feeding problems
Side effects from prescribed medications
Food refusals
Treatment of condition that includes restriction
of certain foods
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
Growth Assessment
• Long-term health goals less important for
children with life-shortening conditions
• Warning signs for growth problems:
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Plateau in weight
Pattern of weight gain & then loss
Failure to regain weight lost during an illness
Unexplained/unintentional wt gain
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
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 (See Table 13.1)
• Conditions that do not have growth charts include:
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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:
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Kidney disease
Some cancers
Severe cerebral palsy
Cystic fibrosis
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 and
increase needs include:
– Drooling from cerebral palsy
– Constipation from neuromuscular disorders
– Multiple medication use
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
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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
Cystic fibrosis
• Common lethal genetic condition
• Interferes with lung function
• Causes decreased absorption nutrients
• Malabsorption due to lack of pancreatic
enzymes
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
Diabetes Mellitus
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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
• Seizures = Epilepsy
• Results of a seizure range from mild blinking to
severe jerking
• Postictal state—time after seizure of altered
consciousness
Seizures
• Treatment:
– Medications—may impact growth and/or
appetite
– Ketogenic diets—severely low-CHO diet with
increased calories from fat
Cerebral Palsy
• Group of disorders
resulting from brain
damage with impaired
muscle activity &
coordination
• Spastic quadriplegia
presents most
nutritional problems
Cerebral Palsy
• Nutrition concerns:
– Slow growth
– Difficulty feeding &
eating
• Athetosis (less
common form of
CP)—uncontrolled
movement which
increases energy
expenditure
Growth Chart
Phenylketonuria (PKU)
• Inborn error of
metabolism
• Body lacks enzyme
needed to metabolize
phenylalanine
• Require intervention
to manage breakdown
of dietary proteins
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
Modified Food Pyramid for
PKU
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
Attention Deficit Hyperactivity
Disorder (ADHD)
• Nutritional concerns:
– Medications:
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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
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
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
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
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
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
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