HUN 3403 Wk3 D1b

Chapter 13Child and Preadolescent Nutrition: Conditions and Interventions

Introduction

• Discussion of nutrition needs of children with chronic conditions– Cystic fibrosis– Diabetes mellitus– Cerebral palsy– Phenylketonuria– Behavioral disorders

“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:– Low energy intake with small muscle size– 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 ASD

Protein Needs

• Protein needs vary by condition• Recovery from burns & cystic fibrosis

increases protein needs to 150% DRI• PKU and other protein-based inborn

errors of metabolism require decreased protein

• Some conditions may require hydrolyzed or specific amino acids

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

• 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:– 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 (See Table 13.1)– 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 and energy are adequate

• Children with special health needs benefit from same dietary recommendations as other children

Methods of Meeting Nutritional Requirements

• Most children will be able to eat and drink like everyone else

• Gastrostomy feeding may be required for:

• Kidney disease• Some cancers• Severe cerebral palsy• Cystic fibrosis

Nutritional Supplements and Formula

Feeding and Eating Schedule

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:

– Uncontrollable drooling– 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

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

• One of most common lethal genetic conditions

• 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– Enzymes 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

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

• Seizures = Epilepsy

• Results of a seizure range from mild blinking to severe jerking

• Postictal state—time after seizure of altered consciousness

Seizures

• Treatment: – Feeding or eating during postictal state not

recommended due to chocking risk– 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

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:

• 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

Childhood Celiac Disease

• Chronic condition increasing in prevalence– Underdiagnosed in children– May interfere with learning and growth– Once diagnosed, will need gluten free diet

for life

Dietary Supplements and Herbal Remedies

• Use of supplements or herbs has not been shown to improve prognosis for special health needs

• However, nutritional claims abound• Families hear from one another about various

nutrient claims• May use diet claims for one condition and

expect it to work for a different condition

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

• Supplemental Social Insurance (SSI)

• Americans With Disabilities Act

• USDA Child Nutrition Program

• USDA 504 Accommodation

• Individuals with Disabilities Education Act (IDEA)

• Maternal and Child Health Block Grants

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• Pediatric Pulmonary Centers• Bright Future Guidelines