28(2) Feeding the Child with Very Low Energy Needs

Neurologic impairments, whether associated with a congenital disorder or due to a traumatic event, can influence the nutritional requirements of children with special health care needs. In some cases the nutrition issues are present due to medical complications and severe disabilities, including seizures, gastrointestinal disturbances such as gastroesophageal reflux (GER), vomiting, or constipation; oral-motor dysfunction, severe intellectual disabilities, hypotonia, minimal physical movement, poor head control, and developmental delays.

Some children, such as those with athetoid cerebral palsy, or those with pulmonary and cardiac conditions, require a very high intake of energy (kilocalories) due to increased muscle tone and respiratory rates and a high level of involuntary movements. Many resources are available to aid in the nutrition management for children with high energy needs. For other children, metabolic rate and activity level are very low compared to children of a comparable age and size. Thus, their energy needs are reduced, but there is little documented information available

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Feeding the Child with Very Low Energy Needs

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28(1) Behavior Management of Feeding Problems

Normal development of feeding skills in children may be altered due to several factors including parenting skills, child’s temperament, family eating patterns, developmental skills, and chronic illness. In addition, feeding problems often include behavior concerns. Interventions directed at improving nutritional intake, without guidance on managing behavior that impacts eating patterns often leads to failure in changing a child’s nutritional status, and increases the risk for nutrition and growth problems. Children with chronic health conditions are at high risk for nutrition and related feeding behavioral problems due to changes in developmental skills, behavior and emotional regulation, and changes in digestion and metabolism related to many chronic conditions. Strategies to address these challenges can augment treatment plans and improve outcomes, including improved growth, behavior, parent-child interaction, and cognitive development.

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Behavior Management of Feeding Problems

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27(6) Emergency Preparedness – Helping Families and Their Children with Special Nutrition Needs

A number of recent natural disasters have brought the importance of emergency preparedness to the public’s attention. As a result, many organizations have issued preparedness recommendations to assist individuals and families in becoming better prepared for an emergency. Despite a number of available preparedness recommendations, few exist to assist families caring for children with special nutrition needs. In addition, regardless of special health care needs and concerns related to emergencies, families remain unprepared for a disaster event.

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Emergency Preparedness – Helping Families and Their Children with Special Nutrition Needs

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27(5) The Picky Eater

Children with special health care needs seen for a nutrition evaluation are often described as picky eaters. This is both a vague and variable description, but one commonly used and a challenge to treat. The purpose of this article is to:

• Discuss what a picky eater is, and why a child is described as a picky eater
• Outline components of possible treatment strategies
• Offer practical tips on how to implement change

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The Picky Eater

Also with this issue:
Handout: De-Stressing” Strategies for Parents of a “Picky” Eater

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27(4) Update – Attention Deficit/Hyperactivity Disorder and Nutrition Issues

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the more common neurobehavioral chronic disorders of childhood. ADHD is defined by academic or behavioral
problems and symptoms of inattention, hyperactivity, or impulsivity. These symptoms must be inappropriate for the child’s developmental level, be present (at least in retrospect) before age seven, and be present in more than one setting (usually home and school). It is not enough to just have symptoms – they must be severe enough to interfere with function in the school or social situation.

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Update – Attention Deficit/Hyperactivity Disorder and Nutrition Issues

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27(3) Food Insecurity and Children with Special Health Care Needs

Registered Dietitians, DTRs, and other health care professionals are in a unique position to recognize the issues associated with food insecurity in their patients, and also play a leadership role in the development of programs that can help end food insecurity. RDs and DTRs understand the effects of inadequate dietary intake and food insecurity on health and well being. They recognize that if a child or adult is overweight, this has nothing to do with their degree of food security. They recognize that the root of classroom behavioral issues may be related to food security at home and they also recognize that children with special needs are more likely to live in food insecure homes.

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Food Insecurity and Children with Special Health Care Needs

Review of Resource: Academy of Nutrition and Dietetics Pocket Guide to Children with Special Health Care and Nutritional Needs

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Resource Review: Pocket Guide to Children with Special Health Care and Nutritional Needs

This guide is the 3rd version of a publication originally developed and supported in 1997 by two practice groups, Behavioral Health Nutrition Dietetic Practice Group and Pediatric Nutrition Practice Group. Members of both groups contributed to this updated version that has become a pocket guide.

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Review of Resource: Academy of Nutrition and Dietetics Pocket Guide to Children with Special Health Care and Nutritional Needs

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27(2) Growth-related Updates in Children with Developmental Disabilities

Assessment of growth is essential for all children, but assumes more importance in the care of children with developmental disabilities due to the high risk of problems relating to growth these children may experience. This edition of Nutrition Focus will inform its readers on recent growth-related updates in four of the more commonly encountered developmental disabilities: Prader-Willi syndrome (PWS), Down syndrome (DS), Attention Deficit Hyperactivity Disorder (ADHD), and cerebral palsy (CP). After each case example the discussion will describe: 1) the developmental condition, 2) growth issues associated with the condition, 3) current assessment recommendations and treatment options available, 4) recommendations for each of the individual cases.

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Growth-related Updates in Children with Developmental Disabilities

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27(1) ASSESSMENT OF GROWTH: Part 2 Interpretation of Growth

Growth charts are a major tool used for the assessment of growth and health in infants and children. The charts can also be used as a screening tool by other health professionals for referral to nutrition services provided by the registered dietitian (RD) experienced in the evaluation of the pediatric client.

For the RD, growth charts are used as one of the major components of nutrition assessment. The charts can provide information about a child’s history, give a picture of the current situation or be used to determine future nutrition needs. The best information about growth is obtained by a series of plotted measurements recorded on the chart, which form a growth curve. Accurate measurements and precise plotting of data for weight, stature, and head circumference are essential. Volume 26, No.6, the November/December 2011 issue of NUTRITION FOCUS provides an in-depth review of equipment, techniques for measurement including alternatives for the child with special health care needs (CSHCN), and comments about specialized growth charts.

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ASSESSMENT OF GROWTH: Part 2 Assessment of Growth

Some readers have had difficulty printing the file. A lower-resolution version is available. ASSESSMENT OF GROWTH: Part 2 Assessment of Growth – smaller file

CDC has developed a 1-page sheet, Using the WHO Growth Standard Charts – Basic Information about Clinical Use, that calls attention to features of the WHO growth charts.

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26(6) ASSESSMENT OF GROWTH: Part 1 Equipment, Technique and Growth Charts

Anthropometry is the measurement of body size, weight and proportion. In infants and children growth data, regularly obtained by accurate measurements, can be an indicator of health status and/or an effective screening tool for referral to nutrition services provided by the registered dietitian (RD) experienced in pediatrics. Growth attainment is often the critical objective data on which clinical interventions are based; therefore, accuracy is essential. Weight for age, height or length for age, and weight/length or Body Mass Index (BMI – for those age 2 and older) should always be plotted. Head circumference should be measured and plotted during the first two years of life.

The best information about growth is shown through a series of plotted measurements forming a growth curve. Regular measurements recorded on growth charts may indicate trends of excessive or inadequate increases in weight or length or height. This is especially true for children with special health care needs (CSHCN). At times the growth of some CSHCN is less than typical for age. A series of measurements that follows a curve can reassure both the parents/caregivers and the health care professionals that growth is occurring or it can be an indication of the need for a referral to the RD due to concerns about growth. CSHCN may be at increased risk for inappropriate growth patterns due to their disability, repeated medical crisis situations, or inability to consume adequate amounts of food. However, individual interpretations of growth patterns for all children should be made using not only growth charts but other assessment tools including a food history and intake record, a review of medical issues, and laboratory data.

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ASSESSMENT OF GROWTH: Part 1 Equipment, Technique and Growth Charts




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