32(6) Children with Cleft Lip and/or Palate: Feeding and Nutrition

Cleft lip and/or palate (CLP), also known as orofacial clefts, are one of the most common birth defects. They occur at a rate of 1 in 500-700 births. Considerable variation in incidence exists between geographic and ethnic origin, with the highest among those of Asian descent and lowest among those of African descent. The incidence in the United State is 7.75 per 10,000 live births. International incidence is 7.94 per 10,000 live births.

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Children with Cleft Lip and/or Palate: Feeding and Nutrition

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32(5)Nutrition and Autism Spectrum Disorders – Part II Treating Obesity in ASD

According to the Centers for Disease Control and Prevention (CDC) one out of five school aged children is obese, a number that has tripled since the 1970s. The etiology of obesity is multi-factorial and includes not only individual biology but also social-emotional and environmental factors. For children with autism spectrum disorders (ASD), causal factors associated with obesity can be amplified by the characteristics of the disorder, which leads to a higher prevalence in children with ASD as compared with typically developing peers. Increased risk continues through adulthood; obesity is 69% higher in adults with ASD compared to the general population, as are associated disorders – hypertension and diabetes are 42% and 50% higher, respectively.

Success in treating pediatric or adult obesity is elusive due to entrenched behaviors, physical and social environment, genetics and physiological changes associated with both obesity and weight loss. Prevention of obesity is critical to mitigating individual and societal costs. Recommendations for prevention of obesity in children applies to all children, regardless of the presence of autism.1 This article seeks to identify differences seen when assessing and treating overweight/obesity in children and adolescents with ASD.

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Nutrition and Autism Spectrum Disorders – Part II Treating Obesity in ASD

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32(4) Nutrition and Autism Spectrum Disorders – Part I Assessment and Treatment

Autism spectrum disorders (ASD) are neurodevelopment disorders characterized by impairments in social interactions and communication. The Centers for Disease Control and Prevention (CDC) reports that the prevalence of autism has been increasing with an estimated 1 in 68 children affected, which translates to 1-2% of the population. ASD is five times more common in boys than girls although Rett’s syndrome, a similar disorder is primarily found in girls.

Since the first descriptions of autism by Leo Kanner in 1943 and Hans Asperger in 1944, etiology has been an active area of study. Autism was initially viewed as solely a behavioral disorder. It is now understood to be a pervasive, systemic syndrome influencing neurologic, immunologic, gastrointestinal and endocrine functions. It is complex and heterogeneous with multiple etiologies and subtypes; each with different developmental trajectories. Etiology includes genetic and environmental factors with genetic links identified for about 10-25% of diagnoses. Poor maternal nutritional status, both prior to and during pregnancy is a risk factor for autism and for outcomes like prematurity and cardiac defects which are associated with greater risk. Maternal and paternal obesity are both linked to autism. Prenatal supplementation, especially with folic acid appears to be protective.

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Nutrition and Autism Spectrum Disorders – Part I
Assessment and Treatment

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32(3) Nutrition and Feeding for the Premature Infant after Hospital Discharge

In the United States about 1 in 10 babies is born at less than 37 weeks gestation. The most recent data available (2015) identified preterm births accounting for 9.63% of births (approximately 383,130 infants) in the United States (US). This is a slight increase from 9.57% of births in 2014. Seventy-one percent of these births are classified as “late preterm” births, defined as 34 0/7 through 36 6/7 weeks gestation. Increases in preterm births were seen among non-Hispanic black and Hispanic women.1 Additional information, including state-specific data can be found on the March of Dimes website: www.marchofdimes.org/mission/prematurity-reportcard.aspx.

Advances in respiratory management and nutrition support of the premature infant have contributed to dramatic increases in survival of VLBW and ELBW infants. Eighty to ninety percent of infants <750 grams survive to discharge. With increases in late preterm births and survival of VLBW and ELBW infants, there is considerable diversity among infants classified as “preterm.” Many prenatal and postnatal factors contribute to this diversity (see Figure 1). The infant born at 33 weeks who was exposed to drugs in-utero may have very different needs than the ELBW infant born at 24 weeks with chronic lung disease. This edition of NUTRITION FOCUS is the first of two issues related to the child born prematurely. This issue, Part 1, discusses discharge planning, nutrition assessment, and interventions during the transition from hospital to home and throughout the first year. To demonstrate the many issues that may face infants born early and at an ELBW, we will follow Aidan from the hospital to home until one year corrected age. The second case study, about Lily, illustrates early discharge issues of the late preterm infant. Read more.... Nutrition and Feeding for the Premature Infant after Hospital Discharge

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32(2) Nutrition and Oral Health for Children

Dental caries is the most common chronic disease of childhood. It is more prevalent than asthma, which is the second most common chronic disease. It is estimated that 17.5% of 5-19 year olds have untreated dental caries.

Problems with oral health affect all children. However, the importance of oral health for children with special health care needs is particularly relevant. Special health care needs can increase a child’s risk for oral health problems and can make the overall effects of poor oral health more severe.

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Nutrition and Oral Health for Children

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32(1) Nutrition Assessment and Management of the Child with Cancer

Despite recent advances in research and treatment, cancer is still the leading cause of death by disease for all children past infancy in the United States. As recent as 2014, researchers estimated 10,450 new cancer cases and 1,350 cancer deaths among children from birth to 14 years, and an additional 5,330 new cases and 610 deaths were expected in adolescents between 15-19 years old.

Progress in survival rates is nevertheless being made nationwide. An estimated 379,112 survivors of childhood cancer were in remission in the United States as of January 1, 2010. The five-year relative survival rate for all children diagnosed with cancer under age 20 years, increased from 58% in the late 1970’s (1975-1979), to over 83% between 2007-2013.2 This dramatic increase in childhood cancer survival is due to multiple factors, including improved treatment protocols; the opportunity for children and adolescents to participate in sophisticated clinical trials, such as those from Children’s Oncology Group (COG), and the increasing acceptance of interdisciplinary supportive care teams that specialize in treating and caring for children undergoing treatment.

More recently, since Nutrition Focus published “Nutrition Assessment and Management of the Child with Cancer” in 2009,4 researchers and treating providers have developed, and are now administering, new treatment options for certain relapsed pediatric cancers. These “novel” treatments, including biologic and immune-based therapies, harvest the patient’s own T-Cells, genetically modify them and reintroduce the cells into the body. This complex process is intended to boost the immune system to eradicate malignant tissues and lessen side effects caused by some cancer treatments. A recent published phase 1 trial of 45 children and young adults with relapsed or refractory CD 19* B-lineage acute lymphoblastic leukemia (ALL), with a dismal prognosis, were treated with CD19 CAR-T cells. The trial outcome showed patients can achieve remission of disease, without need for prolonged chemotherapy or allogeneic hematopoietic cell transplantation (HCT).

As further progress is made towards curing childhood malignancies, researchers will continue to focus on improving outcomes for all pediatric cancers by incorporating more precision treatment strategies based on specific tumor targets and approaches to new therapies. The challenge for oncology dietitians will be to continue to define and address the nutritional status of this patient population, to focus on reliable standards of care to prevent malnutrition and to support the child though their treatment process. This issue of Nutrition Focus addresses nutrition assessment and management of children with cancer. Nutritional effects of cancer therapy and nutrition support practices are also addressed.

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Nutrition Assessment and Management of the
Child with Cancer

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31(6) Children and Weight: Providing Help, Preventing Harm Part 2 – Nutrition Intervention

Parents and caregivers receive many different messages about children, weight, and food, and it can be confusing for parents to navigate what is sound advice versus what is dangerous. How can health care providers help families and children without doing harm? These topics are discussed in this issue and the previous issue of the Nutrition Focus Newsletter:

  • Part 1 – Children and Weight: Providing Help, Preventing Harm – Nutrition Assessment
  • Part 2 – Children and Weight: Providing Help, Preventing Harm – Nutrition Intervention

This issue of Nutrition Focus examines intervention strategies,
with a focus on supporting a positive dynamic between
parent(s) and child(ren) around food.

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Children and Weight: Providing Help, Preventing Harm Part 2 – Nutrition Intervention

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31(5) Children and Weight: Providing Help, Preventing Harm Part 1 – Nutrition Assessment

Parents and caregivers receive so many different messages about children, weight, and food, and it can be difficult and confusing to navigate for families and health care providers alike. What is sound advice? What is dangerous? How can health care providers help families and their children to develop and sustain positive feeding and eating relationships? These topics are discussed in the next two issues of the Nutrition Focus Newsletter:

  • Part 1 – Children and Weight: Providing Help, Preventing Harm – Nutrition Assessment
  • Part 2 – Children and Weight: Providing Help, Preventing Harm – Nutrition Intervention

This issue of Nutrition Focus highlights the essential components of a comprehensive nutrition assessment with consideration of feeding and eating dynamics between parent and child. This newsletter will:

  • Review various growth patterns in children
  • Discuss causes of growth problems in children
  • Review the division of responsibility in feeding

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Children and Weight: Providing Help, Preventing Harm Part 1 – Nutrition Assessment

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31(4) A Look at Blended Tube Meals: Part 2 – The How-To’s

This issue of Nutrition Focus is the second in a two-part series about blended tube meals (BTMs). Part 1 updated a 2004 issue discussing homemade blended tube feedings. Interest has grown in the use of blended food in a tube feeding. Families are requesting advice and guidance from health care providers.

Part 1 of this topic suggested the name, blended tube meals, to acknowledge the use of blended food (blended at home or commercially), fed via the tube as a meal whether for an adult or child. Part 1 also reviewed the continuum of food choices for a tube feeding, why BTMs are popular, who is a candidate, the RDN’s role, and recent research on this topic. An extensive list of resources and references was included. The list of resources are also included in this issue, as well as the pertinent references.

In Part 2, the “how-to’s” of the actual process for BTMs is discussed including delivery method, food safety, and inclusion of all nutrients and appropriate fluids. Examples of foods that work from each food group are given. Two family stories illustrate the decision to move to BTM and the outcomes for their children.

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A Look at Blended Tube Meals: Part 2 – The How-To’s

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31(3) A Look at Blended Tube Meals: Part 1 – An Update

In 2004, Nutrition Focus ran an article entitled “Homemade Blended Tube Feeding,” by Ellen Duperret, RD, Jude Trautlein, RD, and Marsha Dunn Klein, OTR/L, MEd. The purpose of this article is to revisit this evolving conversation and share expanding professional and parent experiences. The current authors are experienced in the provision of these meals with children, so this article focuses on pediatric use. We recognize that many registered dietitian nutritionists (RDNs) working with adults are also recommending blended meals by tube.

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A Look at Blended Tube Meals: Part 1 – An Update

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