Nutrition Focus

35(4) Avoidant Restrictive Food Intake Disorder (ARFID)

Posted on February 8, 2022 by nutrfoc

Avoidant Restrictive Food Intake Disorder (ARFID) is a broad diagnosis that includes children and adults with selective food intake (severe picky eating, typically associated with sensory issues), restricted intake due to fear of consequences of eating (e.g., fear of vomiting or choking), or limited intake due to lack of appetite or interest in eating. In all cases the avoidant or restricted eating results in deficiency of energy and/or specific micronutrients. The ARFID diagnosis can apply to anyone with these characteristics from infancy through adulthood. Children with special health care needs often meet criteria for this diagnosis due to poor appetite (e.g., children with ADHD who are treated with stimulant medications), fear of eating (e.g., children who have experienced negative consequences of eating due to gastroesophageal reflux, eosinophilic esophagitis, or disorders that cause gastrointestinal pain and/or nausea, such as celiac disease, Crohn’s disease or ulcerative colitis), or selective eating due to sensitivity to tastes and textures (e.g., children with autism spectrum disorder).

This issue of Nutrition Focus reviews ARFID: definition, diagnosis, and suggested treatment approaches. It uses a series of case examples to illustrate different types of ARFID and the use of an interdisciplinary treatment team. A previous issue (volume 35, number 3 – “Anxious Eaters, Anxious Mealtimes: Support for Seriously Picky Eaters”) examined feeding problems and ARFID in younger children.

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Posted in General Topics Related to CSHCN, Specific Conditions | Tagged appetite, ARFID, behavior, calories, CSHCN, development, education, energy, family centered care, feeding, growth, growth charts, intervention, nutrition management, selectivity, sensory issues, team members | Comments Off

35(3) Anxious Eaters, Anxious Mealtimes: Support for Seriously Picky Eaters

Posted on September 3, 2020 by nutrfoc

There are picky eaters and there are SERIOUSLY PICKY eaters! Parents and therapists alike face the challenges of supporting children with both mild and extreme picky eating tendencies. We know it is developmentally appropriate for toddlers to be picky. However, some toddlers don’t naturally outgrow their strong tendencies and continue to have narrow diets with very few foods and few food groups. These children and their parents struggle to enjoy mealtimes. Oftentimes their dietitians and feeding therapists struggle to help them. Let’s take a look at the continuum of picky with a focus on the children who are most worried about new foods and how to help them.

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Posted in General Topics Related to CSHCN | Tagged anxious eaters, ARFID, behavior, family centered care, intervention, mealtime peace, new foods, pediatric feeding disorder, pfd, sensory, sensory issues, systematic desensitization, team members, trust | Comments Off

35(2): Nutrition Implications in Cerebral Palsy

Posted on August 12, 2020 by nutrfoc

The first section of this issue will define cerebral palsy (CP), describe its causes, and review its classification types. Associated deficits related to CP will also be described. The next section will discuss nutrition assessment of children with CP followed by treatment options.

CP is the most common motor disability in childhood. Prevalence estimates from the Centers for Disease Control (CDC) range from 1.5 to more than 4 per 1,000 live births. CP is a term that refers to a number of disorders in the development of movement and posture that result from an injury to the central nervous system (CNS) during early brain development. The brain is unable to regulate muscle tone, strength, and coordination of movement. CP has been classified in different ways, including the level of severity, topographical distribution (parts of the body), physiological classification (motor type), and most recently by gross motor skill function (see Figure 1). The Gross Motor Functional Classification System (GMFCS) is a standardized functional classification system which utilizes an ordinal grading system of gross motor functional performance. Classification systems using the same grading system have also been developed for upper extremity function, communication, and eating/drinking (see Table 1).

CP can manifest in one of three periods: intrauterine, intrapartum, or postnatal. Risk factors for CP include premature birth, low birthweight, disruption of blood and oxygen supply to the developing brain, maternal infection, congenital malformations, multiple gestations, genetic disorders, and other factors. CP is non-progressive, but the manner in which it expresses itself may change over time as the brain matures. CP is a lifelong condition with no cure.

Interdisciplinary treatment and therapeutic intervention will lessen the effects and can assist the individual with CP in functioning successfully in their environment. Health care delivery to children and adolescents who have a developmental disability such as CP requires participation and sharing of expertise among multiple medical, social, therapeutic, and psychological disciplines.5 Members of the interdisciplinary team share the responsibility for making decisions about the patient’s care. The team members typically involved for those with CP may include but are not limited to the following disciplines: Developmental Pediatrics, Gastroenterology, Neurology, Neurosurgery, Orthopedics, Nursing, Nutrition, Physical Therapy, Occupational Therapy, Speech Language Pathology, Social Work, and Child Life.

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Posted in Specific Conditions | Tagged anthropometrics, assessment, body composition, calories, cerebral palsy, constipation, CSHCN, development, education, energy, enteral nutrition, failure to thrive, family centered care, feeding, GI, GMFCS, gross motor, growth, growth charts, IDDSI, intervention, medication interactions, muscle tone, nutrition management, oral health | Comments Off

35(1): Type 1 Diabetes – Part 3: Diabetes Technology and Nutrition Care Considerations

Posted on May 20, 2020 by nutrfoc

There are about 200,000 American youth 20 years and younger living with Type 1 Diabetes (T1D). Due to a rising prevalence of T1D, dietitians and care providers will encounter youth and families with T1D seeking advice more frequently than in the past.

Once a person is diagnosed with T1D, they must receive insulin to survive. While there is no cure for T1D, this autoimmune condition can be managed with different forms of insulin. Blood glucose can be measured using a variety of devices. Data about insulin action and blood glucose can help the person with T1D determine appropriate actions to take in context of real time situations, whether it is tailored to the amount of food or physical activity planned.

Advanced diabetes devices and new insulin types are sophisticated technologies available for self-management popular amongst youths. This newsletter is intended to 1) introduce clinically relevant features of new forms of insulin and advanced diabetes devices, 2) highlight parameters that can be adjusted in these systems of insulin delivery, and 3) discuss areas of optimization in nutrition management with these new technologies.

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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, blood glucose, CGM, continuous glucose monitoring, CSHCN, diabetes, education, family centered care, hypoglycemia, insulin, insulin pump, intervention, medications, nutrition management, physical activity, resources, team members | Comments Off

34(6) Type 1 Diabetes Part 2: Nutrition Management

Posted on May 20, 2020 by nutrfoc

This issue of Nutrition Focus explores nutrition management and planning for school for the child with type 1 diabetes. Nutrition education is an integral component in the care of the child with diabetes. It includes assessing nutrition status and developing a food plan that considers the modality of insulin therapy. The overarching goals are to maintain best growth, health, and development, optimize glycemic control, and prevent acute and chronic complications associated with type 1 diabetes.

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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, carbohydrate counting, CGM, continuous glucose monitoring, CSHCN, development, diabetes, education, family centered care, intervention, laboratory assessment, meal planning, medications, MNT, nutrition management, physical activity, resources, school | Comments Off

34(5): Type 1 Diabetes – Part 1: Family Education Following Diagnosis

Posted on May 20, 2020 by nutrfoc

Type 1 diabetes (previously called insulin dependent diabetes mellitus or juvenile diabetes) affects approximately 193,000 children and adolescents in the United States.1 Every year, more than 17,900 youth are diagnosed with diabetes. There are striking racial differences in the risk of type 1 diabetes. In the United States, non-Hispanic whites are one and a half times more likely to develop type 1 diabetes than African Americans or Hispanics.
This three-part series includes a general update on type 1 diabetes in children, the educational process that takes place when a child is initially diagnosed, the common dietary questions during and after hospitalization and sick day management, and a discussion of new advances in diabetes management.

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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, CSHCN, diabetes, DKA, education, endocrine, family centered care, glucose, hypoglycemia, insulin, intervention, ketones, medications, nutrition management, physical activity, resources, self-management, team members | Comments Off

34(4) Update: Overview of Assessment of Nutrition Status for Children with Metabolic Disorders

Posted on February 19, 2020 by nutrfoc

Metabolic disorders are genetic (inherited) conditions. Previously identified through clinical symptoms (which were often catastrophic), advances in technology have allowed identification of metabolic disorders through newborn screening (NBS). Registered dietitians nutritionists (RDNs) are involved in the care of children with metabolic disorders – in the community, in the specialty care setting, and in the acute care setting.

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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, CSHCN, galactosemia, genetics, growth, intervention, mcad deficiency, medical food, metabolic disorders, newborn screening, nutrition management, pku, team members | Comments Off

34(3) Update: Nutrition for Congenital Heart Disease

Posted on October 21, 2019 by nutrfoc

Nearly 1% or 40,000 births (or nearly 1 in 100 babies) each year in the United States are affected by congenital heart disease (CHD), with approximately 25% of those infants having critical cardiac defects that require surgery or catheter-based intervention within the first year of life. Due to this high prevalence, in 2011 the Secretary of Health and Human Services recommended that pulse oximetry screening be added to the US Recommended Uniform Screening Panel as a means for detection not only for CHD but also other conditions, like sepsis. Currently, all 50 states have implemented policies that mandate screening for critical CHD. Survival of infants born with CHD depends on the severity of the defect, timing of diagnosis, and how the anomaly is treated. With improved detection and infant survival there is a growing population of older children and adults living with heart defects. Many centers have ongoing improvement efforts to individualize the care for the thriving population of CHD.

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Posted in Specific Conditions | Tagged assessment, calories, congenital heart disease, CSHCN, energy, enteral nutrition, GI, growth, infants, intervention, medication interactions, nutrition management, oral-motor, parenteral nutrition, protein, team members, tube feeding | Comments Off

34(2) Supplements for Children with Special Health Care Needs

Posted on September 27, 2019 by nutrfoc

The focus of this article is micronutrient (vitamin and mineral) supplements for children, particularly children with special health care needs. The article explores current trends in dietary supplementation, oversight of supplement quality, estimates of children’s nutritional intake from foods, and assessment of need for micronutrient supplementation. In addition, supplements for children with special health care needs, and vulnerability for excessive or unnecessary supplementation are discussed. The last section uses attention-deficit/hyperactivity disorder (ADHD) as an example.

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Posted in General Topics Related to CSHCN | Tagged adhd, assessment, CSHCN, diabetes, down syndrome, medication interactions, minerals, nutrition management, supplements, vitamins | Comments Off

34(1) Human Milk and Pediatric Formula Update

Posted on August 22, 2019 by nutrfoc

This issue includes an abbreviated discussion on human milk and pediatric formula, as well as a formula comparison guide. The included Pediatric Formula Comparison Guide, compiled by this author and John Kerner, MD, will be used at Lucile Packard Children’s Hospital Stanford as an education tool and reference, and it was presented by Dr. Kerner at the Stanford 27th Annual Pediatric Update Conference (July 2019).

Infant and pediatric formula options seem to have exploded in recent years, as formula companies continue to compete for sales in a profitable market. It is difficult to navigate the formula options and ongoing changes, including frequent product name changes as a result of marketing slight differences. Because formula companies are allowed to directly advertise to consumers, and ambitiously do so, providers may discover changes or new products after caregivers have inquired about them.

Pediatric Formula Comparison Guide. Special thank you to Andrea Gilbaugh, John Kerner, and Jo Ann Hattner for sharing this resource with Nutrition Focus readers.

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Posted in General Topics Related to CSHCN | Tagged breast milk, breastfeeding, calories, fluid, formula, human milk, infants, lactoferrin, milk fat globule membrane, oligosaccharides, probiotics, resources | Comments Off

Nutrition Focus

35(2): Nutrition Implications in Cerebral Palsy

34(3) Update: Nutrition for Congenital Heart Disease

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