Nutrition Focus

33(6) Prader-Willi Syndrome – Nutrition Update

Posted on June 30, 2019 by nutrfoc

Max, a 6-month-old infant, has recently had a gastrostomy tube placed after receiving breast milk via NG tube due to significant hypotonia. His length is <5th percentile, weight is at 5th percentile, and weight-for-length is 50th percentile.

Maddie is 4 years old and participates in Head Start. Her parents report that she asks for food between meals and regular snacks, and will often have tantrums if denied. The Head Start meals are served family style, but Maddie’s parents would like to have more control over her intake. Her BMI has gone from the 75th to the 95th percentile in the past 6 months.

All of these children have Prader-Willi syndrome (PWS). Their nutrient needs will depend on their age, stage of development, medical complications, and motor/activity level. Each individual will manifest the characteristics of the syndrome differently, so the “typical” does not always apply to the individual. Each family is unique in their strengths, management style, and the education and support needed. The role of the Registered Dietitian Nutritionist (RDN) is to work with the family to ensure optimal nutrition and weight management, provide anticipatory guidance, and communicate with the health care team and educators.

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Posted in Specific Conditions | Tagged assessment, behavior, calories, CSHCN, development, education, energy, enteral nutrition, failure to thrive, family centered care, feeding, genetics, growth, growth charts, infants, intervention, nutrition management, obesity, physical activity, prader-willi syndrome, school, team members, transition | Comments Off

33(5) Working with Children in Foster Care – Nutrition Issues and Practice Implications

Posted on June 30, 2019 by nutrfoc

Providing medical nutrition therapy to children within foster care is complex as providers have numerous additional hurdles to navigate, including the psychological impact and effect of transitional care, logistical management among multiple caregivers and home environments, and patient confidentiality. This article has been developed with the aim of providing an overview of available evidence to guide clinical practice for registered dietitian nutritionists (RDNs) providing nutrition therapy to children in foster care.

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Posted in General Topics Related to CSHCN | Tagged assessment, CSHCN, disordered eating, failure to thrive, family centered care, feeding, food insecurity, food security, foster care, nfpe, pica, resources, team members | Comments Off

33(3) Childhood Lead Poisoning and the Role of Nutrition

Posted on May 1, 2018 by nutrfoc

Lead exposure is a serious yet preventable environmental public health issue. The persistence of lead poisoning continues to challenge clinicians and public health practitioners despite everything that is known about the sources, pathways and prevention of lead exposure. Lead has no known physiological benefit, and children are particularly susceptible to its toxic effects. No safe blood lead level in children has been identified. Most exposed children have no apparent symptoms, and consequently many cases go undiagnosed and untreated. Recent studies suggest that even blood lead levels below 5 micrograms per deciliter (µg/dL) can adversely affect a child’s IQ, ability to pay attention, and academic achievement.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, behavior, CSHCN, development, growth, lead, resources | Comments Off

33(2) Medication-Nutrient Interactions

Posted on March 1, 2018 by nutrfoc

Medication-nutrient interactions occur any time a medication interferes with a food or nutrient, or vice versa, a food or nutrient interferes with the action of a medication.

Many children with special health care needs receive one or more medications on a regular basis. Healthcare professionals who work with these children and their families should be aware of each medication and potential adverse interactions with foods/nutrients. Those who are at highest risk for drug-nutrient interactions require long term or multiple medications. The risk is compounded for children whose primary condition causes marginal nutritional status to begin with, due to poor appetite, increased energy needs, poor absorption, impaired metabolism of nutrients or dysphagia (e.g., in conditions such as cystic fibrosis, celiac disease, renal failure, pulmonary or cardiac diseases, or neurodevelopmental disorders).

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Medication-Nutrient Interactions

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, constipation, CSHCN, education, energy, fluid, growth, intervention, medication interactions, medications, nutrition management, resources, team members | Comments Off

33(1) Introduction of Complementary Foods in Infancy: When, What and How

Posted on January 1, 2018 by nutrfoc

Introduction of complementary foods (solid foods and liquids other than breast milk or infant formula) during infancy is a practice that has evolved and changed over time and across cultures. Introducing complementary foods to an infant is both an art and a science that relies heavily on caregivers to assess the infant’s readiness to begin and advance the type, texture and amount of food. As a result, it can feel like an overwhelming process if the caregiver feels uncertain about the infant’s readiness. Additionally, caregivers are often exposed to a wide variety of information about when, what, and how to offer complementary foods – and that information is often conflicting. This article aims to provide evidence-based guidance on complementary foods and when, what and how to introduce them to infants.

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Introduction of Complementary Foods in Infancy: When, What and Ho
NOTE: Updated Editor’s Note added 10/2018

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, complementary foods, CSHCN, development, developmental disabilities, education, family centered care, feeding, infant feeding, infants, nutrition management, oral health, oral-motor | Comments Off

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

Posted on December 1, 2017 by nutrfoc

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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Posted in Specific Conditions | Tagged assessment, cleft lip, cleft palate, CSHCN, development, education, enteral nutrition, equipment, family centered care, feeding, growth, intervention, nutrition management, oral-motor, pierre robin sequence, team members | Comments Off

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

Posted on September 1, 2017 by nutrfoc

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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Posted in Nutrition-related Issues, Specific Conditions | Tagged ASD, assessment, autism, behavior, CSHCN, development, education, energy, family centered care, feeding, growth, intervention, medication interactions, nutrition management, overweight/obesity, physical activity, school, team members | Comments Off

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

Posted on July 1, 2017 by nutrfoc

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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Posted in Specific Conditions | Tagged assessment, autism, behavior, development, family centered care, feeding, growth, intervention, medication interactions, nutrition management, oral health, sensory issues, team members | Comments Off

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

Posted on May 1, 2017 by nutrfoc

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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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, calories, CSHCN, development, energy, failure to thrive, family centered care, feeding, fluid, growth, growth charts, infants, late preterm, nutrition management, oral-motor, prematurity, preterm, protein, reflux, team members, transition | Comments Off

Nutrition Focus

33(6) Prader-Willi Syndrome – Nutrition Update

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

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

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