Why Nutrition and Children with Special Health Care Needs?
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Why nutrition and children with special health care needs?

Nutrition concerns for children with special health care needs include delays in feeding skill development, feeding problems, including the need for tube-feeding and issues around the transition to eating, and chronic medication use (Cloud, 2004). Medical conditions can contribute to increased nutrient needs, and symptoms of medical conditions can be barriers to meeting those needs (Cloud, 2004; Berkowitz, 1999; Mugrditchian, 1992).

Undernourished children become inactive and apathetic; their attention span and exploratory behaviors decrease, resulting in decreased interaction with the environment. This is thought to be responsible for the adverse effects of poor nutrition on cognitive development (Baer, 1999). Screening data for children with, or at risk for, special health care needs in Region IX (Arizona, California, Hawaii, Nevada) indicate that about 62% have at least one nutrition risk factor; and 21% have three or more nutrition risk factors (unpublished data from the Region IX Nutrition Database, 1995, and the UAP LA County CCS Nutrition Database, 1999). Children ages 0-6 tend to have the highest number of risk factors. One of the major reasons for this increased risk in younger children is feeding difficulties (Bujold, 1994).

The important role of nutrition education and services in assuring improved health outcomes is recognized in the Healthy People 2010 National Health Promotion and Disease Prevention Objectives. Specifically, Objective 19.17 for Nutrition acknowledges the importance of nutrition assessment, counseling, and service provision for all populations, including those with, or at risk for, special health concerns and calls for primary care providers to provide "nutrition assessment and counseling and/or referral to qualified nutritionists or dietitians" (US DHHS, 2000). The Healthy People 2010 Objectives include Nutrition Objective 19.4 to reduce growth retardation in children, and a Maternal and Child Health Objective 16.23 to increase the number of states and territories that have service systems for children at risk for chronic and disabling conditions.

Healthy People 2010 also acknowledges that within the service delivery system there is a lack of professionals prepared to accommodate the needs of children with, or at risk for, chronic or disabling conditions. Thus, Objective 23.10 calls for increased continuing education for public health workers to reflect the principles of comprehensive, community-based, coordinated, family-centered care for these children, and to provide a wide range of health prevention, promotion, education, and service activities tailored to their needs.

The Bright Futures Guidelines identify nutrition as a key concern during all stages of development (Green, 2000). The critical role nutrition plays in health promotion and disease prevention is recognized throughout the document, and these principles apply for all children, including those with special health care needs. Anticipatory guidance specific to nutrition is provided for each developmental stage, indicating the importance of nutrition education and services to the overall health of all children. The guidelines call for culturally-sensitive, family-centered care for all children that is integrated between services throughout the community (Green, 2000; Story, 2000).

In April, 1995, the Maternal and Child Health Interagency Nutrition Group (MCHING) Coordinating Council reaffirmed the need for continued activity toward meeting the 1990 MCHING policy recommendations for, among others: increasing the number and improving the quality of personnel providing nutrition services (#4); expanding access to nutrition services in all settings serving children with special health care needs and their families, and ensuring these services are culturally sensitive, family-centered, and community-based (#25); and improving the quality of nutrition services available to children with special health care needs (#26) (Baer, 1991).

References

Baer MT, Farnan S, Mauer AM. (1991) Children with special health care needs. In: Sharbaugh Co, ed, Call to Action: Better nutrition for mothers, children, and families, Executive Summary. Washington DC: National Center for Education in Maternal and Child Health.

Baer MT, Poulsen MK, Howard-Teplansky RB, Harris AB. (1999) Effects of nutrition on development and behavior. In: Levine MD, Carey WB, Crocker AC, eds. Developmental-Behavioral Pediatrics, 3rd ed.

Berkowitz CD. (1999) Cardiopulmonary problems and disorders of the head and neck. In: Kessler DB and Dawson P, eds. Failure to Thrive and Pediatric Nutrition. Brookes Publishing Co., Baltimore MD.

Bujold C. (1994). Validation of a parent-completed nutrition screening questionnaire for children with special health care needs. Master's thesis, University of Washington.

Cloud HH, Posthauer ME. (2004). Providing nutrition services for infants, children, and adults with developmental disabilities and special health care needs. J Am Diet Assoc. 104:97-107. Online: http://www.eatright.org/Public/GovernmentAffairs/92_18463.cfm.

Green M, Palfrey JS, eds. (2000). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2nd ed. Arlington VA: National Center for Education in Maternal and Child Health.

Mugrditchian L, Arent-Fine J. Dwyer J, Holland M, Polhamus B. (1992). The nutrition of the HIV-infected child: Part II: Care management. Top Clinical Nutrition. 7(2):11-20.

Story M, Holt K, Sofka D, eds. (2002). Bright Futures in Practice: Nutrition (2nd ed.). Arlington, VA: National Center for Education in Maternal and Child Health.

US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington DC: US Government Printing Office, November, 2000.