Nutrition Focus

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

Posted on March 1, 2012 by nutrfoc

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).

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, attention deficit/hyperactivity disorder, cerebral palsy, CSHCN, down syndrome, growth, growth charts, prader-willi syndrome | Comments Off

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

Posted on January 1, 2012 by nutrfoc

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.

CSHCN may be at increased risk for growth concerns related to their disability, repeated medical crises or the inability to consume adequate amounts of food. For CSHCN regular measurements recorded on the Centers for Disease Control (CDC) or World Health Organization (WHO) growth charts may indicate trends of inadequate or excessive weight gain or growth. Some specialized growth charts are available for specific disabilities. Specialized charts can be used in conjunction with the CDC/WHO charts but the authors believe that the CDC/WHO charts are the best evaluation tools of growth, even for children with special health care needs, using the recommended measurement and plotting procedures. The specialized charts can, with careful consideration of the limitations of each individual chart, be used as an additional piece of information in the overall nutrition assessment. The previous issue has a charts.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, CSHCN, growth, growth charts | Comments Off

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

Posted on November 30, 2011 by nutrfoc

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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Posted in General Topics Related to CSHCN | Tagged assessment, cerebral palsy, CSHCN, development, down syndrome, education, failure to thrive, family centered care, genetics, growth, growth charts, nutrition management, team members | Comments Off

26(5) FROM MILK TO TABLE FOODS: A Parent’s Guide To Introducing Food Textures

Posted on September 30, 2011 by nutrfoc

Learning to eat a variety of foods is something that is often taken for granted. As with most things, this process can take longer for babies and children with Down syndrome due to low muscle tone, muscle coordination problems, sensory issues, or a variety of medical complications. Many families find it takes years for their children to progress to eating a variety of table foods and they express frustration when their child has trouble moving past a particular food texture. Though most parents accept that many skills take longer for their child to master, they didn’t expect the progression to crunchy table foods to take eight, nine, or ten years. As I meet parents of children with Down syndrome from around the country, this concern is always a topic and sometimes is the predominant concern of a workshop or group.

In a perfect world, families in this situation would contact a feeding team to receive guidance, coaching, and support. Looking back, it would have been very helpful for me to have a feeding team evaluation when my son with Down syndrome was young. I now realize that others would find it helpful as well. However, the feeding issues most commonly seen in children with Down syndrome do not scream: “Send me to the feeding team!” In addition, there may be financial, time, and client-demand limitations to feeding team referrals.

The following article is written with all of these issues in mind. It is written for parents of children with Down syndrome to provide insight about the process of learning to eat, hints for encouraging the necessary development for eating, and suggestions regarding when to seek a referral to the feeding team. Although this information is designed as a parent education tool, it is also useful for professionals working with children with Down syndrome and related disabilities. Information is powerful. Providing parents with tools that can diffuse worry in any area of parenting a child with a disability is a wonderful gift we can offer. It also strengthens the collaboration and teamwork needed to build successful, healthy adults who have special health care needs.

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Posted in General Topics Related to CSHCN | Tagged assessment, behavior, cerebral palsy, CSHCN, education, family centered care, feeding, nutrition management, team members | Comments Off

26(4) Feeding Problems in Metabolic Disorders

Posted on July 30, 2011 by nutrfoc

Feeding problems in childhood are becoming more widely recognized. Metabolic dietitians are likely to encounter concerns regarding eating in their patients. A feeding problem can be viewed from many perspectives. For metabolic dietitians, a feeding problem can be defined as the inability or refusal to eat the quantity, variety, or texture of foods that are appropriate for a person’s developmental age, medical condition, social group, and nutrient needs. Common feeding concerns are listed in Table 1. Limited food variety includes self-restriction based on preferred characteristics of food (rules about specific brands, colors, presentation, etc.) and persistent cumulative food jags in which, over time, more and more previously accepted foods are rejected. Restrictions in the foods a child will accept make a metabolic diet even more difficult to manage.

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Posted in Nutrition-related Issues, Specific Conditions | Tagged assessment, behavior, CSHCN, education, feeding, genetics, metabolic disorders, nutrition management, oral-motor, team members | Comments Off

26(1) Nutrition Issues Facing Children with Special Health Care Needs in Early Intervention Programs and at School

Posted on January 30, 2011 by nutrfoc

Sound nutrition practices are necessary for the growth and development of all infants and children. Physical complications and emotional stresses of a disability or chronic illness may put a child at risk for nutrition related disorders. When a diet or feeding regimen is modified to improve the child’s nutritional status, the child is better able to function in activities of daily living and to tolerate his/her medical treatments and therapies.

Many children with developmental disabilities and/or special health care needs are receiving services in early intervention programs and schools. In these settings they receive meals and snacks which may require modification to meet their special dietary needs. Federal regulations assure that children with special needs have equal access to nutrition programs and services. This issue of NUTRITION FOCUS will discuss how nutrition and feeding services can be provided as a part of early intervention services and within the school setting.

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Posted in General Topics Related to CSHCN, Nutrition-related Issues | Tagged assessment, behavior, CSHCN, development, education, family centered care, intervention, nutrition management, school, team members | Comments Off

25(5) Nutrition Education for the Child with a Metabolic Disorder

Posted on October 31, 2010 by nutrfoc

This article describes the process of nutrition education for children with metabolic disorders using phenylketonuria (PKU) as a model. Although you may not work directly with this population of children, the article will assist you in recognizing what most pre-schoolers through adolescents understand about foods and nutrients, and children’s ability to choose items to eat. This knowledge may be helpful in your daily practice when counseling parents and their children about nutrition, especially if eating becomes an issue in the family.

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Posted in General Topics Related to CSHCN | Tagged CSHCN, education, genetics, intervention, management, metabolic disorders, nutrition resources, pku | Comments Off

25(3) Nutrition and Constipation

Posted on June 30, 2010 by nutrfoc

Constipation is one of the most common concerns that parents/caregivers bring to health care professionals. For many parents, a child’s problems with constipation are quite obvious and can cause much worry. This edition of Nutrition Focus will discuss constipation and its specific problems in children with developmental disabilities. A ready to copy informational handout appropriate for use with families is available with both a version in English and one in Spanish. The information is intended for use with children age one year and older. New to this issue is a table listing laxatives, their action and how they work and increased information about encopresis.

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Posted in Nutrition-related Issues | Tagged constipation, fiber, fluid, handout, intervention, medications, nutrition management, recipe | Comments Off

25(2) Practical Strategies to Enhance Nutrient and Energy Density of Oral Feedings for Children with Special Needs

Posted on April 30, 2010 by nutrfoc

Some children with special health care needs (CSHCN) may not consume adequate amounts of food to meet their energy and/or nutrient needs. This may compromise growth and overall health. The reasons for poor oral consumption are varied. Some children may have altered energy needs due to their underlying medical condition, e.g., malabsorption disorders such as cystic fibrosis.

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Posted in Nutrition-related Issues | Tagged allergies, assessment, calories, cerebral palsy, CSHCN, energy, failure to thrive, feeding, fluid, FTT, handout, intervention, intolerances, micronutrients, protein, recipe, reflux, volume | Comments Off

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