Influence of Medical Conditions

Medical conditions can have an impact on nutrient needs and intake in a number of ways. Some conditions actually alter a child’s nutrient needs, while other conditions interfere with adequate nutrient intakes.

Several resources provide guidelines for adjusting energy estimates based on a child’s medical condition. A table that includes estimates for Down syndrome, spina bifida, Prader Willi syndrome, cystic fibrosis, and pediatric HIV infection or AIDS is found in the January/February 2005 issue of Nutrition Focus. Again, these are general recommendations, and a child’s individual growth pattern, actual intake, and medical status should be considered.

Increased nutrient needs

Some medical conditions are associated with increased nutrient needs. For example, children with cardiac disorders or HIV/AIDS-associated wasting often have energy needs that are greater than typically-developing children. Children with athetoid cerebral palsy can have increased energy needs because of energy expended through involuntary movements.

Other conditions may seem to be associated with greater-than-typical nutrient needs because children with these conditions may be underweight. A more accurate description is that the conditions have symptoms that interfere with adequate intakes.

Neurologic problems (e.g., with as cerebral palsy) can cause problems with feeding such as a hyperactive gag reflex or ineffective sucking and swallowing. Likewise, low muscle tone might impair a child's ability to chew and swallow.

Decreased nutrient needs

Children with some conditions (e.g., Down syndrome and Prader-Willi syndrome) are genetically predisposed to being shorter than their typically-developing peers. For many of these children, the adolescent growth spurt is diminished or absent. The energy needs of children with these types of conditions will be lower than what is recommended for children who are developing typically. Some syndromes are also associated with decreased metabolic rates.

It is not uncommon for families to forget about a child's short stature and expect him to eat the same amount of food as his typically-developing siblings. Also, if a child had feeding difficulties or was underweight in infancy (which is common with Down and Prader-Willi syndromes), focus on decreasing intake as the child gets older may seem like a "mixed message" to families.

Conditions can also be associated with lower than typical energy needs because of differences in body composition. Children with hypotonia (low muscle tone) have lower basal metabolic needs than children with normal muscle tone. This is one reason for using kilocalorie per centimeter of height (vs. kilocalorie per kilogram of body weight) equations to estimate energy needs of many children with special health care needs.

Problems with muscle coordination and gross motor skills or paralysis will contribute to a decreased level of physical activity...and thus, decreased energy needs. This should be accounted for when estimating an individual child's energy needs.

Altered micronutrient needs

Few medical conditions have a primary effect on an individual's micronutrient needs. There are, of course, a few exceptions, such as Wilson's disease (affects copper status) and other metabolic disorders. For the most part, the primary concerns around altered micronutrient needs are associated with medication-nutrient interactions.

The DRIs for micronutrients are based on the vitamin and mineral needs of individuals with typical energy intakes. Some nutrients are known to be used for energy metabolism and thus, theoretically, requirements for these nutrients are dependent on energy intake. There is not enough evidence, however, to suggest that recommended intakes of these nutrients be adjusted when an individual's energy intake is not typical.

The DRIs (EAR, RDA, AI) remain the best basis for nutrient intake recommendations for children with special health care needs.