Pediatric Nutrition Challenges and Interventions

1. Chapter 11Toddler and Preschooler Nutrition:Conditions and Interventions Nutrition Through the Life Cycle Judith E. Brown

2. Who Are Children with Special Health Care Needs? • Criteria for “chronic condition” or “disability” varies from state to state • Estimates range from 5% to 31% of children • ~90% of children with disabilities have a nutrition problem

3. Eligibility for Early Intervention Services are Based on: • Developmental delays: • Cognitive, physical, language & speech, psychological, or self-help skills • Physical or mental condition with a high probability of delay • At risk medically or environmentally for substantial delay without services

4. Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions • DRIs are a starting point for setting protein, vitamin and mineral needs • Specific conditions need adjustments • May cause poor appetite & increased caloric needs • May lead to over- or under-weight • Caloric & nutrient recommendations should be customized for each child

5. Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions

6. Growth Assessment • Nutrition assessment should be first step to determine if nutrition services are needed • Assessment answers the following: • Is child’s growth on track? • Is child’s diet adequate? • Are feeding or eating skills age appropriate? • Does diagnosis affect nutritional needs?

7. Growth Assessment • Interpretation of growth charts should consider special health condition • Growth charts specific to some conditions include: • LBW or VLBW • Special head growth chart

8. Nellhaus Head Circumference Growth Chart Plotted for Girl with Rett Syndrome

9. Feeding Problems • Special health care needs cause feeding problems in young children combined with typical feeding issues of the average toddler or preschooler • Examples include: • Low interest in eating • Long mealtimes • Preferring liquids over solids • Food refusals

10. Behavioral Feeding Problems • Mealtime feeding problems are common with toddlers & preschoolers with behavioral & attention disorders • Behavioral disorders that affect nutritional status • Autism • Attention deficit hyperactivity disorder (ADHD) • May be suspected in preschool years but usually treated in the school years

11. Other Feeding Problems • Excessive fluid intake • Child would rather drink than eat • Feeding problems & food safety • Mashed or pureed foods and tubing or devices for feeding may be contaminated or spoilage may occur • Feeding problems from disabilities involving neuro-muscular control

12. Nutrition-Related Conditions • Failure to thrive (FTT) • Toddler diarrhea & celiac disease • Autism • Muscle coordination problems & cerebral palsy • Pulmonary problems • Developmental delay & evaluations

13. Failure to Thrive (FTT) • What is FTT? Inadequate wt or ht gain with growth declines more than 2 growth percentiles • May result from: • Digestive problems • Asthma or breathing problems • Neurological conditions • Pediatric AIDS

14. Failure to Thrive (FTT)

15. Toddler Diarrhea and Celiac Disease • “Toddler diarrhea” typically caused by sucrose & sorbitol content of fruit juices • Celiac disease results in diarrhea & caused by sensitivity to the protein gluten found in wheat & other grains

16. Autism • No scientifically proven diet is recommended for prevention or treatment • Gluten-free & casein-free diets have been recommended via Internet and support groups but not scientifically shown beneficial

17. Muscle Coordination Problems & Cerebral Palsy • Cerebral palsy • Group of disorders characterized by impaired muscle activity & coordination present at birth or developed during early childhood • Spastic quadriplegia: a form of cerebral palsy • Reduced dietary intake results from child easily becoming tired while eating

18. Meal Pattern & Recommended Foods • Meal pattern may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals • Foods recommended are easy to chew and small

19. Meal Pattern & Recommended Foods

20. Pulmonary Problems • Examples of pulmonary (breathing) problems are brochopulmonary dysplasia & asthma • Breathing problems increase nutrient needs, lower interest in eating & can slow growth • Preterm infants at high risk of breathing problems

21. Developmental Delay & Evaluation • Developmental delay may be suspected when: • Specific nutrients are inadequately or excessively consumed • May result from iron deficiency or lead toxicity • Physical growth may be impacted

22. Food Allergies and Intolerance • True food allergies seen in ~2% to 8% of children • Common food allergies include: • Milk • Eggs • Wheat • Peanuts • Walnuts • Soy • Fish

23. Dietary Supplements and Herbal Remedies • Parents should be cautioned about use of supplements and/or herbs to treat various conditions • Often unproven recommendations come from support groups or the Internet

24. Sources of Nutrition Services • State programs • Early intervention programs • Early childhood education programs (IDEA) • Head Start • Early Head Start • WIC • Low birthweight follow up • Child care feeding programs