Description of Selected Disabilities

1. Description of Selected Disabilities Stephanie Alsbrook, RD, LD Arkansas Department of Education Child Nutrition Unit

2. Objectives • Identify and define common disabilities found in children. • Identify specific dietary restrictions or modifications associated with the disabilities.

3. SPECIAL NOTE • We are discussing the most common disabilities and the most often prescribed dietary restrictions and modifications. • This does NOT mean that any Child Nutrition personnel should make changes to diets without written documentation from a licensed physician or recognized medical authority.

4. Autism • Part of the Autism Spectrum (or group) of disorders. • Identified when a child has many behavioral problems: • Not connecting with children or adults • Refusing to make eye contact • Not talking to others • Often very limited in food intake

5. Diet Prescription • Children with Autism are often treated with a special meal plan: • Omits all foods that contain gluten (a product of wheat and some other cereals) • Omits casein (protein component of milk)

6. Cerebral Palsy • A disorder where there has been an injury to the developing brain early in life. • Is frequently the result of a premature birth or other problems associated with pregnancy. • Occurrence is two per 1000 live births. • Signs and symptoms can include increased motor tone, abnormal motor patterns or postures, and low muscle tone

7. Cerebral Palsy • CP is primarily a motor disability, but can be accompanied by mental retardation and learning disabilities. • Often have trouble eating and gaining weight.

8. Diet Prescription • Increased calories • Texture changes – could be chopped, pureed, or blended • Special utensils for self-feeding • Positioning • Thickened liquids

9. Epilepsy or Seizure Disorder • Has multiple causes involving the brain. • The seizures that occur are sudden episodes of abnormal behavior which result from what is described as “firings” within the brain. • Causes of seizures: low blood sugar, electrolyte abnormalities (sodium or potassium) • Many children are on anticonvulsant meds

10. Diet Prescription • Some children with epilepsy or seizures may have a low calorie diet due to excessive weight gain as a result of the anticonvulsant medication. • A ketogenic diet – managed by RD following the child. • Instructions to address feeding problems.

11. Muscular Dystrophy • A group of genetic disorders characterized by progressive weakness and degeneration of the skeletal muscles that control movement. • Some forms are present at birth and others are not identified until adolescence.

12. Diet Prescription • Feeding problems • Need for special utensils • Texture modification for chewing and swallowing problems • Increased calories

13. Mental Retardation • Often caused by conditions called syndromes. • Syndromes are defined as a set of characteristics which occur together. • Two most common: • Down Syndrome • Prader-Willi Syndrome

14. Down Syndrome • A disorder of the chromosomes. The normal genetic pattern of chromosomes is when each individual has 23 pairs in each cell or a total of 46 chromosomes. • Individuals with Down Syndrome will have an extra chromosome on the 21st chromosome and is sometimes called Trisomy 21.

15. Diet Prescription • Low calories for the child who is overweight • Texture modification for chewing and swallowing problems • Self-feeding devices

16. Prader Willi (PW) Syndrome • Involves the 15th chromosome. • Often have failure to thrive as infants. • Preschool children with PW have an overwhelming appetite and lack the ability to know when they are full. • Limiting food intake and availability is very important.

17. Diet Prescription • Decreased calories • Supervision to prevent food seeking (Environmental controls are essential because children with PW cannot control this continual urge to obtain additional food.)

18. Spina Bifida • A term frequently used to describe various forms of a neural tube defect. • These children are born with a lesion in the spinal column. • In normal development, the spine is formed with a spinal cord making a column along the back surrounded by a membrane and the bones of the spine. • In spinda bifida, the formation is incomplete and a sac is formed in the back.

19. Folic Acid • Since 1995, folic acid has been used to supplement the dietary intake of women of childbearing age, and its use has resulted in a 20% decrease in the incidence of spina bifida.

20. Diet Prescription • Possible low calorie meal plan • Extra fluids including cranberry juice • Increased fiber • Texture modification

21. Cystic Fibrosis (CF) • A disorder of childhood characterized by the production of increased amounts of mucus, progressive lung disease, and impaired absorption of fat and protein. • May also cause the duct connecting the pancreas to the intestines to become clogged, resulting in CF induced diabetes.

22. Cystic Fibrosis • Treatment consists of taking enzymes (usually with every meal and snack) which improve the absorption of proteins and fats. • The child with CF may have lactose intolerance which requires the elimination of milk and milk products. • Lack of weight gain is frequently a problem, along with limited growth and vitamin and mineral deficiencies.

23. Diet Prescription • Increase calories • Lactose free or reduced-lactose food choices • Increased protein

24. Rett Syndrome (RS) • A neuron developmental disorder primarily involving girls. • A genetic disorder characterized by a period of apparently normal development followed by the decrease of developmental skills.

25. Diet Prescription • Increased fiber • Texture modification • Increased calorie needs • Special feeding devices • Occasionally, tube feedings

26. Celiac Disease • A complex genetic disease • An immune response to the ingestion of gluten (found in wheat, barley, and rye) that damages the small intestine • Can present itself in several ways ranging from failure to thrive to no symptoms at all. • An increased number of diagnoses because of more frequent testing for Celiac Disease. • Sometimes associated with children who have type 1 diabetes (both autoimmune related).

27. Diet Prescription • Gluten Free Diet • Gluten – storage proteins in wheat, barley, and rye.

28. Wheat Rye Oats Barley Semolina Durham Einkorn Triticale Spelt Kamut Farina Flour Breading/Cereal Malt/Malt Flavoring/Malt Syrup Malt Vinegar Cracked Wheat Graham Flour/Crackers Wheat Germ Wheat Starch Bulgur Wheat Gluten (Seitan) Matzo/Matzo Meal Couscous Orzo Ingredients to Avoid

29. Broth Candy Coating Mixes Communion Wafers Croutons Imitation bacon Imitation seafood Marinades Processed Meats Roux Sauces/Gravies Seasoning Self-basting poultry Seasoning Soup bases Soy sauce Stuffing Thickeners Vegetarian Meat Substitutes Frequently Overlooked Foods that May Contain Gluten

30. Buckwheat/Kasha Millet Monosodium Glutamate MSG Maltodextrin Corn Gluten Glutinous Rice Starch Mono and Diglycerides Vegetable Broth Canola Oil Vinegar (except malt vinegar) Spices Gluten Free Ingredients That Are Frequently Questioned

31. More Resources • Contact ADE, CNU (501) 324-9502 • www.gluten.net • www.celiac.org • www.celiachealth.org • www.celiackids.com • www.csaceliacs.org • www.americanceliac.org

32. Renal Disease • End-stage Renal Disease • Kidneys have nearly or completely stopped functioning • Dialysis is required • Most children use peritoneal dialysis • Handful of children in Arkansas use hemodialysis • Progressive Renal Disease • Kidneys are at various stages of function

33. Diet Prescription • Low Sodium Diet • Low Phosphorous Diet • Low Potassium Diet • Or any combination of the three restrictions. • Some children have all three. • Work closely with child’s registered dietitian.

34. Diabetes • Type 1 – autoimmune related • Diet Prescription: regular diet, carbohydrate counting, will require insulin injections or pump • may not have regular soda, kool-aid, or sweet tea. • May have desserts. • May experience low blood sugar and require extra snacks, including those that contain sugar. • Type 2 – most commonly associated with childhood obesity • Diet Prescription: Reduced calories, protein, and fat. Weight loss required to improve condition. • May or may not be on oral meds or insulin.

35. Additional Information • For more information on any of the conditions that we covered today or any other condition, please contact ADE, CNU at (501) 324-9502. Thank-you!!