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

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

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

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

Nutrition Needs of Toddlers & Preschoolers with Chronic Conditions

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?

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

Nellhaus Head Circumference Growth Chart Plotted for Girl with Rett Syndrome

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

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

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

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

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

Failure to Thrive (FTT)

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

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

Muscle Coordination Problems & 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

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

Meal Pattern & Recommended Foods

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

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

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

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

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