Transcript Nutrition and Developmental Disabilities

Nutrition and Developmental
Disabilities
Definitions
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Developmental delay: a finding 1.5
standard deviations below the age adjusted
norm on a standardized test.
Age adjusted: chronological age – weeks
born early. Used until 2-3 years old.
Special needs: a catch all term including
children with a medical, developmental and
learning diagnosis.
Why does nutrition matter for kids
with special needs?
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These are the kids at nutritional risk in this country
Complicated
 Baer
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Differential development
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model
Achieving one milestone doesn’t predict the achievement of the
next
In Atlanta study, children < 3rd percentile
– 85% inpatients had disease or low birth weight
– 55% outpatients had disease or low birth weight
 Sherry
et al, Nutrition Research 2000 20:1689-1696
Why does nutrition matter for kids
with special needs?
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Increasing numbers of children are surviving
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Require life long care
Children are being cared for by their families
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Lack of supportive medical services
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Nutrition and medical supplies
Matters to families
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Notice improvements in simple things, hair, skin
Improved medication usage
Nutritional problems
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Various studies show +70% of children with special
needs require nutritional intervention.
Why so many problems?
Complex medical and therapeutic interventions.
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Lots of secondary malnutrition
Doctor shopping
Lack of concern for “normal” nutrition and growth?
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Can’t cure them, so …..
Definitions of Malnutrition
Protein Energy Malnutrition (PEM)
 Primary: inadequate food intake
 Secondary: result of disease
Failure to thrive (FTT)
 In-organic: inadequate food intake
 Organic: result of disease or disability
Etiology of FTT
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Failure to thrive = long term caloric deficit
Caloric deficit = STARVATION
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Primary
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Lack of adequate food :STARVATION
Child abuse and/or neglect
Secondary
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STARVATION because of disability or disease
Acceptable?
Common consequences of poor
nutrition
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Constipation, diarrhea: change in appetite
Immune system: infection
Drug utilization
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Altered metabolism of drugs
ADHD and drugs
Long term functional changes in brain
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Iron
FTT similar to language disorders Dykman: 00
Consequences
 Feeding
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dysfunction Fung:02
None:
Mild
Moderate
Severe
 Tube
fed
-1.7 z-score
-2.5
-3.3
-1.8
Consequences
Selected factors associated with increased risk of
mortality in children with CP Stauss:98
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Spasticity and some self-feeding skill
Quadriplegia type CP
Severe, profound mental retardation
Fed by others, no feeding tube
Cannot lift head when lying on stomach
Feeding tube
1.00
1.40
3.11
6.18
13.91
23.65
Parents Perspective's
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Important!
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More information: less stress
Associated with morning the loss of a “normal” child
Trace of guilt
Lack of support
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Tube feeding
Feeding difficulties
Brotherson and Kennedy
Nutrition Interventions
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Cost effective
$1 spent on nutrition saves $20 in medical
costs
Team oriented
Community based or group home
Problem based
Assessment of growth
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Length (over 24 months, Height), Weight
Use normal CDC standards; unless
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Head circumference: often not helpful
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Genetic difference
Lack of age appropriate mobility
Physical lack
Hydrocephalus, microcephalus
Triceps skin fold: can always store fat
Problem based intervention
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Changes in nutrient need and changes in
nutrient absorption and utilization.
Medication Nutrient interactions
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Seizure meds: Vit D, Folic acid, Carnitine, bone
density
Laxatives: fat soluble, K deficiency
Steroids: growth changes, bone (CA, Phos) and
insulin resistance
Problem based intervention
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Constipation: major problem
Diarrhea
Oral feeding
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Behavior issues
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Delay start
Hydration problems
Unidentified sensory problems
What is normal? Or is that not important?
Weight based interventions
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A little makes a big difference!
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Weight never gained may exacerbate existing
problems
Weight gained may never be lost and cause new
problems
Mobility and muscle tone alters calorie needs
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Unexpected?
Weight based interventions
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Disease conditions:
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Bronchopulmonary dysplasia,
Cystic fibrosis
Congenital heart disease
Chronic renal failure
Sickle cell disease
Asthma
Allergies
Metabolic disorders
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Restriction of one or more dietary
components
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Amino acid disorders
Carbohydrate disorders
Use of special formulas: Ross Labs
VERY restricted diet
Monitor hydration, feeding problems
Illness: catabolism leads to metabolic crisis
Ketogenic diet for seizures
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Very trendy!
Dates to 1920’s
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Brain uses ketones, not glucose for energy
Used when medication fails
Ages 2-5
Cream or MCT oil diet
Generally started in major research center
Generally started in hospital
Ketogenic diet
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Initial fast to induce ketosis
4:1 - Four grams of fat for every one gram of
CHO and PRO combined
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Start at 75% estimated caloric needs
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Severe restriction of CHO: meds, toothpaste
I gm protein/kg
Fluid restriction: 60-70cc/kg body weight
On diet for two years
Ketogenic diet
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MCT oil 9 tbsp and 1 tsp
41 grams protein
90 grams CHO
20 grams fat not MCT oil
Food:1/2 oz meat, ¼ c fruit, extra fat as
mayo, whipping cream to drink
Alternative therapy
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Mega vitamin therapy
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Feingold diet
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Exceed UL
Nutrient imbalance
Eliminates artificial colors and salicytes
Almonds, apricots, apples, ice cream, asprin
Pica
Feeding disorders
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Cause of secondary malnutrition
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Anatomical
Neurological
Behavioral
Sensory
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Hypersensitive: Touch of food on lips, shudder or spit
Hyposensitative: not respond to food
Environmentally sensitive
Interventions
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Positioning
Texture modification
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Thick liquid
Special equipment
Parent education
Important to coordinate care with the
complete team so nutritional status is not
compromised.