FEEDING AND NUTRITION OF YOUNG CHILDREN WITH DISABILITIES

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FEEDING AND NUTRITION OF YOUNG CHILDREN WITH
DISABILITIES

• Elisabeth Ceysens, MS, RD, LN
• Pat Lilley, MS, CCC-SP
• REACH Telehealth Presentation
• 10/15/04

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Malnutrition

• Undernutrition underconsumption of energy
  (calories), protein and nutrients (vitamins and
  minerals).
• Severe and/or prolonged undernutrition leads to
  malnutrition

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Types of Malnutrition

• Acute Malnutrition
• Low weight-for-age
• Sparing of height and head circumference growth
  parameters
• Results from acute illness or short-term
  undernutrition
• Weight rebounds/catches up quickly

• Chronic Malnutrition
• Low weight-for-age
• Low height-for-age
• May have low weight-for-height or be well
  proportioned
• Head circumference affected only in severe and
  prolonged malnutrition

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Effect of Malnutrition on Physical Development

• Low growth parameters
• Difficulty gaining weight weight loss or below
  average rate of weight gain
• Low fat and muscle mass

• Poor wound healing
• Decreased immune response
• Decreased energy for play and learning
• Lack of focus/energy
• Lethargy

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Effect of Malnutrition on Mental Development

• Brain atrophy possible
• May decrease IQ and scholastic achievement
• Effect worse in first six months of life

• Effect may be (partially) reversed with nutrition
  rehabilitation
• Nutrients for brain growth calories, protein,
  vitamin A, iron, zinc, marine fat

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Causes of malnutrition

• Lack of food
• Oral motor difficulties/inability to feed
  self/below age eating skills/dental problems
• Gastrointestinal problems (reflux, constipation,
  malabsorption)
• Self-regulation problems/sensory integration
  difficulties
• Medical conditions
• Frequent illness/multiple medications

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Nutrition Screening

• Purpose to identify infants and children with
  nutrition problems and those at-risk for
  developing nutrition problems.
• Screening should be routine and periodic for all
  children.
• A nutrition screening tool may be used to
  identify at-risk children.
• Screening may be done by parent or staff member
• Example The PEACH survey

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Referring for Nutrition Services

• Registered dietitian (RD) or licensed
  nutritionist (LN) on contract with EI agency
• Consulting pediatric RDs and LNs
• University Hospital, Carrie Tingley and
  Presbyterian Hospital nutrition clinics and
  specialty clinics
• CMS nutritionist for support and referral
• If nutrition services are required more than once
  or twice a year, the service should be included
  in IFSP. Nutritionist should be part of team.

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EI Video
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Feeding the Young Child with Disabilities

• Knowledge of normal/typical feeding development
• Medical conditions that may affect feeding
• Chronic lung disease
• Prematurity
• Anatomical problems
• Developmental delays

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Reading Cues Approach

• Predictable hunger times
• Visual interest in bottle
• Reaching for breast/bottle
• Anticipating signs

• Easy mouth opening for nipple/spoon
• Interest in family meals
• Reaching for parents plate/cup
• Efficient nippling, eating (15-20 min.)

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Approach Cues
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Reading Cues Avoidance

• Withdrawal from touch
• Jaw clenching
• Lip pursing
• Hyperactive gag
• Tongue retraction
• Tongue thrusting

• Feeding refusal
• Difficulty transitioning to early solids
• Accepting bottle only when asleep

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Avoidance Cues
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Identifying Abnormal Feeding Problems

• Disorganization/Delay
• Dysfunction

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Gastroesophageal Reflux(GER)

• Exposure of esophagus to gastric contents
• Occurs in 50 of newborns
• In 95 of children with reflux, it resolves by
  9-12 months of age

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Gastroesophageal refluxSymptoms

• Emesis during/after feeding
• Hyperextension of neck/arching
• Refusing nipple after only part of feeding
• Oral aversion
• Sudden waking and crying
• Excessive NNS and swallowing
• Unexplained night time cough
• Preference for nipple when asleep

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Factors that contribute to increased GER in
infants and young children

• Supine position
• Decreased lower esophageal sphincter (LES) tone
  and pressure
• Motility problem
• Hiatal hernia
• Increased abdominal pressure from abnormal muscle
  tone, seizures, hip flexion

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Treatments for GER

• Best cure is time and maturation
• Medications
• Surgery
• Positioning and dietary modifications
• Upright during and after feeding
• Thickened liquids
• Smaller more frequent feedings

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Reflux
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Sensory Based Oral Feeding Problems

• Difficulty with transition to pureed foods
• Hypersensitive gag
• May smell or lick food
• May bite or chew food but not swallow
• Rigid behaviors about mealtime choices, may avoid
  participating in mealtime
• Often has functional, age appropriate oral motor
  skills

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Treatment Strategies for Sensory Based Feeding
Problems

• Gradually increase texture of foods over time
  (two weeks)
• Use chewing and fun feeding activities as
  needed
• Use appropriate utensils for liquids and pureed
  food (alternative cups, spoons)
• Increase opportunities for finger feeding/self
  feeding
• Use enhanced flavors

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Neuromotor Feeding ProblemsSymptoms

• Hypertonic
• Jaw thrust, clenching
• Tongue thrust
• Tongue and/or lip retraction
• Poor grading of movements
• Fatigue with eating

• Hypotonic
• Poor lip closure
• Persistent open mouth
• Flaccid, protruding tongue, limited movement
• Drooling
• Fatigue with eating

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Treatment Strategies for Motor Based Feeding
Problems

• Positioning
• Jaw and/or cheek support
• Decrease jaw thrust
• Increase grading of jaw movement
• Facilitate lip closure
• Improve tongue movement and facilitate central
  tongue groove

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Practical Suggestions

• POSITIONING
• Look very carefully at positioning
• Develop seating systems that work easily for the
  family
• Use blanket rolls, towels, small pillows to
  optimize use of high chair, booster seat or car
  seat for supportive positioning

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Practical suggestions

• FOODS
• Proper measurement of formula and supplements
• Use foods family typically eats (to extent
  possible)
• Thicken liquids and modify texture to appropriate
  consistencies

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Practical Suggestions

• EQUIPMENT
• Use developmentally appropriate cups, utensils
  (child-sized spoon, sippy cups, etc.)
• Use of baby food grinder or simple ways to modify
  table foods

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Practical Suggestions

• FEEDING ROUTINES
• Identify current family routines and work
  together to modify childs eating schedule as
  needed
• Identify strategies to support positive behaviors
  around eating

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Practical Suggestions

• OTHER
• Try to follow typical timelines for transitioning
  to solid foods, weaning from bottle, introducing
  cup drinking and finger feeding
• Encourage families to follow reflux medication
  regimen carefully

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How to Start a Feeding Intervention Program

• Home Based Feeding Intervention Program

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The Division of Responsibility in the Feeding
Relationship

• The parent is responsible for what, when and
  where
• The child is responsible for how much and whether

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Ellyn Satter
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Making the Eating Experience Pleasurable
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