Nutrition and Developmental Disabilities

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Nutrition and Developmental Disabilities
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Definitions

• 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.

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Why does nutrition matter for kids with special
needs?

• These are the kids at nutritional risk in this
  country
• Complicated
• Baer model
• Differential development
• Achieving one milestone doesnt predict the
  achievement of the next
• In Atlanta study, children lt 3rd percentile
• 85 inpatients had disease or low birth weight
• 55 outpatients had disease or low birth weight
• Sherry et al, Nutrition Research 2000
  201689-1696

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Why does nutrition matter for kids with special
needs?

• Increasing numbers of children are surviving
• Require life long care
• Children are being cared for by their families
• Lack of supportive medical services
• Nutrition and medical supplies
• Matters to families
• Notice improvements in simple things, hair, skin
• Improved medication usage

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Nutritional problems

• Various studies show 70 of children with
  special needs require nutritional intervention.
• Why so many problems?
• Complex medical and therapeutic interventions.
• Lots of secondary malnutrition
• Doctor shopping
• Lack of concern for normal nutrition and
  growth?
• Cant cure them, so ..

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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

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Etiology of FTT

• Failure to thrive long term caloric deficit
• Caloric deficit STARVATION
• Primary
• Lack of adequate food STARVATION
• Child abuse and/or neglect
• Secondary
• STARVATION because of disability or disease
• Acceptable?

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Common consequences of poor nutrition

• Constipation, diarrhea change in appetite
• Immune system infection
• Drug utilization
• Altered metabolism of drugs
• ADHD and drugs
• Long term functional changes in brain
• Iron
• FTT similar to language disorders Dykman 00

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Consequences

• Feeding dysfunction Fung02
• None -1.7 z-score
• Mild -2.5
• Moderate -3.3
• Severe -1.8
• Tube fed

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Consequences

• Selected factors associated with increased risk
  of mortality in children with CP Stauss98
• Spasticity and some self-feeding skill 1.00
• Quadriplegia type CP 1.40
• Severe, profound mental retardation 3.11
• Fed by others, no feeding tube 6.18
• Cannot lift head when lying on stomach 13.91
• Feeding tube 23.65

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Parents Perspective's

• Important!
• More information less stress
• Associated with morning the loss of a normal
  child
• Trace of guilt
• Lack of support
• Tube feeding
• Feeding difficulties Brotherson and Kennedy

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Nutrition Interventions

• Cost effective
• 1 spent on nutrition saves 20 in medical costs
• Team oriented
• Community based or group home
• Problem based

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Assessment of growth

• Length (over 24 months, Height), Weight
• Use normal CDC standards unless
• Genetic difference
• Lack of age appropriate mobility
• Physical lack
• Head circumference often not helpful
• Hydrocephalus, microcephalus
• Triceps skin fold can always store fat

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Problem based intervention

• Changes in nutrient need and changes in nutrient
  absorption and utilization.
• Medication Nutrient interactions
• Seizure meds Vit D, Folic acid, Carnitine, bone
  density
• Laxatives fat soluble, K deficiency
• Steroids growth changes, bone (CA, Phos) and
  insulin resistance

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Problem based intervention

• Constipation major problem
• Diarrhea
• Oral feeding
• Delay start
• Hydration problems
• Behavior issues
• Unidentified sensory problems
• What is normal? Or is that not important?

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Weight based interventions

• A little makes a big difference!
• Weight never gained may exacerbate existing
  problems
• Weight gained may never be lost and cause new
  problems
• Mobility and muscle tone alters calorie needs
• Unexpected?

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Weight based interventions

• Disease conditions
• Bronchopulmonary dysplasia,
• Cystic fibrosis
• Congenital heart disease
• Chronic renal failure
• Sickle cell disease
• Asthma
• Allergies

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Metabolic disorders

• Restriction of one or more dietary components
• Amino acid disorders
• Carbohydrate disorders
• Use of special formulas Ross Labs
• VERY restricted diet
• Monitor hydration, feeding problems
• Illness catabolism leads to metabolic crisis

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Ketogenic diet for seizures

• Very trendy!
• Dates to 1920s
• 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

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Ketogenic diet

• Initial fast to induce ketosis
• 41 - Four grams of fat for every one gram of CHO
  and PRO combined
• Severe restriction of CHO meds, toothpaste
• Start at 75 estimated caloric needs
• I gm protein/kg
• Fluid restriction 60-70cc/kg body weight
• On diet for two years

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Ketogenic diet

• MCT oil 9 tbsp and 1 tsp
• 41 grams protein
• 90 grams CHO
• 20 grams fat not MCT oil
• Food1/2 oz meat, ¼ c fruit, extra fat as mayo,
  whipping cream to drink

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Alternative therapy

• Mega vitamin therapy
• Exceed UL
• Nutrient imbalance
• Feingold diet
• Eliminates artificial colors and salicytes
• Almonds, apricots, apples, ice cream, asprin
• Pica

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Feeding disorders

• Cause of secondary malnutrition
• Anatomical
• Neurological
• Behavioral
• Sensory
• Hypersensitive Touch of food on lips, shudder or
  spit
• Hyposensitative not respond to food
• Environmentally sensitive

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Interventions

• Positioning
• Texture modification
• Thick liquid
• Special equipment
• Parent education
• Important to coordinate care with the complete
  team so nutritional status is not compromised.