Nutrition Interventions for Children with Special Health Care Needs

Chapter 13 - Nutrition Interventions for Overweight and Obesity
An accurate diagnosis of overweight and obesity requires measurements of length
or height, weight, a visual assessment, and previous growth data to determine
rates of weight gain over time. This data can then be compared to norms, although
interpretation requires professional judgment with certain conditions and diagnoses,
since standards are not available for children with special health care needs. Either
weight for length or BMI should be used to determine overweight or obesity along
with other data and history. Each child’s individual diagnosis and body composition
should be considered when evaluating overweight and/or obesity.
Overweight and obesity in children with disabilities may impair their mobility,
balance, and ability to progress in gross motor skills. As a consequence, the child’s
energy needs may be further reduced. Overweight children who are not ambulatory
also require greater physical effort from family and other caregivers in their daily
activities.
Children who have short stature and/or limited mobility are more prone to excessive
weight gain than their typically developing peers. For non-ambulatory children,
energy needs are 25 to 50% lower than those of ambulatory children (3). Additional
factors that may contribute to obesity include: a family history of obesity; family
eating patterns that result in excess energy intake; frequent snacking or lack
of structured meals and snacks; use of food as a bribe or reward; and limited
opportunities for physical activity (4).
Children with Prader-Willi syndrome are at high risk for obesity unless diet
management and control of food access is consistently implemented. The risk of
weight gain in most other conditions associated with overweight, such as spina bifida
or Down syndrome, is related directly to the factors of short stature, limited activity
or mobility, and energy intake. Due to the common characteristic of short stature
in many children with developmental disabilities, assessment of energy intake and
determination of energy needs for weight maintenance or loss should be based on
height, e.g. kilocalories per centimeter (3,5).
Routine periodic monitoring of growth parameters allows the identification of a
pattern of weight gain likely to result in obesity. This allows early intervention
to correct the factors contributing to excessive weight gain before obesity is
established. Frequent growth monitoring is especially important for children who are
at risk for obesity.
The remainder of this chapter presents guidelines for nutrition assessment,
intervention, and evaluation/outcome for children with obesity.
144 Nutrition Interventions for Children With Special Health Care Needs