Nutrition Interventions for Children with Special Health Care Needs

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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
Table 13-1: NuTriTioN iNTerveNTioNs for overweighT aNd obesiTy assessmeNT iNTerveNTioN evaluaTioN/ouTcome Anthropometric * Measure and plot on appropriate growth chart: For child who is moderately obese, set goal of weight maintenance or decreased rate of weight gain. For child who is significantly obese, set goal of slow weight loss (no more than 2 lb/mo) 6 . • Length/height for age • Weight for age • Weight for length or BMI • Head circumference (
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Nutrition Interventions for Childre
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Kay Kopp, OTR/L Occupational Therap
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Appendices Appendix A Sample Screen
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ii Nutrition Interventions for Chil
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Population “Children with special
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vi Nutrition Interventions for Chil
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Chapter 1 - Nutrition Screening and
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Chapter 2 - Anthropometricss needs,
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Chapter 2 - Anthropometricss Statur
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Chapter 2 - Anthropometricss Techni
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Chapter 2 - Anthropometricss paraly
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Chapter 2 - Anthropometricss time a
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Chapter 2 - Anthropometricss measur
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Chapter 2 - Anthropometricss Mild m
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Chapter 2 - Anthropometricss 9. Re-
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Chapter 2 - Anthropometricss 5. Per
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Chapter 2 - Anthropometrics Table 2
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Chapter 2 - Anthropometricss Refere
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Chapter 2 - Anthropometricss 26. Kr
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Chapter 3 - Physical Activity for C
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Chapter 4 - Breastfeeding recommend
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Chapter 4 - Breastfeeding Table 4-1
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Chapter 4 - Breastfeeding Assessmen
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Chapter 4 - Breastfeeding 58 Nutrit
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Chapter 5 - Medication-Nutrient Int
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Chapter 6 - Nutrition Interventions
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Chapter 17 - Nutrition Intervention
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Chapter 22 - Ketogenic Diet for Sei
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Appendix A Please list any other nu
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Appendix A Baby formula What kind o
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Appendix B Manufacturer Description
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Appendix C 282 Nutrition Interventi
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Appendix D 284 Nutrition Interventi
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Appendix E 292 Nutrition Interventi
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Appendix E Table 3: Parent-Specific
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Appendix F Percentiles of Upper Arm
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Appendix F 302 Nutrition Interventi
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Appendix G 304 Nutrition Interventi
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Appendix H 312 Nutrition Interventi
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Appendix I 320 Nutrition Interventi
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Appendix J 328 Nutrition Interventi
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Appendix K 336 Nutrition Interventi
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Appendix K 338 Nutrition Interventi
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Appendix L 340 Nutrition Interventi
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Appendix M 342 Nutrition Interventi
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Appendix M 344 Nutrition Interventi
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Appendix N Gastrostomy Tube Feeding
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Appendix N activities. When feeding
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Appendix N Feeding Sets/Extensions
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Appendix N Fluid and Electrolytes W
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Appendix N osmolality of full-stren
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Appendix N Modular Products Modular
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Appendix N his family, and the home
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Appendix N • The feeding tube may
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Appendix N equipment. The Special S
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Appendix N Table N-2: Common Compli
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Appendix N Complication Possible Ca
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Appendix N 368 Nutrition Interventi
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Appendix O Some conditions increase
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Appendix O Table O-3: Recommended P
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Appendix O 374 Nutrition Interventi
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Appendix P Diet Prescription for Me
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Appendix Q Goals Considerations for
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Appendix R Condition Description Nu
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Appendix R Condition Description Nu
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Appendix R References 1. Ekvall SW
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Appendix S Table S-1: Infant Formul
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Appendix S Comments Osmolality (mOs
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Appendix S Table S-2: Pediatric For
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Appendix S Table S-3: Modular Produ
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Appendix S Comments Energy (kcal) P
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Appendix S Contact Information Abbo
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Appendix T Powdered Formulas Accura
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Appendix T Table T-1: Liquid Concen
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Appendix T 402 Nutrition Interventi
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Appendix U Nutrition Strategies for
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Appendix U ADA Pocket Guide to Nutr
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Glossary Autism Spectrum Disorders
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Glossary Early intervention service
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Glossary Length (recumbent length)
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Glossary Stadiometer moveable headb
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Index specialist 98 target 108 Bink
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Index elemental formula 348 elimina
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Index I ICF. See International Clas
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Index risk indicators 4 screening 1
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Index suppositories 72, 77 Surmonti
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Nutrition Interventions for Children with Special Health Care Needs

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