Nutrition Interventions for Children with Special Health Care Needs

Section 3 - Condition-Specific Nutrition Interventions
Assessment and Treatment of Growth Failure
Primary care providers are encouraged to seek comprehensive evaluation from
feeding and growth experts when a feeding or growth problem is suspected (1,7).
The most effective assessment and intervention for growth failure is by a team of
professionals in pediatric medicine (physicians and nurses), developmental feeding
(specialists from occupational therapy or speech pathology), psychosocial services
(behaviorists, social workers, psychologists, psychiatrists), and nutrition (registered
dietitians) (1-3,7). This interdisciplinary team, along with parents/caregivers, can
identify the factors influencing growth and prioritize interventions for the family
and child (7). Effective intervention can focus on educating parents with regard to
their child’s needs and modeling a positive interactive response to a child’s behavior.
Parents may also need support to identify issues that negatively impact their ability
to implement a treatment plan consistently (7). Intervention should also include the
identification of issues related to the nutrition, medical and developmental needs of
the child and selection of appropriate interventions from the family and community.
Assessing MedicAl contributors
A detailed medical history of both the child and the parents can be compared to a
child’s growth history to identify possible medical and developmental issues that
may negatively impact a child’s emotional and feeding development (1). Examples of
common medical contributors (2,13):
• gastrointestinal—gastroesophageal reflux, malabsorption
• neurological—problems with sucking, chewing, swallowing
• respiratory—increased energy needs, difficulty coordinating suck-swallowbreathing
pattern
• cardiac—increased energy needs, fluid restrictions
• endocrine—alterations in appetite, increased energy needs, coordination of meals
and insulin
See reference 1 for a more detailed review of the medical concerns related to growth
failure.
Assessing A Feeding situAtion
When a growth problem is noted, it is important to observe a typical feeding
situation (1,2,7,11). Growth evaluations completed without a feeding observation
are limited to the parent’s perception of feeding and interaction problems. Feeding
observations may take extra time and expertise, but provide a more accurate
picture of an individual situation. They are ideally performed in a home setting,
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