Nutrition Interventions for Children with Special Health Care Needs

Chapter 14 - Nutrition Interventions for Failure to Thrive
though valuable information may be obtained in the clinical setting (1,2,7). The
feeding can be videotaped to replay for further evaluation, as well as to illustrate
problematic feeding behaviors and behaviors a parent may need to alter. Particular
attention is given to the child’s feeding pace, suck, chewing, and swallowing skills,
feeding independence, and ability to focus and communicate hunger and satiety.
Other factors to assess include the parent’s understanding of the child’s needs,
ease of interaction, ability to read the child’s cues, and meal preparation skills
(1,2,11). Feeding specialists skilled at determining a child’s feeding ability and able
to distinguish between productive and nonproductive parent-child interactions can
provide interventions to help a child begin to unlearn negative associations with food
and feeding (7,11). (See Chapter 9.)
Assessing nutritionAl stAtus
A comprehensive nutrition evaluation by the registered dietitian (RD) who has
experience in growth and feeding dynamics can provide insight to the origins
of the child’s food struggles and the relative risk of physiological complications
associated with undernutrition (1,2,7). The RD evaluates a child’s growth pattern,
comparing an individual’s rate of growth and body composition to reference data.
The RD can then determine reasonable growth goals and provide guidance about
how to accomplish specific goals. In addition to the growth assessment, a history of
feeding development should be obtained, including information about feeding skills,
readiness for independent feeding, and ease of transitions to new tastes and textures
(1,2,7). For infants, breast and bottle feeding frequency, feeding duration, suck
strength, and formula preparation are evaluated. A 3-day diet record for the infant
or toddler gives an approximate nutrient intake, provides information with regard
to meal and snack routine, and can indicate the family’s use of specific diets (e.g.,
vegetarian), supplements, or alternative therapies (1,2,14). A comparison of a diet
recall the day of a clinic visit and a three-day diet record prior to the visit may also
indicate differences between the parent’s perception of the child’s diet and the actual
eating pattern.
Once the initial team evaluation is complete, a conference with the family allows for
the development of a plan that the family can use with follow-up from the team (7).
Nutrition therapy may be as simple as instructing the parent on the child’s needs for
greater energy density, limiting juice intake, or offering developmentally appropriate
foods (2,7,15). Other situations may require further education and support in order
to help parents avoid erratic feeding patterns and move toward more appropriate
meal and snack organization (10). The RD who is experienced with eating disorders
may also provide nutrition therapy in conjunction with psychosocial intervention for
154 Nutrition Interventions for Children With Special Health Care Needs