Nutrition Interventions for Children with Special Health Care Needs

Chapter 1 - Nutrition Screening and Assessment
• diet
• developmental feeding skills
• behavior (related to feeding)
• socioeconomic characteristics
The screening activities in each of these categories are described in Table 1-1.
Nutrition screening can be effective without including all the categories or all
suggested data within a category. The screening protocols must be adapted to the
setting and according to staff availability and other resources (6). Nutrition screening
should be brief and easy to administer. Parent-administered questionnaires and/
or interview methods can be effective tools for obtaining screening data. Screening
can be successfully completed by a variety of individuals such as the parent or
caregiver, public health nurse (PHN), clinic nurse, therapist, social worker, family
resource coordinator (FRC), primary care provider (PCP), registered dietitian (RD),
or dietetic technician (DTR). Nutrition screening can be incorporated into initial
early intervention screenings so that concerns can be identified and referred for an
assessment. Infants and children need to be screened on a regular basis to monitor
growth and nutritional status over time. Sample screening forms are included in
Appendix A.
When a child is identified as having one or more nutritional risk indicators, referral
for nutrition assessment with an RD is needed. Nutrition risk indicators need to be
clearly defined to avoid over-identification or under-identification of those at risk.
Refer to Table 1-1 for examples of risk indicators and sample criteria. In addition
to red flags identified by nutritional risk indicators, parental concerns should be
carefully listened to and considered.
Nutrition Assessment
Once a nutritional risk indicator is identified through screening, a nutrition
assessment serves to obtain all information needed to rule out or confirm a nutritionrelated
problem. Nutrition assessments should be completed by an RD, preferably
with pediatric expertise and/or specialized training for children with special health
care needs and developmental disabilities.
Nutrition assessment consists of an in-depth and detailed collection and evaluation
of data in the following areas: anthropometrics, clinical/medical history, diet,
developmental feeding skills, behavior related to feeding, and biochemical laboratory
data (2). During the assessment, risk factors identified during nutrition screening are
further evaluated and a nutrition diagnosis can be made. The assessment may also
reveal areas of concern such as oral-motor development or behavioral issues that
2 Nutrition Interventions for Children With Special Health Care Needs