Nutrition Interventions for Children with Special Health Care Needs

More documents

Recommendations

Info

Chapter 23 - Nutrition Interventions for Autism Spectrum Disorder Nutrition and Feeding The unique nutrition-related aspect for children with ASD is their selective food choices that often result in a narrow list of foods accepted. Parents frequently report “picky” eating, although this behavior is more persistent than the transient picky eating typically seen in young children. This diet selectivity is influenced by the same range of general behaviors seen in children with ASD. See Table 23-1. Although most parents report that their infants fed well and generally accepted baby foods, the transition to table foods after the first year tends to be more problematic. A frequent pattern is a preference for dry, crunchy foods; and refusal of soft, smooth textures, e.g. mashed potatoes and cooked cereal. Typically, finger foods are preferred to using eating utensils. Foods frequently reported in the diets of children with ASD include dry cereal (eaten as a finger food; no milk added), crackers, chicken nuggets, pizza, bread, hot dogs, and plain pasta, while intake of vegetables and fruits tends to be minimal. Over time, some children narrow their food acceptances even more, to fewer than 10-15 items; within that restriction, only certain brands or methods of preparation are allowed. It is easy to understand that families become anxious when their children continue to refuse foods, despite being offered a variety of foods. Eventually, parents respond by giving their child foods they know he/she will eat. This leads to different and sometimes separate meals for the child, and if behavior is an issue, less participation in family mealtime. Table 23-1 Feeding Behaviors of Children with Autism Autism Concerns Feeding Characteristics • Difficulty in transitioning to textures • Increased sensory sensitivity • Restricted intake due to color, texture, temperature, odor • Decreased acceptance of foods over time; refusal of “new” foods • Difficulty with changes in mealtime routines, tantrums • Preference for dry, crunchy foods (no milk on dry cereal) • Food groups most likely refused or limited – vegetables and fruits • Often adequate intake of protein (though limited selection) and dairy foods • Often prefer finger foods (sensory issues?) • Refusal of vitamin/mineral supplements Children with ASD tend to have growth parameters within normal limits, although overweight and underweight can be seen secondarily to feeding behaviors. Energy needs are usually met, although the food sources may be limited or an entire food group omitted. Due to their selective eating behaviors, the micronutrient intakes of these children may be minimal or inadequate. A recent report of preschool children with ASD indicated nutrients most at risk were vitamin A, vitamin E, fiber, and 264 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition Specific Nutrition Interventions calcium (4). In addition, elimination diets increase the risk of inadequate nutrient status. There have been reports of impaired bone growth in boys with autism, as measured by bone cortical thickness (BCT) (5). These changes were seen in boys whether they were on a restricted diet or not, but there was lower BCT in those on a gluten-free, casein-free diet. Alternative Nutrition Interventions There are many diet-based interventions to treat ASD, although scientific evidence confirming their efficacy is limited. Sophisticated marketing, testimonials, and claims have prompted many parents to adopt dietary changes and supplementation regimens for their children with ASD. The plethora of information available to parents and families on the Internet provides added challenges to RD’s and other health care providers. The most common nutrition interventions include: • Gluten-free/casein-free diet • Specific carbohydrate diet (SCD) • Yeast-free diet • Vitamin supplement for ASD, i.e. “Super Nu-Thera®” • Specific nutrients – B6, magnesium • Fatty acid supplements • Probiotics • Enzymes • Dimethylglycine (DMG) Gluten-free/casein-free (GFCF) diet The GFCF diet is the most popular dietary treatment intervention for children with ASD. The “leaky gut syndrome” (also called the opiate theory) is part of the basis for using the diet, and was originally developed by researchers in Europe (6,7). The theory is that children with ASD cannot properly digest the casein and gluten in dairy and wheat foods, leaving partially broken down polypeptides. With more permeable or “leaky” intestines, these polypeptides are believed to enter the circulatory system, passing through the blood-brain barrier. There they form compounds with endorphin receptors in the brain, causing some of the characteristics and behaviors seen in children with ASD. Removal of casein and gluten from the diet is therefore a treatment. Nutrition Interventions for Children With Special Health Care Needs 265
Page 1:
Nutrition Interventions for Childre
Page 4 and 5:
Page 6 and 7:
Kay Kopp, OTR/L Occupational Therap
Page 8 and 9:
Appendices Appendix A Sample Screen
Page 10 and 11:
Page 12 and 13:
ii Nutrition Interventions for Chil
Page 14 and 15:
Population “Children with special
Page 16 and 17:
vi Nutrition Interventions for Chil
Page 18 and 19:
Chapter 1 - Nutrition Screening and
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Chapter 2 - Anthropometricss needs,
Page 32 and 33:
Chapter 2 - Anthropometricss Statur
Page 34 and 35:
Chapter 2 - Anthropometricss Techni
Page 36 and 37:
Chapter 2 - Anthropometricss paraly
Page 38 and 39:
Chapter 2 - Anthropometricss time a
Page 40 and 41:
Chapter 2 - Anthropometricss measur
Page 42 and 43:
Chapter 2 - Anthropometricss Mild m
Page 44 and 45:
Chapter 2 - Anthropometricss 9. Re-
Page 46 and 47:
Chapter 2 - Anthropometricss 5. Per
Page 48 and 49:
Chapter 2 - Anthropometrics Table 2
Page 50 and 51:
Chapter 2 - Anthropometricss Refere
Page 52 and 53:
Chapter 2 - Anthropometricss 26. Kr
Page 54 and 55:
Chapter 3 - Physical Activity for C
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Chapter 4 - Breastfeeding recommend
Page 70 and 71:
Chapter 4 - Breastfeeding Table 4-1
Page 72 and 73:
Chapter 4 - Breastfeeding Assessmen
Page 74 and 75:
Chapter 4 - Breastfeeding 58 Nutrit
Page 76 and 77:
Chapter 5 - Medication-Nutrient Int
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Chapter 6 - Nutrition Interventions
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Chapter 8 - Oral-Motor Feeding Prob
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Chapter 9 - Behavior Issues Related
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Chapter 10 - Enteral Feeding Other
Page 140 and 141:
Chapter 10 - Enteral Feeding Table
Page 142 and 143:
Chapter 10 - Enteral Feeding Table
Page 144 and 145:
Chapter 10 - Enteral Feeding Refere
Page 146 and 147:
Chapter 11 - Community Monitoring o
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Chapter 12 - Accommodating Special
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Chapter 13 - Nutrition Intervention
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231: Chapter 18 - Nutrition Intervention
Page 264 and 265: Chapter 22 - Ketogenic Diet for Sei
Page 292 and 293: Appendix A Please list any other nu
Page 294 and 295: Appendix A Baby formula What kind o
Page 296 and 297: Appendix B Manufacturer Description
Page 298 and 299: Appendix C 282 Nutrition Interventi
Page 300 and 301: Appendix D 284 Nutrition Interventi
Page 308 and 309: Appendix E 292 Nutrition Interventi
Page 314 and 315: Appendix E Table 3: Parent-Specific
Page 316 and 317: Appendix F Percentiles of Upper Arm
Page 318 and 319: Appendix F 302 Nutrition Interventi
Page 320 and 321: Appendix G 304 Nutrition Interventi
Page 328 and 329: Appendix H 312 Nutrition Interventi
Page 330 and 331:
Appendix H 314 Nutrition Interventi
Page 332 and 333:
Page 334 and 335:
Page 336 and 337:
Appendix I 320 Nutrition Interventi
Page 338 and 339:
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Appendix J 328 Nutrition Interventi
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Appendix K 336 Nutrition Interventi
Page 354 and 355:
Appendix K 338 Nutrition Interventi
Page 356 and 357:
Appendix L 340 Nutrition Interventi
Page 358 and 359:
Appendix M 342 Nutrition Interventi
Page 360 and 361:
Appendix M 344 Nutrition Interventi
Page 362 and 363:
Appendix N Gastrostomy Tube Feeding
Page 364 and 365:
Appendix N activities. When feeding
Page 366 and 367:
Appendix N Feeding Sets/Extensions
Page 368 and 369:
Appendix N Fluid and Electrolytes W
Page 370 and 371:
Appendix N osmolality of full-stren
Page 372 and 373:
Appendix N Modular Products Modular
Page 374 and 375:
Appendix N his family, and the home
Page 376 and 377:
Appendix N • The feeding tube may
Page 378 and 379:
Appendix N equipment. The Special S
Page 380 and 381:
Appendix N Table N-2: Common Compli
Page 382 and 383:
Appendix N Complication Possible Ca
Page 384 and 385:
Appendix N 368 Nutrition Interventi
Page 386 and 387:
Appendix O Some conditions increase
Page 388 and 389:
Appendix O Table O-3: Recommended P
Page 390 and 391:
Appendix O 374 Nutrition Interventi
Page 392 and 393:
Appendix P Diet Prescription for Me
Page 394 and 395:
Appendix Q Goals Considerations for
Page 396 and 397:
Appendix R Condition Description Nu
Page 398 and 399:
Appendix R Condition Description Nu
Page 400 and 401:
Appendix R References 1. Ekvall SW
Page 402 and 403:
Appendix S Table S-1: Infant Formul
Page 404 and 405:
Appendix S Comments Osmolality (mOs
Page 406 and 407:
Appendix S Table S-2: Pediatric For
Page 408 and 409:
Appendix S Table S-3: Modular Produ
Page 410 and 411:
Appendix S Comments Energy (kcal) P
Page 412 and 413:
Appendix S Contact Information Abbo
Page 414 and 415:
Appendix T Powdered Formulas Accura
Page 416 and 417:
Appendix T Table T-1: Liquid Concen
Page 418 and 419:
Appendix T 402 Nutrition Interventi
Page 420 and 421:
Appendix U Nutrition Strategies for
Page 422 and 423:
Appendix U ADA Pocket Guide to Nutr
Page 424 and 425:
Glossary Autism Spectrum Disorders
Page 426 and 427:
Glossary Early intervention service
Page 428 and 429:
Glossary Length (recumbent length)
Page 430 and 431:
Glossary Stadiometer moveable headb
Page 432 and 433:
Index specialist 98 target 108 Bink
Page 434 and 435:
Index elemental formula 348 elimina
Page 436 and 437:
Index I ICF. See International Clas
Page 438 and 439:
Index risk indicators 4 screening 1
Page 440 and 441:
Index suppositories 72, 77 Surmonti
show all

Nutrition Interventions for Children with Special Health Care Needs

Create successful ePaper yourself

Delete template?

Save as template?