Nutrition Interventions for Children with Special Health Care Needs

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Chapter 23 - Nutrition Interventions for Autism Spectrum Disorder Gastrointestinal symptoms, such as constipation and diarrhea, seen in some children with ASD have also led to use of the GFCF diet. And some studies, mostly in vitro, have demonstrated GI inflammation and other abnormalities, in children with ASD, whether they were on a GFCF diet or not (8). Nutrients at risk in the GFCF diet include calcium, vitamin D, zinc, and many B vitamins. Most of the positive reports of the diet have been anecdotal, and randomized, well-controlled studies and systematic reviews have not found the diet to be effective. The Cochrane Database found only two small, randomized controlled trials (RCTs) that were well-controlled, and small positive treatment effects in some of the children (9). Many families still want to try the GFCF diet for their children, and there is need for large scale, quality RCTs. The role of the RD is to discuss the known effectiveness with the family, and then help them provide a GFCF diet that is adequate in nutrients and energy to promote good growth and development. Specific Carbohydrate Diet (SCD) This diet is more restrictive than the GFCF diet as it eliminates grains, dairy, sucrose, and complex carbohydrates; and limits vegetables and fruits. Originally intended for irritable bowel syndrome, ulcerative colitis, and Crohn’s disease, it is supposed to combat bacterial and yeast overgrowth. There is no evidence to support the diet in any disease, and the diet is likely to be inadequate. Supplements Specific vitamin-mineral supplements, such as Super Nu-Thera®, and single supplements such as vitamin B6, magnesium, and fatty acids, are common in children with ASD. Although there are few well-controlled studies of these supplements, the evidence that exists does not support any effectiveness (10,11). Caregivers do not always realize that the components in multivitamin mixtures can also be found in other supplements their child is taking. Families should be counseled as to the tolerable upper limits (ULs) now set for most vitamins and minerals, and should be encouraged not to exceed these levels. Understanding the nature and scope of alternative therapies is important in providing the best quality family-centered care. Families who are searching for effective treatments for their child are often unable to discriminate between anecdotal reports and research-based scientific evidence. RD’s and other health professionals must be able to evaluate information about alternative nutrition therapies for ASD, and use 266 Nutrition Interventions for Children With Special Health Care Needs
Section 3 - Condition Specific Nutrition Interventions evidence-based practice. Open dialogue between the RD and the family is critical, as is understanding of the family’s desire for an effective treatment (12). Feeding Behaviors The persistent picky eating and related behaviors that limit the food intake of a child with ASD can be very challenging to all who work with the child. For many, the self-limited diet is outside the typical developmental picky eating and neophobia. Working on these eating behaviors is most effective when intervention is provided by a team, including feeding therapists and/or behavior specialists. Interventions can be incorporated into a child’s educational goals e.g., Individualized Family Service Plan (IFSP), Individual Education Program (IEP). This requires coordination between the school, family, and the RD. Using an applied behavior analysis (ABA) approach is effective for many children, and can be used in feeding at school, daycare and home. Setting small goals, using a step-wise system, to increase food acceptance is likely to be more successful (6). See Fig 23-1. The remainder of this section presents guidelines for nutrition assessment, intervention, and evaluation/outcome for children with ASD. Nutrition Interventions for Children With Special Health Care Needs 267
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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 8 - Oral-Motor Feeding Prob
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Chapter 9 - Behavior Issues Related
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Chapter 10 - Enteral Feeding Other
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Table
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Chapter 10 - Enteral Feeding Refere
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Chapter 11 - Community Monitoring o
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Chapter 12 - Accommodating Special
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Chapter 13 - Nutrition Intervention
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Page 232 and 233: Chapter 19 - Nutrition Intervention
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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
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Appendix H 316 Nutrition Interventi
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Appendix H 318 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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