Nutrition Interventions for Children with Special Health Care Needs

Chapter 3 - Physical Activity for CSHCN
the experimental groups reported their children had more success and pleasure in
sports, and that they played with other children for longer periods of time (13).
Benefits of Physical Activity for Children with Neuromotor
Disabilities
The benefits of physical activity for children with neuromotor disabilities such as
Down syndrome and cerebral palsy (CP) have been documented in the literature, as
cited below. However, some children may require a health screening from a primary
care provider prior to participating, and some activities may have to be adapted to
ensure that the child or adolescent has a safe, positive experience.
Common physical characteristics of children with Down syndrome include hypotonia,
decreased muscle strength, and ligamentous laxity, which can limit endurance
and restrict participation in physical activities, including play. In addition to these
musculoskeletal impairments, there are other associated medical and health issues
that can affect physical activity including congenital heart defects, atlantoaxial
instability (i.e. an abnormally large space and excessive motion between the first and
second cervical vertebrae), and a tendency toward obesity. All health care providers
should discuss with families the risks that certain physical activities (i.e. gymnastics,
horseback riding) involving neck hyperflexion or hyperextension may pose for
individuals with atlantoaxial instability. Parents in turn need to consult with their
child’s primary care provider before these types of activities are initiated. As long
as medical and health issues are monitored, participation in moderate- to vigorous
intense activity is recommended for children with Down syndrome to reduce their
tendency toward obesity, enhance social opportunities, and promote lifelong health
(14).
For many children with CP, impairments such as muscle weakness, muscle spasticity,
and balance deficits make it difficult to participate in sport and play activities at
sufficient levels to develop and maintain normal physical fitness levels (15). However,
a substantial body of evidence has documented that muscle strength can be
improved in children with CP, and that improved strength can translate into functional
gains such as improved walking efficiency (16,17). Thus, the child’s participation in
physical activities should be encouraged by all members of the individual’s health
care team.
Given the appropriate guidance and supervision, children and adolescents with
neuromotor disabilities can improve fitness and physical activity levels at community
fitness facilities. This option not only allows these children to participate in
42 Nutrition Interventions for Children With Special Health Care Needs