Nutrition Interventions for Children with Special Health Care Needs

Chapter 3 - Physical Activity for CSHCN
limiting sedentary behaviors (e.g. watching TV, playing computer games) may be
indicated. Education regarding proper nutrition, weight management, and exercise
is vital to making choices about a healthy lifestyle. Establishing healthy eating habits
and exercise as a part of one’s lifestyle when a person is young will help ensure they
carry over the behaviors into adulthood.
The Following Case Study Illustrates How the Nutritionist, Using a Family-
Centered Approach, Helps Facilitate a Physical Activity Program for a Boy
With Cerebral Palsy.
Charlie is a 10-year-old boy with a history of premature birth at 28 weeks gestation.
He has a diagnosis of spastic diplegic cerebral palsy (CP). Charlie is a friendly, social
boy, and his cognitive skills are within the average range. He presently ambulates
with Lofstrand crutches for short distances at home and at school, but uses a manual
wheelchair for community access. The family has recently moved to the area, and
Charlie was just enrolled in the 5th grade at a new school. At the first well-child
appointment with his new primary care provider, Charlie’s growth parameters met
the criteria for obesity. His primary care provider made a referral to the nutritionist
at the public health department.
During an interview with Charlie’s mother, the nutritionist learned that Charlie’s
inactivity, coupled with excessive caloric intake, was contributing to his obesity. In
addition to his short-distance crutch walking, his primary form of physical activity
was limited to a home exercise program (HEP) of stretching developed by his
previous physical therapist. Charlie’s mother reported that he was not motivated
to perform his HEP, and that she was tired of nagging him. She was interested in
learning about alternative physical activities that might be more appealing and
motivating for Charlie. A follow-up visit was scheduled to design a plan.
At that visit, the nutritionist, Charlie, and his mother collaborated to make a plan to
decrease Charlie’s caloric intake, as well as increase his physical activity level. The
nutritionist discussed some of the questions in Table 3.1 with Charlie and his mother
to identify family recreation interests. Charlie was fortunate to be part of a family
that valued fitness. The nutritionist learned that Charlie was more motivated to
participate in recreation activities with his family than play in adapted team sports.
Because of the family’s interest in skiing and cycling, the nutritionist suggested
contacting Outdoors for All, a local organization providing year round instruction
in outdoor recreation and modified sporting equipment for people with physical,
developmental, and sensory disabilities. To help maintain weight and promote overall
fitness and conditioning, the nutritionist recommended checking out some of the
local fitness clubs for a family membership. She also suggested that Charlie’s new
physical therapist may be able to consult with the trainer at the club to develop
44 Nutrition Interventions for Children With Special Health Care Needs