Chapter 11: Toddler and Preschooler Nutrition II

Question 1

Children with Special Health Care Needs

Answer 1

A general term for infants and children with, or at risk for, physical or developmental disabilities or chronic medical conditions from genetic or metabolic disorders, birth defects, premature births, trauma, infection, or prenatal exposures.

Question 2

Prader-Willi Syndrome

Answer 2

Condition in which partial deletion of chromosome 15 interferes with control of appetite, muscle development, and cognition.

Question 3

Early Intervention Services

Answer 3

Federally mandated evaluation and therapy services for children in the age range from birth to 3 years under the Individuals with Disabilities Education Act.

Question 4

Cystic Fibrosis

Answer 4

One of the most common life-threatening genetic diseases. Affects all exocrine functions. Many physiologic processes are impacted by a secretion of a thick mucus. Mucus obstructs glands and ducts of many organs.

Question 5

Diplegia

Answer 5

Condition in which the part of the brain controlling movement of the legs is damaged, interfering with muscle control and ambulation.

Question 6

Bronchopulmonary Dysplasia (BPD)

Answer 6

Condition in which the underdeveloped lungs in a preterm infant are damaged so that breathing requires extra effort.

Question 7

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 7

Condition characterized by low impulse control and short attention span, with and without a high level of overall activity.

Question 8

Neuromuscular Disorders

Answer 8

Conditions of the nervous system characterized by difficulty with voluntary or involuntary control of muscle movement.

Question 9

Hypotonia

Answer 9

Condition characterized by low muscle tone, floppiness, or muscle weakness.

Question 10

Hypertonia

Answer 10

Condition characterized by high muscle tone, stiffness, or spasticity.

Question 11

Celiac Disease

Answer 11

A genetic, autoimmune disease that is characterized by intolerance to the protein gluten.

Question 12

Celiac Disease Symptoms

Answer 12

• Digestive problems, sometimes present at age 2
• GI symptoms occur because villi are flattened
• Wt loss/FTT
• Pale, foul-smelling stool
• Anemia
• Bone pain
• Behavior changes
• Muscle cramps
• Fatigue
• Seizures

Question 13

Celiac Disease Diagnosis

Answer 13

Blood test can show that a person has synthesized gluten antibodies. Intestinal biopsy is the “gold standard” of diagnosis. Illness can often be overlooked or misdiagnosed.

Question 14

Nutritional Importance of Celiac Disease

Answer 14

Lifetime gluten-free diet is a must. Acceptable grains are rice, soy, corn, and potatoes. Grains to avoid are barley, rye, wheat and some oats. Diet can be incredibly restrictive/difficult to follow.

Question 15

Cerebral Palsy

Answer 15

One of the most common conditions in children with severe disabilities. CP is not a single disorder, but a group of conditions resulting from damage to the brain. Etiology is not known, but may be related to complications in utero or complications during labor and delivery.

Question 16

Spastic CP

Answer 16

Tense, contracted muscles. Most common type of CP.

Question 17

Athetoid CP

Answer 17

Constant, uncontrolled motion of limbs, head, and eyes.

Question 18

Rigidity CP

Answer 18

Tight muscles that resist effort to make them move.

Question 19

Tremor CP

Answer 19

Uncontrollable shaking, interfering with coordination.

Question 20

Ataxic CP

Answer 20

Poor sense of balance, often causing falls and stumbles.

Question 21

Cerebral Palsy Symptoms

Answer 21

• Thin appearance
• Mental retardation
• Seizures
• Hearing impaired
• Contractures
• Scoliosis
• GERD
• Constipation

Current life expectancy is 20-40 years, but is based on associated conditions

Question 22

Cerebral Palsy Diagnosis

Answer 22

No formal diagnostic methods. Early detection is important to providing early intervention. Ohio is ranked poorly for services provided.

Question 23

Nutritional Importance of Cerebral Palsy

Answer 23

Spastic quadriplegia is the most challenging type of CP from a nutrition standpoint. Commonly seen:

• Slow growth
• Feeding/eating problems
• Altered body composition
• Poor bone density related to medications
• About half with CP have GI/feeding problems

Working with an RD and SLP is vital in these cases

Question 24

Food Allergies

Answer 24

An adverse reaction to food. Must involve IgE immunologic mechanism. Reaction happens consistently following the consumption of a particular food. Allergy causes function change in target organs.

Question 25

Food Allergy Symptoms

Answer 25

• Hives
• Asthma
• Atopic dermatitis
• Rhinitis
• GI symptoms

Question 26

Anaphylaxis in Food Allergy Reactions

Answer 26

• Sometimes first sensation is metallic taste, tingling, itching
• Abdominal pain
• N/V/D
• Hypotension
• CP
• Urticaria
• Shock
• Death

Question 27

Food Allergy Diagnosis

Answer 27

Allergy testing is the most reliable method. Testing should be done at age 3 or greater to reduce the likelihood of false test results (immature immunity).

Question 28

Prick/Puncture Skin Testing

Answer 28

Best used to investigate the possibility of an IgE-mediated reaction to a specific food in a patient with a suggestive clinical history (i.e., a high pre-test probability) of allergy.

Question 29

Trial Elimination Diet

Answer 29

An exclusion diet eliminating all foods suspected by history and/or prick skin testing (or in vitro IgE for IgE-mediated disorders).

Question 30

Double-Blind Placebo-Controlled Food Challenge

Answer 30

The “gold standard” for the diagnosis of food allergies. If a significant amount of the dried food is tolerated without a reaction, then the challenge is followed by an open feeding.

Question 31

In Vitro IgE Testing

Answer 31

In vitro assays used to identify food-specific IgE antibodies in the serum–less sensitive than skin prick tests and more costly, but unaffected by medications, useful when skin tests carry unacceptable risk, and in patients with dermatologic conditions.

Question 32

Nutritional Importance of Food Allergies

Answer 32

Avoid the offending foods. Even if the first reaction was mild, further exposures could produce more intense symptoms. Read labels carefully. Carry Epi-pen/Twinject at all times, if applicable. Never trade foods or accept questionable food from friends. Education of caregivers and school officials. Four hour kiss rule. Wear medical alert bracelet or necklace.

Question 33

Cystic Fibrosis Symptoms

Answer 33

Most commonly affected organs and organ systems are the lungs, GI tract and auxiliary organs, sweat glands, and reproductive organs.

• Lungs: chronic lung disease
• GI: malabsorption/FTT
• Reproductive: infertility is a common issue among adults with CF

Question 34

Cystic Fibrosis Diagnosis

Answer 34

Can be made in the prenatal period if screened for. Some states test for CF at birth. Due to a high sodium and chloride in the sweat of a persons with CF, diagnosis can be confirmed with a positive “sweat test”.

Question 35

Nutritional Importance of Cystic Fibrosis

Answer 35

Kcal and protein needs are 2-4 times higher in those with CF due to malabsorption. Liberal NaCl intake needed to replenish abnormally high losses. Enzyme pills are necessary because they assist with absorption and help to compensate for decreased enzyme secretion of pancreas. 85% have pancreatic insufficiency, so pts must be monitored to CF induced diabetes. Vitamin supplementation and nightly tube feeds common. Growth should be monitored carefully.

Question 36

Phenylketonuria (PKU)

Answer 36

Inborn error of protein metabolism. Characterized by a lack of phenylalanine hydroxylase. Therefore, phenylalanine levels can accumulate to toxic levels in the blood.

Question 37

PKU Symptoms

Answer 37

No symptoms in the early postnatal period. If untreated, initial primary symptom is progressive MR: poor attention span, behavioral difficulties, and poor growth/FTT.

Question 38

PKU Diagnosis

Answer 38

Routinely ruled out in all infants via a blood test shortly after birth (heel prick).

Question 39

Nutritional Importance of PKU

Answer 39

Low phenylalanine diet for a lifetime in classic PKU. If low phenylalanine diet followed consistently and before 3 weeks of age, patient will be asymptomatic. Meat, eggs, peanuts, soy, and regular dairy foods are omitted. Other foods are limited. Special low phenylalanine supplements prevent PEM.

Question 40

PKU and Pregnancy

Answer 40

In maternal PKU, following diet during pregnancy is critical. Uncontrolled maternal PKU can yield infant retardation, microcephaly, heart defects, and LBW.