Chapter 11: Toddler and Preschooler Nutrition II Flashcards
Children with Special Health Care Needs
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.
Prader-Willi Syndrome
Condition in which partial deletion of chromosome 15 interferes with control of appetite, muscle development, and cognition.
Early Intervention Services
Federally mandated evaluation and therapy services for children in the age range from birth to 3 years under the Individuals with Disabilities Education Act.
Cystic Fibrosis
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.
Diplegia
Condition in which the part of the brain controlling movement of the legs is damaged, interfering with muscle control and ambulation.
Bronchopulmonary Dysplasia (BPD)
Condition in which the underdeveloped lungs in a preterm infant are damaged so that breathing requires extra effort.
Attention Deficit Hyperactivity Disorder (ADHD)
Condition characterized by low impulse control and short attention span, with and without a high level of overall activity.
Neuromuscular Disorders
Conditions of the nervous system characterized by difficulty with voluntary or involuntary control of muscle movement.
Hypotonia
Condition characterized by low muscle tone, floppiness, or muscle weakness.
Hypertonia
Condition characterized by high muscle tone, stiffness, or spasticity.
Celiac Disease
A genetic, autoimmune disease that is characterized by intolerance to the protein gluten.
Celiac Disease Symptoms
- 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
Celiac Disease Diagnosis
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.
Nutritional Importance of Celiac Disease
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.
Cerebral Palsy
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.
Spastic CP
Tense, contracted muscles. Most common type of CP.
Athetoid CP
Constant, uncontrolled motion of limbs, head, and eyes.
Rigidity CP
Tight muscles that resist effort to make them move.
Tremor CP
Uncontrollable shaking, interfering with coordination.
Ataxic CP
Poor sense of balance, often causing falls and stumbles.
Cerebral Palsy Symptoms
- Thin appearance
- Mental retardation
- Seizures
- Hearing impaired
- Contractures
- Scoliosis
- GERD
- Constipation
Current life expectancy is 20-40 years, but is based on associated conditions
Cerebral Palsy Diagnosis
No formal diagnostic methods. Early detection is important to providing early intervention. Ohio is ranked poorly for services provided.
Nutritional Importance of Cerebral Palsy
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
Food Allergies
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.
Food Allergy Symptoms
- Hives
- Asthma
- Atopic dermatitis
- Rhinitis
- GI symptoms
Anaphylaxis in Food Allergy Reactions
- Sometimes first sensation is metallic taste, tingling, itching
- Abdominal pain
- N/V/D
- Hypotension
- CP
- Urticaria
- Shock
- Death
Food Allergy Diagnosis
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).
Prick/Puncture Skin Testing
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.
Trial Elimination Diet
An exclusion diet eliminating all foods suspected by history and/or prick skin testing (or in vitro IgE for IgE-mediated disorders).
Double-Blind Placebo-Controlled Food Challenge
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.
In Vitro IgE Testing
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.
Nutritional Importance of Food Allergies
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.
Cystic Fibrosis Symptoms
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
Cystic Fibrosis Diagnosis
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”.
Nutritional Importance of Cystic Fibrosis
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.
Phenylketonuria (PKU)
Inborn error of protein metabolism. Characterized by a lack of phenylalanine hydroxylase. Therefore, phenylalanine levels can accumulate to toxic levels in the blood.
PKU Symptoms
No symptoms in the early postnatal period. If untreated, initial primary symptom is progressive MR: poor attention span, behavioral difficulties, and poor growth/FTT.
PKU Diagnosis
Routinely ruled out in all infants via a blood test shortly after birth (heel prick).
Nutritional Importance of PKU
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.
PKU and Pregnancy
In maternal PKU, following diet during pregnancy is critical. Uncontrolled maternal PKU can yield infant retardation, microcephaly, heart defects, and LBW.
