Chapter 13

Question 1

Children with special health care needs may have additional nutritional needs. List some examples:

Answer 1

a. High protein is needed with high protein losses
b. High protein is needed with high protein losses, such as skin breakdown
d. High fluid volume is needed with frequent losses through vomiting and diarrhea
e. High fiber may be needed for chronic-constipation management

Question 2

Factors that determine energy needs in children with special health care needs include:

Answer 2

a. Activity level
b. Frequency of illness
c. Growth

Question 3

What is the appropriate response for parents of a child with cystic fibrosis who has recurrent illnesses?

Answer 3

Children with CF require close monitoring to avoid malnutrition as the condition progresses. Intensive nutrition intervention may be required to meet higher energy needs.

food refusal are common with recurrent illness, so total intake may be more variable day to day than in other children of the age

Question 4

Explain spinal muscular atrophy.

Answer 4

Condition in which muscle control declines over time as a result or nerve loss, causing death in childhood

Question 5

Protein needs for children with special health care needs are _____ those for other children.

Answer 5

Higher than, lowr than, or the same based on the condition

Question 6

List 2 conditions that INCREASE protein needs:

Answer 6

a. Wound healing

b. Casting after surgery to prevent skin breakdown

Question 7

Children with chronic conditions may have more difficulty meeting the DRI for vitamins and minerals because of:

Answer 7

a. Eating or feeding problems may restrict intake of foods requiring chewing, such as meats, so that certain minerals usually contributed in meats may be low
b. Prescribed medications and their side effects can increase turnover for specific nutrients, raising the recommended amount needed
c. Food refusals are common with recurrent illness, so total intake may be more variable day to day than in other children of the same age
d. Treatment of the condition necessitates specific food and nutrient restrictions, so that vitamins and minerals usually provided in restricted foods have to be supplemented

Question 8

If a child’s condition is known to change the rate of weight or height gain, which of the following signs would indicate a need for attention?

Answer 8

a. A plateau in weight
b. A pattern of gain and then weight loss
c. Not regaining weight lost during an illness
d. A pattern of unexplained and unintentional weight gain

Question 9

Chronic conditions without specialty growth charts include the following:

Answer 9

a. Juvenile Rheumatoid Arthritis
b. Cystic fibrosis
c. Rett syndrome

spina bifida, seizures, diabetes type 1 and type 2

Question 10

Children with _____ and __________would always be interpreted as overweight on standard growth charts because they have altered muscle size and/or short statures.

Answer 10

a. CP ( results in short statues, low muscle tone, low weight)
b. Down syndrome (may reduce muscle tone)
c. spina bifida (reduce muscle tone. may impact muscles only in the lower extremities)

Question 11

What percentage of children with developmental delays have feeding problems?

Answer 11

70%

Question 12

Many families experience difficulties when their child requires nutritional supplementation with a gastrostomy because:

Answer 12

a. eating is such an important aspect of parenting
b. requires test and surgical procedures to create a gastrostomy and monitor it over time
c. insurance coverage and financial questions of paying for complete nutritional supplements

Question 13

Normal amounts of carbohydrates are NOT allowed on what type of diet?

Answer 13

Ketogenic diet, or those made with an artificial sweetener containing phenylalanine not recommended for children with PKU

Question 14

Fat-soluble vitamin supplements are recommended for children with _____ due to poor intestinal absorption of these nutrients.

Answer 14

PKU

Question 15

Galactosemia may impact a child’s intake of which mineral:

Answer 15

Calcium

Question 16

The incidence of cystic fibrosis is highest among which ethnic group?

Answer 16

Caucasians

Question 17

How do energy and protein needs for children with cystic fibrosis compare with those of healthy children?

Answer 17

calories & protein increase 2 to 4 fold

Question 18

List some nutrition interventions that might be appropriate for all children with cystic fibrosis:

Answer 18

a. monitoring growth
b. assessing food and nutrient intake
c. increasing energy and protein by 2-4 times the usual recommendations to compensate for malabsorption

Question 19

Which nutrient is freely used in ketogenic diets?

Answer 19

Fat

severely low-CHO diet with increase calories from fat

Question 20

Define athetosis.

Answer 20

less common form of CP – uncontrolled movement which increase energy expenditure

Question 21

Which type of diabetes is characterized by virtually no insulin production?

Answer 21

Type I

Question 22

What is included in dietary treatment for diabetes?

Answer 22

a.timing and composition of meals and snacks
b insulin injections → for type I
c.exercise

Question 23

What is often a secondary effect of cerebral palsy?

Answer 23

contractures, scoliosis, gastroesophageal reflux, and constipation

Question 24

Why do children with cerebral palsy often have constipation?

Answer 24

because coordinated muscle movements are part of bowel emptying, including the muscle in and over the intestines.

Question 25

The mother of a child with cerebral palsy bought vitamin and mineral supplements containing two times the recommended amounts for healthy children after hearing that her child’s growth was slowed but going well. What would you tell her?

Answer 25

a. no specific vitamins and minerals are known to correct CP
b. problem nutrients are likely to be those related to bone density → calcium and vitamin D or nutrients needed in higher amounts as a result of medication side effects
c. recommendations for energy needs are difficult to determine, even with an in-depth growth assessment

Question 26

Nutritional consequences of spastic quadriplegia include changes in body composition—true or false.

Answer 26

true

Question 27

Define Phenylketonuria

Answer 27

An inherited error in phenylalanine metabolism most commonly caused by a deficiency of phenylalanine hydroxylase, which converts the essential amino acid phenylalanine to the non essential amino acid tyrosine.

Question 28

Children with phenylketonuria have to replace approximately 80% of _____ intake from foods with a mixture of _____ from which phenylalanine has been removed.

Answer 28

protein and amino acids

Question 29

What are some foods that would be allowed on a diet for PKU?

Answer 29

a. Natural sources of protein such as regular crackers, potato chips, rice, potatoes
b. many fruits & vegetables are encouraged if offered without added sources of protein
c. Some,e foods that are high in fats and/or low in sugar and gen low in natural protein such as fried vegetables or candy canes are safe.

Question 30

What are some foods that would be omitted from a diet for children with
phenylketonuria?

Answer 30

a. Meat
b. Eggs/ Dairy Products
c. Peanuts/ Soybeans

Question 31

Explain 504 Accommodation and IDEA

Answer 31

IDEA- special education services may have specific nutrition services written into a childs IEP
504 Accommodation- Modifies regular curriculum teaching methods to fit a child’s educational needs

Question 32

A psychostimulant is a medication given to children with what condition?

Answer 32

ADHD

Question 33

It is estimated that _____ of school-age children have attention deficit hyperactivity disorder (ADHD).

Answer 33

5 to 8 %

Question 34

Nutritional concerns in ADHD include:

Answer 34

a. psychostimulant medication side effects that decrease appeptite
b. growth while being medicated
c. mealtime behavior

Question 35

Why is it important to take pancreatic enzymes if a child has cystic fibrosis?

Answer 35

Children with CF suffer from malabsorption due to the lack of pancreatic enzymes

Question 36

Plan an acceptable breakfast choice for a child on a ketogenic diet.

Answer 36

Eggs with ham and cheese
or
Protein shake with added peanut butter and unsweetened almond milk