Child and Preadolescent Interventions Flashcards
Children with special health care needs have a wide range of nutritional requirements such as:
- ______ needs if small muscle size
- ______ is needed if protein losses or skin breakdown
- ______ is needed if frequent vomiting or diarrhea
- ______ for chronic constipation
- ______ due to DNI
Lower energy
High protein
Increased fluid
High fiber
Increase or decrease in micronutrients
higher protein needs for recovery from ____ or ______
_____ requires 150% of DRI fro protein
_____ require decreased protein
burns or wounds
cystic fibrosis
PKU
___________ are a good starting place for assessing growth
* Adjustments may need to be made for children with some conditions that affect the rate of growth
* _____ is not an appropriate tool for some conditions (i.e. cerebral palsy, paralysis)
CDC 2000 growth charts
BMI
what are some warning signs for growth problems
plateau in weight
pattern of gain and then loss
failure to regain weight lost during an illness
unexplained or unintentional weight loss
Intake may not be the only factor affecting growth for kids with chronic conditions
Other factors that affect growth assessment:
* Age of condition onset - ____ onset is more
likely to affect growth
* Secondary conditions may interfere with accurate measurements
- Example: ______ in children with cerebral palsy
* Activity level may be decreased
earlier
scoliosis
Down syndrome results in short stature and low muscle tone and low weight due to _____________ (rather than nutritional intake)
Spina bifida may impact muscles only in the ____
Identified low fat stores means you need to _____ food intake
neuromuscular changes
lower body
increase
Growth charts are available for some special conditions
* Some special growth charts are only based on the ______ form of the condition
* Many chronic conditions have such a wide range of severity that growth charts _____ be developed
most severe
cannot
conditions that do not have growth charts
juvenile rheumatoid arthritis
cystic fibrosis
Rett syndrome
spina bifida
seizures
diabetes
Children with special health needs often ____ from same general dietary recommendations as other children
* Assess intake to determine if energy & nutrient needs are being met
* Undernutrition may result in decreased effectiveness of _____ and _____ interventions
benefit
educational
medical
_____ feeding is preferred method of feeding
* May require ______ in addition to or to partially replace meals or snacks
_____ feeding may be required for:
* Some cancers
* Severe cerebral palsy
* Cystic fibrosis
* Pediatric AIDS
oral
supplements
Gastrostomy
Cystic fibrosis with pancreatic insufficiency=> requires__________ supplementation in ______ form
fat-soluble vitamin
water-soluble
Galactosemia=> requires _____ supplementation
calcium
Chewing problems=> need _____ supplements
liquid
Children on ketogenic diets=> avoid supplements with _______
added CHO
Children with PKU=> avoid supplements with _____
aspartame
DRI for water is appropriate for most children:
* Age 4-8: ____ L/d
* Age 9-13: ____ L/d females & ____ L/d males
1.7
2.11
2.4
conditions that increase fluid needs include:
Constipation from neuromuscular disorders
Crohn’s disease
Medication side effects
Uncontrollable drooling (from cerebral palsy)
____% of children with developmental delays have feeding difficulties
70 %
Examples of feeding problems include:
* ______ skills are lower than the child’s chronological age, requiring assistance & supervision
* Meals take an _____ amount of time
* The condition requires ______ in the timing of meals & snacks
Self-feeding
excessive
adjustment
Dysfunction of the ______ glands that results in production of abnormally ____ secretions that obstruct glands & ducts
* ____system disorder
* Interferes with _____ function=> Dyspnea, frequent respiratory infections, & permanent lung damage
* Pancreatic insufficiency=> ________ due to lack of pancreatic enzymes
exocrine
thick
multi
lung
malabsorption
nutritional issues for cystic fibrosis include
- _______ nutritional needs due to work of breathing, frequent infections, and malabsorption
- ______ oral intake
- Nutrient _______
- ______ rate of growth
- ______ risk for malnutrition
Increased
decreased
deficiencies
slower
high
Energy needs vary widely: _____ times the DRI for age
* Frequent meals & snacks
* If pancreatic insufficiency=> ________ taken with all meals & snacks to aid in digestion
* MVI with minerals and _________ supplements
* _________ feeding at night may be needed to boost energy intake
1.1-2.0
pancreatic enzymes
fat-soluble vitamin (in water-soluble form)
PEG/gastrostomy
Disorder in insulin regulation and glucose metabolism
diabetes mellitus
problem and intervention for Type 1 diabetes mellitus
virtually no insulin production
CHO counting
Education on meal planning
problem and intervention for Type 2 diabetes mellitus
high blood sugar only
Education on meal planning
weight management
Sudden, excessive, and disordered electrical disturbances in the brain
Epilepsy and seizures (same disorder)
Results of a seizure range from ______ to _______
* When seizures are well-controlled by medications, ______usually continues at a typical rate
mild blinking
severe jerking
growth
treatment of seizures and epilepsy
Eating during postictal state is not recommended due to the risk of choking
- Medications—may impact appetite and nutritional status
- Ketogenic diet—used as a last resort in children with intractable seizures when all other drug therapies fail
Broad range of disorders resulting from brain damage early in life with impaired muscle activity & coordination
cerebral palsy (CP)
_____________ is the form of CP that presents with the most nutritional problems
Spastic tetraplegia/quadriplegia
cerebral palsy side effects
primary
- muscle stiffness
secondary
- contractures
- scoliosis
- GERD
- constipation
nutrition concerns with cerebral palsy
- Difficulty with feeding & eating
- Slow weight gain & growth
- Changes in body composition which cause:
- Fatigue at meal times, spilling food, long meal times, requiring assistance to eat
- Dysphagia due to difficulty controlling
muscles of neck & back for sitting up and muscles of jaw & tongue
energy needs of cerebral palsy
difficult to determine
- Children with small or weak muscles have
lower energy needs - Children with athetosis (uncontrolled
movements of the large muscle groups) have increased energy expenditure
nutrition interventions for cerebral palsy
- Adjusting menus and timing of meals & snacks
at home or school to meet nutritional needs and address fatigue - Adaptive feeding devices
- Dysphagia assessment and interventions
PKU is an inborn error of metabolism
- Absence or deficiency of ___________
– the enzyme needed to ______________ - It accumulates in the ____ and is toxic to _____
– without treatment it causes _____
phenylalanine hydroxylase
metabolize phenylalanine to tyrosine
blood
brain tissue
severe intelectual disability
treatment of PKU
Lifelong restriction of phenylalanine
* 80-90% of protein needs is met by a phenylalanine-free formula
Dietary treatment includes complete avoidance of:
- meat, fish, eggs, dairy products, nuts, legumes, & soybeans
Most common neurobehavioral condition in children is ______
what percent ?
ADHD
11%
medication for ADHD that can affect Nutrition ?
how so?
Ritalin and Adderall
- may decrease appetite
nutrition intervention for ADHD
Time meals considering medication action peaks
* e.g. Providing a large, healthy evening snack when medication effects are lower
*No proven evidence of nutrition as a cause or as a treatment but families still often choose to use herbal medicines & nutrition supplements
Treatment of pediatric HIV includes ______, which may lead to ______.
antiretroviral therapy
anorexia (loss of appetite)
pediatric HIV nutrition interventions?
–Educating family on DNI and feeding schedules
–Education to prevent food-borne illness
–Assessing for financial difficulties and referral to services (i.e. food bank)
If inadequate intake, use of
–Oral nutrition supplements
–Gastrostomy tube feeding
childhood celiac disease is a _____ condition which is _____ in prevalence. It is also ______ in children, maybe bc it ______.
chronic
increasing
under diagnosed
presents differently in children
celiac disease may interfere with _____ and ____.
most effective treatment is ________.
learning and growth
avoiding gluten for life
department of education public school regulations includes
* _____ accommodations
* Requires that school provide a _______ to accommodate for special health care needs
504
written plan
A law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children
- Nutritional services may be written into a child’s _____________
Individuals with Disabilities Education Act (IDEA)
Individualized Education Program (IEP)
