MNT for Intellectual & Developmental Disabilities Flashcards
Developmental Disabilities: Characteristics and Causes
- Severe chronic disabilities attributable to mental and/or physical impairments
Causes:
- fetal abnormalities
- birth defects
- metabolic and chromosomal disorders
Developmental Disabilities:
Functional Limitations x7
- Self-care – need help with normal ADLs (grocery shopping, meal planning, feeding, etc)
- Language
- Learning
- Mobility
- Self-direction – need cueing and supervision
- Independence
- Economic self-sufficiency
Intellectual Disabilities:
Characteristics and Causes
- Below-average intellectual functioning along with functional limitations
Causes:
- Congenital abnormalities
- neuromuscular dysfunction
- neurologic disorders
- prematurity
- cerebral palsy
- untreated inborn errors of metabolism
- environmental toxins (pesticide consumption, mercury exposure, lead, heavy metal consumption)
- nutrient deficiencies - malnutrition in general and raw nutrient deficiency
Anthropometric Measures in I/D Disabled
- many of these patients may not be able to stand up; may be contracted
WEIGHT: chair scales, bucket scales
HEIGHT: arm span, knee height, sitting height
BODY COMP: circumferences, skin folds
Biochemical Measures in I/D Disabled
- there are no specific measures, but assess if you suspect anything (most will be deficient)
Down Syndrome - thyroid status (common for downs to have hypothyroidism)
Prader-Willi Syndrome - glucose tolerance test; also monitor for diabetes (tend to have growth hormone def. which is needed to produce insulin like growth factor and insulin)
Dietary intake in I/D Disabled
Diet history - want to try to get complete diet history
also want to get information about their diet environment: when they eat, where, surroundings, etc.
Energy needs in I/D Disabled
- estimate energy needs based on height
- bc with many of these, overweight and obesity is common, as well as short stature
- measured in Kcal/cm/d
Feeding problems in in I/D Disabled Individuals x5
Oral-motor: difficulty sucking, swallowing, chewing
> change the nipple or change the formula
Positioning: motor development, head control, trunk stability, ability to have hips and legs at right angle
Behavioral: lack of autonomy, environmental factors
> many get distracted from outside environment
Self-feeding: may require training and adaptive feeding equipment
Parents reaction: dont force them to eat, don’t use food as a reward or punishment
Down Syndrome: Health concerns x6
- Delayed growth and development
- Hypothyroidism
- Overweight
- Hypotonia (low muscle tone)
- Poor suck in infancy
- Short stature
risk factor: age of mother > women over age 35 when having children
Down Syndrome: Interventions for overweight
- Energy needs
> Girls 14.3 kcals/cm
> Boys 16.1 kcals/cm - regular eating schedule without distractions
- limit high-fat foods and added sugars
- encourage physical activity
Down Syndrome: Interventions for Feeding Skills
- timing of weaning
- progression to solid foods
Down Syndrome: Interventions for Constipation
- Encourage fluids
- Fiber: 5-6 grams + year of age after age 3, 14g/1000 kcal’s (DRI)
Prader-Willi Syndrome: Health Concerns
- Hypotonia - weak suck, failure to thrive, gastroesophageal reflux
- Insatiable appetite - never satisfied, constantly hungry, always wanting to eat
- Obesity
- Decreased insulin response
- Behavioral problems
Prader-Willi Syndrome: Nutrition Assessment
- Body composition and fat distribution
- Energy needs
> Growth: 10-11 kcals/cm
> Weight loss: 8.5 kcals/cm
Prader-Willi Syndrome: Interventions
INFANCY - concentrate formula or breast milk, SFM (concern is reflux)
TODDLER/PRESCHOOL AGE - structured meal patterns (only eat at certain times)
SCHOOL AGE - environmental controls (lock cabinets, lock fridge)
ADULTHOOD - behavior modification (teach them techniques to get them to stick to patterns)
- After about age 1 – associated with insatiable appetite
- Under age 1 – have poor suck > many have FTT > so you’re concern is under-nutrition/malnutrition »_space;> infancy = concern is with malnutrition
Spina Bifida: what is it
neural tube defect > fails to develop properly or close properly > develops outside the spinal column and thus requires surgery
Spina Bifida: Prevention
folic acid supplementation before conception and during pregnancy
Spina Bifida: Health Concerns
- muscle weakness
- paralysis
- Pressure ulcers
- constipation
- obesity - due to lack of mobility
- latex allergy - bc they are exposed to latex frequently and early in life
- urinary tract infections - bc of nerves that innervate the bladder
- swallowing difficulty
Spina Bifida: Energy Needs
- Maintain weight: 9-11 kcals/cm
- Weight loss: 7 kcals/cm
Spina Bifida: Interventions
- fluids and fiber (for constipation)
- supplements and protein for wound healing (for pressure ulcers)
- cranberry juice for UTI
- dysphagia diet
- latex allergy: avoid bananas, avocados, kiwi
Cerebral Palsy: Health Concerns
(disorder of motor control; lack of coordination > damage to the brain > muscles are fine, problem with signaling from brain to muscles)
- growth problems
- failure to thrive
- feeding problems
- constipation
- gastroesophageal reflux
- **low bone density
Cerebral Palsy: Interventions
- Energy needs
> mild: 14 kcals/cm
> severe: 11 kcals/cm - Delay progression to solid foods
- Concentrate formula or breast milk
- Fiber and fluids
- Calcium and Vitamin D (for low bone density)
Autism: Characteristics
- impairment in social interaction
- poor communication skills
- repetitive and stereotypical behavior
- intellectual compromise
- asberger syndrome - normal to high cognitive levels
Autism: Signs/Symptoms
- lack of eye contact
- abnormal responses to touching or affection (don’t like to be touched)
- inability to follow object visually
- not responding to own name
- lack of facial expressions
Autism: Potential Causes x12
- Toxins in environment or food: pesticides, mercury, lead (HFCS processing involved mercury)
- Nutritionally deficient diet: vitamin D def.
- Immune system problems (autism tend to have poor guts)
- oxidative stress
- alterations in neurotransmitters
- gluten, casein (might have difficulty digesting)
- advanced parental age
- low birth weight
- multiple births
- viral infection during first trimester
- bacterial infection during second trimester
- inflammation
Autism: Feeding Problems
- developmental delays relating to self-feeding
- strong dislikes, picky eating
- fixation on one food
- food jags
- need consistent routine
- sensory processing (sensitivity to sound, too many colors on plate)
Autism: Interventions
- limit processed and refined foods (artificial colors, flavors, preservatives, HFCS, artificial sweeteners)
- Elimination Diets
> gluten and casein free
> LEAP protocol - involves testing of inflammatory mediators; Eliminate foods one by one and measure markers of elimination in the body/by the body; Inflammatory cytokines (interleukins, TNF alpha, histamine)
Autism: Interventions - Supplements x6
- Omega-3 fatty acids – anti-inflammatory, patients with autism have altered ratios of omega-3 to omega-6
- Glutathione – anti-oxidant; can help reduce oxidative stress
- Vitamin D – deficiency is associated with autism (a lot of it has to do with low levels in the mother as well); shown to help reduce oxidative stress and inflammation
- Digestive enzymes and probiotics – because autism pt have digestive complications > enzymes to help break down fats and proteins
- Vitamin B6 and magnesium – tends to be associated with lower severity of these behavioral problems > most patients don’t need to take B6 and magnesium specifically because a multivitamin will take care of it
- Antioxidant vitamins and minerals
Nutrition Interventions for D/I Disabilities
Nutrition Assessment
- medications may cause anorexia (many meds suppress appetite)
- behavioral feeding problems
Interventions
- avoid artificial food colorings (link to hyperactivity)
- eliminate sugar and caffeine
- structured meal times
- small servings, followed by refills
- limit distractions during meals
- essential fatty acid supplementation (may not met normally or absorb optimally)
- behavioral therapy
