Chapter 11Toddler and Preschooler Nutrition:

Conditions and Interventions

Nutrition Through the Life Cycle Judith E. Brown

Who Are Children with Special Health Care Needs?

• Criteria for “chronic condition” or “disability” varies from state to state

• Estimates range from 5% to 31% of children

• ~90% of children with disabilities have a nutrition problem

Eligibility for Early Intervention Services are Based on:

• Developmental delays:– Cognitive, physical, language & speech,

psychological, or self-help skills

• Physical or mental condition with a high probability of delay

• At risk medically or environmentally for substantial delay without services

Nutrition Needs of Toddlers & Preschoolers with Chronic

Conditions• DRIs are a starting point for setting protein,

vitamin and mineral needs

• Specific conditions need adjustments

• May cause poor appetite & increased caloric needs

• May lead to over- or under-weight

• Caloric & nutrient recommendations should be customized for each child

Nutrition Needs of Toddlers & Preschoolers with Chronic

Conditions

Growth Assessment

• Nutrition assessment should be first step to determine if nutrition services are needed

• Assessment answers the following:– Is child’s growth on track?– Is child’s diet adequate?– Are feeding or eating skills age appropriate?– Does diagnosis affect nutritional needs?

Growth Assessment

• Interpretation of growth charts should consider special health condition

• Growth charts specific to some conditions include:– LBW or VLBW– Special head growth chart

Nellhaus Head Circumference Growth Chart Plotted for Girl

with Rett Syndrome

Feeding Problems

• Special health care needs cause feeding problems in young children combined with typical feeding issues of the average toddler or preschooler

• Examples include:– Low interest in eating– Long mealtimes– Preferring liquids over solids– Food refusals

Behavioral Feeding Problems

• Mealtime feeding problems are common with toddlers & preschoolers with behavioral & attention disorders

• Behavioral disorders that affect nutritional status– Autism– Attention deficit hyperactivity disorder

(ADHD)• May be suspected in preschool years but usually

treated in the school years

Other Feeding Problems

• Excessive fluid intake– Child would rather drink than eat

• Feeding problems & food safety– Mashed or pureed foods and tubing or devices

for feeding may be contaminated or spoilage may occur

• Feeding problems from disabilities involving neuro-muscular control

Nutrition-Related Conditions

• Failure to thrive (FTT)

• Toddler diarrhea & celiac disease

• Autism

• Muscle coordination problems & cerebral palsy

• Pulmonary problems

• Developmental delay & evaluations

Failure to Thrive (FTT)

• What is FTT? Inadequate wt or ht gain with growth declines more than 2 growth percentiles

• May result from:– Digestive problems– Asthma or breathing problems– Neurological conditions– Pediatric AIDS

Failure to Thrive (FTT)

Toddler Diarrhea and Celiac Disease

• “Toddler diarrhea” typically caused by sucrose & sorbitol content of fruit juices

• Celiac disease results in diarrhea & caused by sensitivity to the protein gluten found in wheat & other grains

Autism

• No scientifically proven diet is recommended for prevention or treatment

• Gluten-free & casein-free diets have been recommended via Internet and support groups but not scientifically shown beneficial

Muscle Coordination Problems & Cerebral Palsy

• Cerebral palsy– Group of disorders characterized by impaired

muscle activity & coordination present at birth or developed during early childhood

– Spastic quadriplegia: a form of cerebral palsy– Reduced dietary intake results from child easily

becoming tired while eating

Meal Pattern & Recommended Foods

•Meal pattern may be changed to provide small, frequent meals, and snacks to prevent tiredness at meals

•Foods recommended are easy to chew and small

Meal Pattern & Recommended Foods

Pulmonary Problems

• Examples of pulmonary (breathing) problems are brochopulmonary dysplasia & asthma

• Breathing problems increase nutrient needs, lower interest in eating & can slow growth

• Preterm infants at high risk of breathing problems

Developmental Delay & Evaluation

• Developmental delay may be suspected when:– Specific nutrients are inadequately or

excessively consumed– May result from iron deficiency or lead toxicity

• Physical growth may be impacted

Food Allergies and Intolerance

• True food allergies seen in ~2% to 8% of children• Common food allergies include:

– Milk– Eggs– Wheat– Peanuts– Walnuts– Soy – Fish

Dietary Supplements and Herbal Remedies

• Parents should be cautioned about use of supplements and/or herbs to treat various conditions

• Often unproven recommendations come from support groups or the Internet

Sources of Nutrition Services

• State programs

• Early intervention programs

• Early childhood education programs (IDEA)

• Head Start

• Early Head Start

• WIC

• Low birthweight follow up

• Child care feeding programs