Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
Nutrition Problems
Who is at risk for nutrition-related Health Problems?
Children and youth with special health care needs are at risk for nutritionrelated
health problems. This population is defined as “those (children/youth)
who have or at increased risk for a chronic physical, developmental, behavioral,
or emotional condition who require health and related services of a type or
amount beyond that required by children generally.” Approximately 7-18% of
children and youth ages birth to 18 years in the United States have a chronic
physical, behavioral, developmental or emotional condition causing limitations in
activities, and/or requiring special care. The etiology of developmental
disabilities and special health care needs is complex. Children and youth with
special health care needs may have physical impairments, developmental delays
or chronic medical conditions that are caused by are associated with the
following factors;
Chromosome anomalies, genetic conditions
Congenital infections
Inborn errors of metabolism
Prematurity
Neurologic insults
Neural tube defects
Trauma
Maternal substance abuse
Environmental toxins
What is the significance of nutrition-related problems in children
with special health care needs?
It is estimated that up to 40-50% of children and adolescents with special
health care needs have nutritionrelated risk factors or health problems that
require the attention or a registered dietitian, nutritionist, or health
care professional. Nutrition risk factors may be physical, biochemical,
psychological or environmental in nature. Physical conditions such as cleft lip or
palate or a disease process such as cystic fibrosis may limit an individual’s
ability to feed, digest, or absorb food. Drug-nutrient interactions may alter
digestion, absorption or the bioavailability of nutrients in the diet.
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
Psychological factors play a role in an individual’s ability to accept and cope with
a disability or treatment plan. For example, depression may alter an individual’s
appetite and motivation to follow a specified diet plan. Environmental factors
such as family and social support, finances and reinforcements for following
certain dietary regimens. One or more of these factors may put a child or
adolescent with special health care needs at risk for nutrition problems. Common
nutrition problems for the child or youth with special care needs may include the
following:
Altered energy and nutrient needs
Delayed or stunted linear growth
Underweight
Overweight or obesity
Feeding delays or oral-motor dysfunction
Elimination (bowel) problems
Drug-nutrient interactions
Appetite disturbances
Unusual food habits
Dental and gum disease
How Can Intervention Help
Nutrition services for a child or youth with special health care needs may
require more specialized services to address complex nutrition issues and may
involve an interdisciplinary team. The team approach allows for individuals from
different disciplines to address the multifaceted problems that may impact
nutrition and feeding. The child and caregiver(s) should be key members of the
team in the identification of problems and setting priorities to be addressed in
the treatment plan. Through the team approach a comprehensive plan is
developed to address all factors that may impact growth, development, and
general health. The goal of the treatment plan is to provide optimal nutrition to
support growth, development and level of functioning. Examples of the problems
that may impact feeding and the respective team members to address these
needs are outlined below:
Medical issues—physicians, nurses
Neuro-motor problems—physical therapists, occupational therapists, speech
pathologists
Behavior problems—psychologists
Dental and oral health problems—dentists
Financial issues and—social workers
Community resources—local health education and information center
Quality and quantity of diet, growth—dietitian or nutritionist
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
All children and youth with special health care needs should have a consistent plan
across all the environments where they live, study, play and work. An excellent
strategy for incorporating nutrition goals and objectives outside the home is to
work with the school system. In local communities, public schools provide a
resource for children and youth with special health care needs through the Child
and Adult Care Food Program which administers the National School Lunch and
National School Breakfast Programs. Federal regulations permit modified school
meals, at no extra cost, for students with disabilities or chronic medical problems
who require special diets. Food substitutions and modified meals required for a
medical or special dietary need are provided for individuals identified by the
school system as having a disability. To receive this benefit, children and youth in
special education programs must have a diet prescription from a physician. The
prescription must include the following information:
A statement identifying the disability, and how the disability affects the child’s
diet.
A statement identifying the major life activity affected by the disability.
A specific list of dietary changes, modifications or substitutions required for
the diet.
Children and youth with special health care needs who require a special diet but
are not receiving special education services must have a written order from a
recognized medical authority (e.g., physician, physician’s assistant, nurse
practitioner or other specialist identified by the state). For children and youth
with chronic conditions such as diabetes or allergies who are not receiving special
education services, determinations about providing meal modifications are made on
a case-by-case basis. To make sure that nutrition goals and objectives are
addressed in the child’s educational program, it is important to have nutrition
goals and objectives incorporated in the Individualized Education Plan or 504
Accomodation for children and youth with significant dietary and nutrition
concerns.
Can Nutrition-Related Problems Be Prevented?
All health care professionals should be aware that children and youth with special
health care needs are at increased risk for nutrition problems. Nutrition
screening, early identification of problems, and nutrition education should become
parts of routine medical care for children and youth with special health care
needs. Beginning early in childhood, children with special needs should be screened
for nutrition problems and caregivers should be provided with anticipatory
guidance regarding the risk of nutrition problems and practical interventions for
prevention, so as to avoid chronic nutrition-related problems.
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
Resources:
Children and youth with special health care needs may require many kinds of
services to meet their general health and nutritional needs. In order to provide
family-centered care, it is important to coordinate nutrition services with other
medical appointments within the community. Dietitians with expertise in
disabilities and special health care needs may be found in University Centers
for Excellence in Developmental Disabilities, Title V-funded specialty clinics,
pediatric units and outpatient departments of local hospitals, local health
departments, dietitians in private practice, and local pediatric and public health
nutrition practice groups of the American Dietetic Association.
Before prescribing specialized nutrition formulas and supplements for an
individual, the dietitian or health care provider should make sure that the
family has the resources to support the dietary recommendations or has
access to food assistance services. Selected resources to explore include the
following:Title V, Maternal and Child Health (MCH) programChildren and Youth with Special Health Care Needs (CYSHCN) programMedical Assistance Services / MedicaidFood Stamps ProgramSchool Lunch and School Breakfast ProgramsState Child Health Insurance Program (SCHIP)Private Insurance
To contact Family Voices of North Dakota:
888-522-9654 or fvnd@drtel.net or go to www.fvnd.org
Department of Health Children’s Special Health Services.
Nutrition Problems
Who is at risk for nutrition-related Health Problems?
Children and youth with special health care needs are at risk for nutritionrelated
health problems. This population is defined as “those (children/youth)
who have or at increased risk for a chronic physical, developmental, behavioral,
or emotional condition who require health and related services of a type or
amount beyond that required by children generally.” Approximately 7-18% of
children and youth ages birth to 18 years in the United States have a chronic
physical, behavioral, developmental or emotional condition causing limitations in
activities, and/or requiring special care. The etiology of developmental
disabilities and special health care needs is complex. Children and youth with
special health care needs may have physical impairments, developmental delays
or chronic medical conditions that are caused by are associated with the
following factors;
Chromosome anomalies, genetic conditions
Congenital infections
Inborn errors of metabolism
Prematurity
Neurologic insults
Neural tube defects
Trauma
Maternal substance abuse
Environmental toxins
What is the significance of nutrition-related problems in children
with special health care needs?
It is estimated that up to 40-50% of children and adolescents with special
health care needs have nutritionrelated risk factors or health problems that
require the attention or a registered dietitian, nutritionist, or health
care professional. Nutrition risk factors may be physical, biochemical,
psychological or environmental in nature. Physical conditions such as cleft lip or
palate or a disease process such as cystic fibrosis may limit an individual’s
ability to feed, digest, or absorb food. Drug-nutrient interactions may alter
digestion, absorption or the bioavailability of nutrients in the diet.
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
Psychological factors play a role in an individual’s ability to accept and cope with
a disability or treatment plan. For example, depression may alter an individual’s
appetite and motivation to follow a specified diet plan. Environmental factors
such as family and social support, finances and reinforcements for following
certain dietary regimens. One or more of these factors may put a child or
adolescent with special health care needs at risk for nutrition problems. Common
nutrition problems for the child or youth with special care needs may include the
following:
Altered energy and nutrient needs
Delayed or stunted linear growth
Underweight
Overweight or obesity
Feeding delays or oral-motor dysfunction
Elimination (bowel) problems
Drug-nutrient interactions
Appetite disturbances
Unusual food habits
Dental and gum disease
How Can Intervention Help
Nutrition services for a child or youth with special health care needs may
require more specialized services to address complex nutrition issues and may
involve an interdisciplinary team. The team approach allows for individuals from
different disciplines to address the multifaceted problems that may impact
nutrition and feeding. The child and caregiver(s) should be key members of the
team in the identification of problems and setting priorities to be addressed in
the treatment plan. Through the team approach a comprehensive plan is
developed to address all factors that may impact growth, development, and
general health. The goal of the treatment plan is to provide optimal nutrition to
support growth, development and level of functioning. Examples of the problems
that may impact feeding and the respective team members to address these
needs are outlined below:
Medical issues—physicians, nurses
Neuro-motor problems—physical therapists, occupational therapists, speech
pathologists
Behavior problems—psychologists
Dental and oral health problems—dentists
Financial issues and—social workers
Community resources—local health education and information center
Quality and quantity of diet, growth—dietitian or nutritionist
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
All children and youth with special health care needs should have a consistent plan
across all the environments where they live, study, play and work. An excellent
strategy for incorporating nutrition goals and objectives outside the home is to
work with the school system. In local communities, public schools provide a
resource for children and youth with special health care needs through the Child
and Adult Care Food Program which administers the National School Lunch and
National School Breakfast Programs. Federal regulations permit modified school
meals, at no extra cost, for students with disabilities or chronic medical problems
who require special diets. Food substitutions and modified meals required for a
medical or special dietary need are provided for individuals identified by the
school system as having a disability. To receive this benefit, children and youth in
special education programs must have a diet prescription from a physician. The
prescription must include the following information:
A statement identifying the disability, and how the disability affects the child’s
diet.
A statement identifying the major life activity affected by the disability.
A specific list of dietary changes, modifications or substitutions required for
the diet.
Children and youth with special health care needs who require a special diet but
are not receiving special education services must have a written order from a
recognized medical authority (e.g., physician, physician’s assistant, nurse
practitioner or other specialist identified by the state). For children and youth
with chronic conditions such as diabetes or allergies who are not receiving special
education services, determinations about providing meal modifications are made on
a case-by-case basis. To make sure that nutrition goals and objectives are
addressed in the child’s educational program, it is important to have nutrition
goals and objectives incorporated in the Individualized Education Plan or 504
Accomodation for children and youth with significant dietary and nutrition
concerns.
Can Nutrition-Related Problems Be Prevented?
All health care professionals should be aware that children and youth with special
health care needs are at increased risk for nutrition problems. Nutrition
screening, early identification of problems, and nutrition education should become
parts of routine medical care for children and youth with special health care
needs. Beginning early in childhood, children with special needs should be screened
for nutrition problems and caregivers should be provided with anticipatory
guidance regarding the risk of nutrition problems and practical interventions for
prevention, so as to avoid chronic nutrition-related problems.
Funding for this publication comes from Maternal and Child Health Bureau under Grant H84MC07992-01-01 and
Department of Health Children’s Special Health Services.
Resources:
Children and youth with special health care needs may require many kinds of
services to meet their general health and nutritional needs. In order to provide
family-centered care, it is important to coordinate nutrition services with other
medical appointments within the community. Dietitians with expertise in
disabilities and special health care needs may be found in University Centers
for Excellence in Developmental Disabilities, Title V-funded specialty clinics,
pediatric units and outpatient departments of local hospitals, local health
departments, dietitians in private practice, and local pediatric and public health
nutrition practice groups of the American Dietetic Association.
Before prescribing specialized nutrition formulas and supplements for an
individual, the dietitian or health care provider should make sure that the
family has the resources to support the dietary recommendations or has
access to food assistance services. Selected resources to explore include the
following:Title V, Maternal and Child Health (MCH) programChildren and Youth with Special Health Care Needs (CYSHCN) programMedical Assistance Services / MedicaidFood Stamps ProgramSchool Lunch and School Breakfast ProgramsState Child Health Insurance Program (SCHIP)Private Insurance
To contact Family Voices of North Dakota:
888-522-9654 or fvnd@drtel.net or go to www.fvnd.org
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