Chapter 11
Toddler 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:
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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
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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:
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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:
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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
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State programs
Early intervention programs
Early childhood education programs (IDEA)
Head Start
Early Head Start
WIC
Low birthweight follow up
Child care feeding programs