Chapter 11
Toddler and Preschooler
Nutrition:
Conditions and Interventions
Key Nutrition Concepts
• Nutrition problems in young
children with special health care
needs are underweight,
overweight, feeding difficulties,
and higher nutrient needs as a
result of chronic health problems.
Key Nutrition Concepts
• Feeding difficulties in preschoolers
and toddlers appear as food
refusals, picky appetites, and
concerns about growth.
• Nutrition services for toddlers and
preschoolers with chronic health
problems are provided in various
settings, including schools and
other educational programs and
specialty clinics.
Key Nutrition Concepts
• Toddlers and preschoolers at risk
for chronic conditions have the
same nutritional problems,
concerns and needs as other
children.
Key Terms
• Children with Special Health Care
Needs—Infants & children with, or at risk
for, physical or developmental disabilities,
or chronic medical conditions from genetic
or metabolic disorders, birth defects,
premature births, trauma, infection, or
prenatal exposure to drugs.
• Chronic Condition (or disability)—
disorder of health or development that is
unlikely to change.
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
• Many DRIs apply, but specific
conditions require adjustments
• May cause poor appetite & increased
caloric needs
• May cause overweight or underweight
• Caloric & nutrient recommendations
should be customized for each child
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
Examples of Likes & Dislikes of a 2.5
y/o Child with Developmental Delay
Behavioral Feeding
Problems
• Mealtime feeding problems are common
with toddlers & preschoolers with
behavioral & attention disorders
• Autism—deficits in communication &
social interactions with onset generally
< 3 y/o
• Attention deficit hyperactivity disorder
(ADHA)—low impulse control & short
attention span with & without a high
level of overall activity
Dietary Intake of a 2 y/o
with Suspected Autism
Other Feeding Problems
• Excessive fluid intake
• Feeding problems & food safety
• 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
Growth Chart
for Child with
FTT Before and
After
Intervention
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
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
• Child is considered to be
developmentally delayed when there
is at least a 25% delay in one or
more areas of development
• 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
