Feeding & Nutrition
Feeding & Nutrition Issues in Children with Complex Conditions
Faltering Growth
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“Undernourishment” is also used to express lower than expected weight gain or inadequate nutrient intake.[National: 2017] Inadequate intake may lead to poor brain development and physical growth and is associated with poor health and nutritional
status. [Henderson: 2007] Even in children with adequate calories, micronutrients may be deficient. [Hillesund: 2007]
Faltering growth may be due to:
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- Unrecognized or under-treated gastro-intestinal problems, such as reflux, constipation, poor motility, or intolerance to foods (e.g., lactose intolerance). For assessment and management information, see Gastroesophageal Reflux Disease and Constipation.
- High cost of nutritious foods, recommended formulas, or supplements
Overweight
Evaluation Challenges
- Weight-for-height percentiles and body mass index may not be adequate to assess under-nourishment even though they are frequently used in the primary care setting. [Fung: 2002]
- Use of evidence-based, condition-specific growth charts is controversial due to medical and nutritional confounders. [Zemel: 2017]
- Standard measures of nutritional status, such as serum albumin and prealbumin, may not be consistently reliable in this population. [Ong: 2014] [Jaramillo: 2016] Elevated inflammation can distort serum levels of micronutrients. [Cho: 2017]
- Parents often over-record food intake when compared to actual measures of caloric intake.
- Linear growth can be difficult to assess when there are contractures, scoliosis, difficulty with standing, and/or lack of cooperation.
- Determining energy needs may be complicated in children with cerebral palsy or other chronic conditions. Some children may have decreased physical activity and decreased caloric need while others will have increased caloric need due to the presence of spasticity, constipation, drooling, and/or excessive sweating.
Assessment Tips
- Measure weight and length/height consistently and watch for trends (weight gain, linear growth, weight loss trends during illness).
- Measure fat stores if you have a skinfold caliper, or refer to a nutritionist. Use of bioelectrical impedance analysis to evaluate body composition is emerging as a fairly reliable measure although norms for various pediatric populations are still being established. [Samson-Fang: 2013]
- Perform segmental measurements (e.g., tibial length). Extrapolating segmental measures provides a reasonable estimate of height that can be plotted on a standard growth curve.
- If nutritional status is deemed optimal, but the child continues to have poor growth velocity, evaluate for growth hormone deficiency.
- Keep in mind that 10-25% weight for age is acceptable in non-ambulatory children.
- Use condition-specific growth charts when available and recommended by experts.
Resources
Services in Utah
Developmental Pediatrics
We currently have no Developmental Pediatrics service providers listed; search our Services database for related services.
Nutrition Assessment Services
See all Nutrition Assessment Services services providers (21) in our database.
Nutrition, Metabolic
We currently have no Nutrition, Metabolic service providers listed; search our Services database for related services.
Pediatric Gastroenterology
See all Pediatric Gastroenterology services providers (3) in our database.
For other services related to this condition, browse our Services categories or search our database.
Page Bibliography
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Hair Mineral and Trace Element Contents as Reliable Markers of Nutritional Status Compared to Serum Levels of These Elements
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W, Stevenson RD.
Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy.
J Am Diet Assoc.
2002;102(3):361-73.
PubMed abstract
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Nutrition biomarkers and clinical outcomes in critically ill children: A critical appraisal of the literature.
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PubMed abstract
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PubMed abstract
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