May 2011 Issue

Preventing Obesity in Kids With Special Needs — Dietitians Play an Integral Role
By Melissa Ip, MA, RD
Today’s Dietitian
Vol. 13 No. 5 P. 50

Although the obesity epidemic has become widespread across all segments of the U.S. population, its impact on children with special healthcare needs has typically received little attention. Such children “have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and … also require health and related services of a type or amount beyond that required by children generally.”1 Estimates indicate that 12.8% of U.S. children under the age of 18 have a special healthcare need.1

Children with special healthcare needs are at a higher risk of overweight and obesity for a variety of reasons.2 Genetic disorders such as Prader-Willi syndrome or Bardet-Biedl syndrome include obesity as a clinical feature. Certain medications, including some antidepressants and anticonvulsants, are associated with weight gain. Children with cerebral palsy, spinal cord injury, muscular dystrophy, or spina bifida experience significant mobility limitations that limit physical activity. Providing opportunities for physical activity, such as having adaptive equipment or a pool membership, can be costly for families with already high healthcare costs.

Dietitians and nutrition professionals should strive to better understand the challenges unique to youths with special healthcare needs to ensure they receive individualized nutrition care and help them lead more active lives.

Tailoring Obesity Prevention Messages
Despite an increasing national effort to address childhood obesity, few programs are tailored to meet the special healthcare needs of children. Children with disabilities are less likely to participate in school and other social activities and more likely to be institutionalized; therefore, they are less likely to be exposed to obesity prevention programs.1 Because youths with disabilities have a wide range of abilities related to mobility, communication, and learning, it is important that obesity prevention programs as well as nutrition counseling are tailored specifically to individual healthcare needs.

“I Can Do It, You Can Do It” was a nationwide initiative launched in 2004 by Health and Human Services that aimed to increase physical activity and healthful dietary behaviors among children with disabilities. The program linked children with disabilities to physically fit mentors (with or without a disability) who provided guidance and training to help the children become more physically active.

KIDS FIRST, an early intervention program at the University of Arkansas for Medical Sciences department of pediatrics, provides therapeutic services to young children with special healthcare needs in Arkansas. Services include developmental skills, nutrition, behavioral therapy, and social services. Created by KIDS FIRST’s multidisciplinary staff, “Putting KIDS FIRST: A Nutrition and Physical Activity Curriculum” is an award-winning curriculum that incorporates all learning domains into a program that includes art, food, music, and moving. The curriculum is available to order at www.arpediatrics.org/kidsfirst/about-kids-first/award-winning-curriculum.

What Dietitians Can Do
Youths with special healthcare needs should receive individualized nutrition assessment. “Kilocalorie and nutrient needs must be individualized for this population,” says Verna Baker, MS, RD, LD, who oversees KIDS FIRST’s nutrition services. Growth charts for Down syndrome, Prader-Willi, and other genetic disorders can be used as references for normal growth and development.

Focus group research shows that parents of children with special healthcare needs often encourage “calories at any costs” for children who face immediate health crises.2 When these children grow older and their health conditions stabilize, parents then find it difficult to promote more healthful eating patterns.2 Parents also find it hard to set limits concerning food choices, especially as children with special healthcare needs already have challenges with many other activities. Therefore, parents and children with special healthcare needs “may benefit from guidance around how to change dietary practices as health status improves.”2

Nutrition counseling for children with special healthcare needs is often similar to that for any other child, says Angie Hasemann, RD, a clinical dietitian at the University of Virginia Children’s Hospital. She often emphasizes the importance of regular mealtimes, portion control, and the consumption of fruits, vegetables, and more healthful beverages. Additionally, children with special healthcare needs may spend more time watching TV than other children. Screen time is especially popular among children who get tired easily due to cardiac or respiratory conditions. Therefore, “Limiting screen time to two hours per day or less is very important in this population,” says Hasemann.

Anne Marquart, RD, LD, a bariatric dietitian in Fayetteville, Ark., and the mother of a child with Down syndrome, recommends that dietitians working with children with Down syndrome be mindful of their lower calorie requirement, which is approximately 80% of the calories their counterparts need. Marquart recommends low-fat protein foods, whole grains, and fruits and vegetables to meet their needs. Parents should be encouraged to recognize and honor their children’s satiety cues. Children should be allowed to eat slowly and without distraction.

Crucial Role  
Children with special healthcare needs are at greater risk of overweight and obesity, yet their needs are often neglected in childhood obesity prevention efforts. As members of the multidisciplinary care team, dietitians play an integral role in providing individualized nutrition care to these children and their families. Dietitians and nutrition professionals can also advocate and support policies that increase access to venues for physical activity to all youths, regardless of abilities.

— Melissa Ip, MA, RD, is a health educator in New York City.

 

Resources for Dietitians
• American Dietetic Association Pediatric Nutrition Care Manual: http://peds.nutritioncaremanual.org

• Ekvall SW, Ekvall VK. (eds.) Pediatric Nutrition in Chronic Diseases and Developmental Disorders: Prevention, Assessment and Treatment. 2nd ed. New York: Oxford University Press; 2005.

• Interdisciplinary Leadership Training in Overweight Prevention and Intervention for Children with Special Health Care Needs: www.uthsc.edu/bcdd/training/community/cshcn.php

• National Center on Physical Activity and Disability: www.ncpad.org

• Nutrition for Children With Special Health Care Needs in Washington State: http://depts.washington.edu/cshcnnut/resources/cshcn.html

• Nutrition Strategies for Children with Special Health Care Needs: www.uscucedd.org/index.php?option=com_content&view=article&id=166&Itemid=230

 

Resources for Kids
• Body and Mind: Meeting the Challenge: www.bam.gov/sub_physicalactivity/physicalactivity_meetchallenge.html

• Kids’ Quest on Disability and Health: www.cdc.gov/ncbddd/kids/index.html

 

References
1. Kumanyika S, Obarzanek E, Stettler N, et al. Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance: A scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention. Circulation. 2008;118:428-464.

2. Minihan PM, Fitch SN, Must A. What does the epidemic of childhood obesity mean for children with special health care needs? J Law Med Ethics. 2007;35(1):61-77.

 

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