3.4 Anticipatory Guidance
More contributors to nutritional problems that are common among
children with special health care needs:
- Medications can affect nutritional status. Several anti-seizure medications interfere with vitamin D and folate metabolism. Vitamin D deficiency hinders the absorption of calcium and phosphorus and thus interferes with the mineralization of bones and teeth. Folate deficiency may result in lesions on the lips or tongue and may interfere with food and fluid intake.
- Children with developmental delays may also be delayed in their development of feeding skills. Oral-motor activity involves body positioning, fine and gross motor skills, social interactions, and sufficient cognition, any of which may be negatively affected by a child’s overriding medical condition. Advise the parents that the child’s ability, not chronological age, should determine the oral feeding stage. However, infant foods are not nutritionally dense enough for the older child, even if the texture is appropriate. Table foods that have been blended may be more appropriate. Some children require supplemental feedings of high-calorie, nutrient-dense formulas, which can be highly carogenic.
- Behavioral problems may be common in children with special health care needs because of parent/child control issues at mealtimes. Advise the parents to separate food-related behavior and parent-child interactions. Feeding can become more manageable when families seek the support of an interdisciplinary feeding team, which includes a behavioral specialist.
In general, multidisciplinary involvement is critical to promote optimal nutritional status for children with special health care needs. Oral health professionals should coordinate dietary and feeding recommendations with a dietitian/nutritionist or other health professionals (e.g., occupational therapist, psychologist) involved in the child’s nutritional care.