Nutritional Assessment for Special Needs

Nutritional Assessment for Special Needs

Nutrition therapy for children with special needs varies greatly and must be individualized for each issue.  Swallowing difficulties, positioning and nutrient deficiencies are just a few of the variables that can have an impact on your child’s growth and development.  Recognizing potential problems and understanding how those should be monitored can help in finding solutions.

Eating issues are found more often in children with special needs because of underdeveloped muscle tone, which can cause delayed oral motor skills and swallowing difficulties. An occupational therapist can work with parents on special techniques to use with their child to continue oral feedings; however, if your child coughs or chokes at meals and swallowing difficulties are suspected, consult with a speech therapist who can perform a swallowing evaluation to identify if oral feedings are safe. Modifying the consistency of liquids or changing to a non-oral route of nutrition to prevent aspirating may be recommended.  

How your child sits while eating food or receiving tube feedings is also a factor that impacts nutrition. Children who have difficulty sitting upright or who have neurological impairments are at risk for gastroesophageal reflux. This condition can be difficult for the non-verbal child to express so the parent must identify the symptoms. If your child refuses to eat, stops eating after only taking a small amount, vomits, cries or arches his back while eating, you should discuss with your pediatrician. There are many solutions that may include keeping your child’s upper body elevated after eating, providing a reflux medication or changing the volume and frequency of tube feedings.

Beyond neuromuscular complications, the combination of medications, a limited diet and inadequate fluid intake can result in additional problems such as vitamin deficiencies, constipation or dehydration. Consider creative ways to add nutrients, fiber and extra fluids within the framework of your child’s textural sensitivities and tastes. Smoothies or popsicles made from pureed fresh fruit and cooked vegetables are a good way to meet nutrition needs. A chewable or liquid multivitamin should also be considered. If your child receives a tube feeding and displays symptoms of constipation or dehydration, discuss with your dietitian about changing the formula or adding boluses of water throughout the day.

Once you’ve addressed your child’s feeding concerns, how do you know whether he is meeting his nutrition needs and growing appropriately?  When your child visits the pediatrician, length and weight are measured and then plotted on growth charts for the child's age.  There are special charts available for children with:

These charts reflect the unique growth patterns for each condition and your child should be plotted on whichever is applicable. A child with Cerebral Palsy might appear to be failing to thrive when plotted on the Center for Disease Control’s pediatric growth charts; however, if plotted on charts that compare him to other children with Cerebral Palsy, clinicians may find he is growing just right at the 50th percentile.

No matter what growth chart is used or what percentile your child is in, he should continue to follow his own growth curve pattern. If you are concerned that your child’s weight is lower or higher than his same-age peers, you can ask the doctor to evaluate whether his weight is appropriate for his length by using the weight-for-length or body mass index chart. If he suddenly drops two percentiles below where he previously plotted, this should be discussed with the doctor or dietitian to determine the root cause.  

Parents of children with special needs may face a wide range of nutrition challenges from delayed oral motor skills to medication side effects. Early identification of feeding issues and careful monitoring of your child’s growth will ensure he is able to thrive and grow to his full potential.

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Written by: Louise Goldberg, RD, CSP, LD, CNSC See other articles by Louise Goldberg, RD, CSP, LD, CNSC
About the Author:

Louise Goldberg, RD, CSP, LD, CNSC, is one of only 60 board certified pediatric nutrition specialists in the state of Texas. She has been a Registered Dietition for 12 years. Prior to starting her practice, she worked at Children's Memorial Hermann Hospital in the Houston Medical Center. Find out more about nutrition counseling at her website, An Apple A Day Nutrition Counseling.

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