Outcomes of Today’sWorkshop Understand basic aspects of humannutrition Recognize nutrition issues common inyoung children with special needs Review some of the special diets seenin children with special needs,particularly child with ASD
Outcomes of Today’sWorkshop Identify family concerns, priorities,experiences and resources regardingnutrition and feeding issues, andunderstand common stressors thatfamilies experience. Obtain resources for addressingfeeding and nutrition issues.
General Roles of theFeeding Team Members FamilySpecial Educators and ParaeducatorsNurseOccupational TherapistSpeech TherapistMedical Specialists– Primary Care Physician– Pediatric Specialists (ie: Gastroenterologist) Registered Dietitian (Nutritionist)
Common StressorsFamilies Experience Issues with confidence in parenting roleIsolationFrustrationDepressionFeeling overwhelmedToo little or too much “help” fromprofessionals
Potential Effects ofFeeding Issues in Children Stress on the primary parent-infantrelationship and family system Risk of nutritional deficiency (FTT) Slowed growth during rapid braindevelopment Speech, language, cognitive and social/emotional issues
Nutrition Defined Nutrition – the science of foodsand the nutrients they contain– Also consider the action of these foodsand the nutrients in the body
Nutrition Defined Actions in the body include:– Ingestion– Digestion– Absorption– Transport– Metabolism– Excretion
Diet and Health Diet - the foods one consumesThe quality of your daily dietaffects development andincrease the risk of chronicdiseases
What’s Considered Food? Foods contain nutrients and arederived from plant or animalsources Nutrients are used by the bodyto provide energy and to supportgrowth, maintenance and repair ofbody tissues– 40 nutrients identified at this time
Classifying NutrientsThere are 6 Classes of Nutrients1.2.3.4.5.6.CarbohydratesLipids (fats)ProteinsVitaminsMineralsWater
Describing the Nutrients There are several ways to classifythe classes of nutrients.––––Organic or inorganicEssential or nonessentialMacronutrient or micronutrientEnergy yielding or not
Classifying Nutrients Essential nutrients – nutrients thebody either cannot make or cannotmake enough of to meet its needs.– These nutrients must be obtained fromfoods (ingested in some manner)– Examples: Vitamins Calcium, iron, and other minerals Some of the amino acids
Quantity Needed Macronutrients: need in relativelylarge amounts Carbohydrates, lipids, proteins Micronutrients: need in relativelysmall amounts All other nutrients
Classifying Nutrients Energy-yielding nutrients (3):– Carbohydrates– Fats (lipids)– Proteins Where does the energy come from?
A little more on energy Measure energy in kilocalories in U.S.– What most think of as a “calorie” isreally a kilocalorie– Kcal amount of energy needed to raisethe temperature of 1 kg of water by 10C
Energy-YieldingNutrients
Energy-YieldingNutrients Carbohydrates: C, H, O– 4 kcal/gram– Body’s primary source of energy Use as glucose– Brain’s only source of energy– Stores are limited 12-24 hours (in liverand muscle) Carbohydrate rich foods .
Energy-YieldingNutrients Fats: C, H, O– 9 kcal/gram– Body’s alternate source of energy Use fat along with glucose as an energysource most of the time– 4 types: saturated, monounsaturated,polyunsaturated (omega-3 and omega-6),and trans-fat– Stores are unlimited
Energy-YieldingNutrients Proteins: C, H, O, N, S– 4 kcal/gram– Body’s least desirable source of energy WHY? .– Protein is used for energy only whenthere isn’t any carbohydrate available asan energy source.
Daily ValuesRecommended intakes of nutrients vary by age andgender and are known as Recommended DietaryAllowances (RDAs) and Adequate Intakes (AIs).However, one value for each nutrient, known asthe Daily Value (DV), is selected for the labels ofdietary supplements and yvalues.aspx
Vitamins Essential Organic, micronutrient Not energy-yielding Fairly easily destroyed/damaged Can be water-soluble or utrition/vitamins
Minerals Essential Inorganic, micronutrient Not energy-yielding Indestructible Macro (calcium, phosphorus, magnesium,sodium, potassium, chloride, and sulfur) andTrace minerals (iron, manganese, copper,iodine, zinc, cobalt, fluoride, and selenium) http://kidshealth.org/parent/
From Food Pyramids to“Choose My Plate” http://www.choosemyplate.gov/preschoolers.html
Sear’s Nutrition DeficitDisorder (NDD) “Brain Foods” especially foods with Omega3 Fatty Acids (Fish) Smart Foods: Blueberries, Nuts, Salmon &Spinach “Dumb” Foods: Excitotoxins, e.g. MSG,aspartame, food colorings, andpreservatives, fiber-poor carbs,hydrogenated oils, “Liquid candy” –sweetened trition/ndd
Nutrition affects thebrain in three ways: The cell itself needs proper nutrition to carry onits functions just like any other cell in the body. The myelin sheath covers the axon of the celllike insulation covering electrical wires.Deficiencies of nutrients that compose myelin,such as essential fatty acids, delay nerve-impulsetransmission. The neurotransmitters, carry messages fromone cell to the other and affect mood as well asthoughts and actions. Some of the nutrientsbecome part of the neurotransmitters that helpus think
The Science of Nutrition– Evaluating Internet HealthSites Use webeval.html– What is the evidence .?Empirical vs anecdotal– Standards of andardsof-care/
ASD – Brain –Nutrition
Nutrients Critical for Brain Function ProteinCarbohydrateFatOmega-3 Fatty AcidsAmino AcidsVitaminsMineralsWater
Common Nutrition andFeeding Concerns “Picky” eating behaviors Difficulty with transitioning to ageappropriate diet Increased sensory sensitivity Oral motor and/or motor planning issues Short attention span Limited variety in diet Need for routine
Eating Preferences Preference for dry, crunchy foodsRefusal of soft, smooth texturesDislike of fruits and vegetablesPreference for finger foodsPreference for certain brands andpreparation methods Preference for food of particularcolor(s)
Preferred Foods dry cerealcrackerschicken nuggetspizzabreadhot dogspasta
Other NutritionConcerns Vitamin and mineral deficiencies Gastrointestinal concerns (reflux,constipation, diarrhea) Drug-nutrient interactions Food allergies and Celiac disease Alternative therapies (CAM)
Nutrition Therapies Still limited evidence-based research toshow effectiveness of alternativetreatments Need for more research New gf/cf study [2/12} just 02/120229105128.htm Need to be individualized Select therapy with caution and beaware of possible toxicity
Nutrition TherapyGoal of Nutrition Therapy for ASD: Support the structure and function of thechild’s brain and body to perform at theiroptimum level. Maximize the child’s brain function toenhance their response to other treatmentapproaches (SLP, OT, PT, Behavioral,Special Education Instruction, etc ).
Nutrition TherapyFrom Elizabeth Strickland RD“Eating For Autism”Heal the Child’s gutElimination/Challenge DietIdentify & Treat Food AllergiesHerbs, Nutraceuticals, and NutrientsTreat the Feeding ProblemEnhance Child’s Cognitive FunctionEnhance the Immune SystemEnhance the Detoxification System
“Eating for Autism”** Many of the following slides are from ElizabethStrickland book and presentation
Eating for AutismThe 10 – Step Nutrition Plan to Help TreatAutism Transition to a healthy diet Consume adequate basic nutrients Select a multi-vitamin/mineral supplement Select an omega-3 fatty acid supplement Treat child’s feeding problem Heal the gastrointestinal tract Identify and treat food allergies Consider special diets Trial response of high dose vitamin B6 Consider additional supplements http://www.asdpuzzle.com/eating-for-autism
Adverse Reactions toFood Toxic Non-Toxic– Food Intolerances: metabolic,pharmacologic, idiosyncratic More likely to occur in ill or malnourished– Food Allergies: IgE Non- IgE Mixed IgE and Non IgE
Nutrition TherapyComponents of a NutritionAssessment:1.) Anthropometrics- Growth measurements2.) Biochemical3.) Clinical4.) Dietary5.) Environmental6.) Feeding
Nutrition TherapyFeeding Assessment Does your child have a history of any of the following?–––––RefluxProblems with breast-feedingProblems with bottle feedingsDifficulty transitioning from baby food to table foodsFed a special formula as an infant Does your child eat a limited variety of foods ( 20 foods)? Does your child tantrum when presented with new foods? Has your child discontinued eating foods he/she used toeat? Does your child have any rituals at meal-time? Does your child refuse foods of a certain texture?
Nutrition TherapyFeeding Assessment Does your child need assistance to feed himself? Does your child use age appropriate feeding anddrinking utensils? Does your child have trouble chewing orswallowing? Does your child express hunger? Does your child have a good appetite? Is food or candy ever used as a reward? Has your child ever received Feeding Therapy? Are you concerned that your child has a feedingproblem?
Autism & FeedingProblems“The prevalence of problem eatingbehaviors in children with autism hasbeen estimated to range between46% and 89%.”Feeding problems in children with autism spectrum disorders: areview.Focus Autism Other Dev Disabil.2006;21(3):153-166.
Autism & FeedingProblemsCommon Mealtime Behaviors: Selective food refusalFood neophobia (fear of trying unfamiliar foods)Nonfunctional mealtime ritualsTantrums
Picky Eater vs. ProblemFeederPicky Eater Decreased variety of food( 30 foods). Foods lost due to burn-out.Regained after 2 weeks. Able to tolerate new foodson plate, touch, or taste. Eats at least 1 food frommost food textures. Adds new foods torepertoire in 15-25 steps.Problem Feeder Restricted range offoods ( 20 foods). Foods lost due toburn-out, foods notregained. “Falls apart” whenpresented new foods. Refuses entirecategories oftextures. Adds new foods in 25 steps.Kay Toomey, Ph.D.
Contributing FactorsMedical Food allergies, sensitivities, andintoleranceMedication side effectsPrevious invasive interventionsDental problemsGastrointestinal Disorders
GastrointestinalDisorders Studies suggest that the majority ofchildren with autism may have agastrointestinal disorder. Most of these children continue to sufferwith undiagnosed GI disorders unable toverbally express the pain they feel. Identifying and correcting the child’s GIdisorder can lead to significant overallimprovement in digestion, health, behavior,and brain function.
GastrointestinalDisordersGastrointestinal Symptoms RefluxVomitingAbdominal nt stoolStraining to pass stoolLoose stool
GastrointestinalDisordersVocal Behaviors Clearing of throat Screaming Sobbing Whining Moaning Delayed echolalia Direct verbalizationsMotor Behaviors Facial grimacing Gritting teeth Grazing Mouthing on clothes Unusual posturing Pacing Jumping up and down Self-jury Aggression Puts pressure onabdomen
GastrointestinalDisordersChanges in OverallState Sleep disturbances Increased irritability Oppositional behaviorMealtime Behaviors Food refusal Limited variety offoods Mealtime tantrums Discontinue eatingfoods used to eat
GastrointestinalDisorders“70% of autistic children were found to havea lifetime history of gastrointestinalsymptoms such as abnormal stools,constipation, frequent vomiting, andabdominal pain.”Journal of the Developmental and Behavioral PediatricsApril 2006Niehus, et al
GastrointestinalDisordersContributing Factors to GI Disorders: Nutrient deficienciesMalnutritionInadequate water intakeInadequate fiber intakeLow or increased muscle toneDecreased physical activityIrregular toilet habitsUnable to communicate need to have a bowel movementHolding their stoolMedication side effectsLong-term use of laxatives, suppositories, and enemasCow’s milk allergyMedical conditions
Potential Nutritional Deficiencies Protein Vitamins:– C, E, B- complex, B 6, Vitamin D Minerals:– Calcium, magnesium, chromium Calories Fiber
Resources --SpecialDiets Seen in Childrenwith ASD* Autism Research Institute (DAN)http://www.autism.com/faq diets.asp* Autism n-research-report-special-diets
Autism Diets GFCF (Gluten-Free CaseinFree) Low Oxalate SCD (Specific Carbohydrate) Body Ecology Feingold Weston A. Price (NourishingTraditionsnourishinghope.com/
rg/family-resources/gfcfsf-diet-on-a-budget/ The place many families start – Many families have positive results– Restrictive diet – socially isolating
Gluten Content of Foods Gluten– Commonly found in Wheat, Rye andBarley Breads, pastas, cereals, processed foods– Oats safe grain but caution with crosscontamination– Hidden sources – potential problem Thickener for soups, gravies, sauces Art and craft supplies– Ubiquitous ingredient
Research conclusions Gluten-free diet– Potentially deficient in: calcium, fiber, iron and B Complex vitamins Alternatives– Increase use of greens, fruits andfolate rich vegetables – Hallert– Increase total number of grain servingsper day, especially whole grain Thompson
Casein Content of Foods Casein– Protein found in milk Yogurt, puddings, cheese, ice cream Added to breads, crackers, cookies– Labels Listed as milk, dry milk powder, sodiumcaseinate, hydrolyzed protein
Casein content of foods Hidden sources– Packaged mixes– Sauces– Baked products– Snacks and snack bar****CAREFUL LABEL READING****
Nutritional Approach toGFCF Careful label reading Many non gluten or casein baseditems could be potentially irritating– Many hidden sources of gluten andcasein– Many sugar substitutes– Many gums– Many artificial colors, flavors etc
Mealtime Strategies Do NOT allow child to grazeSchedule meal and snack timesLimit juice, milk, and beverages toappropriate amountsLimit distractions during mealsSocial modelingOffer manageable foodsUse verbal positive reinforcementUse appropriate mealtime languageAvoid food burn-out
Feeding TherapyWhat feeding methods are helpful?A combination of feeding methodsvarying for each child based on theirindividual feeding problems.
Feeding TherapyBuilding on preferred foods: Food ChainingCheri Fraker, CCC-SLPExpands the child’s food repertoire byintroducing new foods that have the samefeatures as the foods the child currentlyeats.http://cheriandlaura.blogspot.com/
Feeding TherapyBehavioral: Positive reinforcementTangible item and/or praise Escape extinctionNonremoval of spoon and/or physical guidance Stimulus fadingIncreasing the number of bites and/or amount offood presented on spoon
Feeding TherapySensory: Sequential Oral Sensory Approach to Eating(SOS)Dr. Kay Toomey, PhD– 32-step plan to ease the child into tolerating,interacting, smelling, touching, tasting, andeating a new food.http://www.spdparentzone.org/
Other Resources “Child of Mine”– E. Satter “Just Take a Bite” and “Finicky Eaters”– L.Ernsperger and T. Stegen-Hanson “Changing the Course of Autism”– B. Jepson “ Special-Needs Kids Eat Right”– J. Converse “What’s Eating Your Child”– K. Dorfman “Just Two More Bites!– L. Piette “ Poor Eaters”– J. Macht
IFSP/IEP – FeedingProblem** Do you have outcomes or goals foryour students with feeding issuesExampleGoal:Child will master the basic life skill ofindependently eating a variety of ageappropriate nutritious foods.
Summary Eating is one of the most importantand complex skills acquired in earlychildhood. Children with ASD typically haveproblems with feeding. Feeding problems may lead tomalnutrition negatively impacting brainand body function. A multi-disciplinary approach toassessing and treating the feedingproblem is critical. The feeding treatment methods shouldbe individualized for each child.
Foods lost due to burn-out. Regained after 2 weeks. Able to tolerate new foods on plate, touch, or taste. Eats at least 1 food from most food textures. Adds new foods to repertoire in 15-25 steps. Problem Feeder Restricted range of foods ( 20 foods). Foods l
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Independent Personal Pronouns Personal Pronouns in Hebrew Person, Gender, Number Singular Person, Gender, Number Plural 3ms (he, it) א ִוה 3mp (they) Sֵה ,הַָּ֫ ֵה 3fs (she, it) א O ה 3fp (they) Uֵה , הַָּ֫ ֵה 2ms (you) הָּ תַא2mp (you all) Sֶּ תַא 2fs (you) ְ תַא 2fp (you
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