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sCHOOL HEALTH MANUAL

 

 

CONTENTS-NUTRITION

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Nutrition

Potential Nutrition Problems/Childhood Diseases

 

NUTRITION

School Nutrition Programs, Department of Education, 287-5315

Maternal and Child Health Nutrition Program, Division of Community and Family Health, Bureau of Health, Department of Human Services, 287-5366

 

Children need a nutritious diet so that they may learn, grow and be healthy.  Daily nutritional needs can be met by offering a variety of foods as outlined in the Food Guide Pyramid.  In addition, the Dietary Guidelines for Americans recommend an adequate intake of fiber and moderation of sodium, fat, sugar, and cholesterol.  Nutrition education can help to promote good nutrition and physical fitness habits that will last a lifetime.

 

State and Federal food assistance and nutrition education programs provide important resources for children and their families.  Some of the programs available in Maine include the National School Lunch Program, School Breakfast Program, Special Milk Program, Summer Food Service Program, Food Stamps, WIC, Child and Adult Care Food Program, Head Start, Cooperative Extension, Expanded Food and Nutrition Education Program, and Emergency Food Assistance Program. Other resources for nutrition education are the Maine Dietetic Association, Maine Nutrition Council, Maine Dairy and Nutrition Council, Maine School Food Service Association, Maine Nutrition Network, Maine Family and Consumer Science Association,  the Five-A-Day Coalition, and Bureau of Health.

 

As part of the School Meals Initiative for Healthy Children, the U.S. Department of Agriculture published regulations for improving school meals.  The School Nutrition Programs use nutrient standards based on both the Recommended Dietary Allowances and the Dietary Guidelines for Americans.1

 

Common nutrition issues in children include obesity, eating disorders, under-nutrition, metabolic disorders and iron deficiency.  Nutritional requirements during adolescence are increased due to the growth spurt that occurs during this period.  Athletes have additional nutritional needs depending on the intensity, duration and type of exercise.  These individuals may need guidance regarding sound nutrition concepts which promote good health as well as improve performance.

 

Children with special health care needs require the same nutrients as normal healthy children, but the quantities may vary due to differences in growth, weight, and height; drug-nutrient interactions; oral-motor and/or psychosocial feeding difficulties.  Successful feeding may require special eating utensils or equipment, modifications of texture, temperature, and consistency, and use of commercial supplements or formulas and thickening agents.  It is important to involve school food service personnel and parent/caregiver(s) when a child needs meal alterations.2

 

Screening for nutrition problems in children can help prevent illness and promote health.  Accurately determined anthropometric measurements are one of the best indicators of nutritional status in children.  Growth charts from the National Center for Health Statistics are used to assess a child’s growth progress over time.  The section in this manual on physical examination/screening provides guidance on anthropometric measurements.  Specific growth charts have been developed for some children with special health care needs including Down Syndrome.

 

The following table outlines potential nutrition problems and recommendations of common childhood diseases and disorders.  A registered dietitian should be consulted to provide nutrition assessment, medical nutrition therapy, and monitoring of quality nutrition care.

 

 

1Healthy School Meals Training Manual, US Department of Agriculture, Food and Consumer Service, April 1996.  (Available from your School Food Service Department or the Maine Department of Education, Nutrition Education and Training Program)

2Accommodating Children with Special Dietary Needs in the School Nutrition Programs, Guide for School Food Service Staff, US Department of Agriculture, Food and Consumer Service, May 1995. (Available from the Maine Department of Education, Nutrition Education and Training Program)

 

 

Potential Nutrition Problems and Recommendations in Childhood Diseases/Disorders

Disease/Disorder

Potential Nutrition Problems

Diet/Nutrition Recommendations

Anorexia Nervosa

·    Excessive dieting/exercise

·    Distorted body image

·    Unusual eating habits

·    Amenorrhea

·    Extreme weight loss

·    Treatment involves medical, psychological, and nutrition intervention

·    Treatment should be individualized

Bulimia Nervosa

·    Binge eating

·    Purging

·    Vomiting

·    May be underweight, normal, or overweight

·    Treatment involves medical, psychological, and nutrition intervention

·    Treatment should be individualized

Cancer

·    Weight loss

·    Loss of appetite

·    Caloric adjustment

Cerebral Palsy

·    Feeding problems may include: sucking, swallowing or chewing difficulties; and abnormal bite or gag reflexes

·    Vomiting and refluxing

·    Underweight or overweight

·    Dental problems including caries and gum disease

·    Constipation

·    Feeding evaluation by qualified professional

·    Use of adaptive equipment

·    Texture modification

·    Caloric adjustment

·    Good oral hygiene

·    Adequate fluid and fiber intake

Cystic Fibrosis

·    Poor weight gain and growth

·    Malabsorption of fats and proteins

·    Fat-soluble vitamin deficiencies

·    Diet is high in calories and protein with liberal amounts of fat and sodium chloride

·    If pancreatic insufficiency is present: vitamin supplementation and pancreatic enzyme replacement therapy*

Diabetes Mellitus

·    Uncontrolled diabetes may lead to: hyperglycemia, glycosuria, polyuria, polydipsia, polyphagia, rapid weight loss, ketosis, ketonuria, acetone breath, and coma

·    Diet modifications are based on individual needs according to activity level, medication and growth rate+

Down Syndrome

·    Feeding problems may include: sucking, swallowing and chewing difficulties

·    Excessive weight gain

·    Dental problems: delayed tooth development, malocclusion, and gum disease

·    Feeding evaluation by multidisciplinary team

·    Texture modification

·    Adaptive feeding equipment

·    Use appropriate growth charts

·    Caloric adjustment

·    Good oral hygiene

Food Allergy

 

 

·    Food allergy: abnormal immuno- iogic reaction.  The most common food allergens include eggs, milk, nuts, peanuts, seafoods, soy, and wheat.  Severe reaction will require administration of medications.++

·    Avoidance of specific food allergens while maintaining adequate intake

Disease/Disorder

Potential Nutrition Problems

Diet/Nutrition Recommendations

Food Intolerance

·    Food intolerance is a non-immunologic reaction to a food, or the result of an enzyme deficiency

·    Avoidance of problem food(s) while maintaining adequate intake

Hunger

·    Apathy, irritability

·    Decreased activity level

·    Reduction in rate of weight gain

·    Impaired cognitive development

·    Family may need referral to food assistance/nutrition education programs

Juvenile Rheumatoid Arthritis

·    Inadequate growth

·    Side effects from medications: stomach upset, altered taste, increased or decreased appetite

·    Temporomandibular joint arthritis may lead to poor appetite

·    Nutritional anemia

·    Weight gain may occur due to decreased activity level and steroid medications

·    Energy and nutrient dense diet

·    Weight management

·    Texture modification, small portion sizes

·    Prolonged use of medications with nutrient interactions may lead to calcium and folic acid supplementation*

 

Obesity

·    May lead to other health complications (ie. diabetes, high blood pressure, heart disease)

·    Anthropometric measurements: high weight-for-height (>95th percentile or 120% ideal body weight)

·    Proper diet, exercise and behavior changes that lead to slow weight loss and/or weight maintenance while promoting growth and development

Phenylketonuria

·    Excess phenylalanine in the blood can interfere with normal brain development

·    Since phenylalanine is an essential amino acid, it is restricted in the diet to maintain adequate serum levels

 

·    Diet restricts the essential amino acid phenylalanine

·    Formulas may include: PKU2, Maximaid XP,  or Phenyl-Free*

·    Special low protein foods

·    Foods and beverages containing aspartame are avoided

Seizure Disorders

·    Drug-nutrient interactions caused by anticonvulsants may include: nutrient deficiencies especially folic acid, vitamin D and calcium, poor appetite, and gum problems

·    Caloric adjustment

·    Vitamin/mineral supplements*

·    Good oral hygiene

Spina Bifida

·    Excessive weight gain

·    Urinary tract infections

·    Bowel management issues

·    Caloric adjustment

·    Adequate fluid and fiber intake

Tube feeding

·    Common complications include vomiting, diarrhea and constipation

·    Tolerance to the tube feeding should be monitored

·    Possible causes of complications: feeding is too rapid or too concentrated, bacterial overgrowth, inadequate fluid or fiber, medications, and lack of activity*

 *  See Medications section of this Manual

 +  See Chronic Conditions section of this Manual      ++ See Emergencies/First aid section of this Manual