Nutrition Problems

Who is at risk for nutrition-related Health Problems?

Children and youth with special health care needs are at risk for nutrition related health problems.
This population is defined as “those (children/youth) who have or at increased risk for a chronic physical,
developmental, behavioral, or emotional condition who require health and related services of a type or
amount beyond that required by children generally.” Children and youth with special health care needs
may have physical impairments, developmental delays or chronic medical conditions that are caused by
are associated with the
following factors;
 Chromosome anomalies, genetic
conditions  Neural tube defects
 Congenital infections  Trauma
 Inborn errors of metabolism  Maternal substance abuse
 Prematurity  Environmental toxins
 Neurologic insults

What is the significance of nutrition-related problems in children with special health care

needs?

It is estimated that up to 40-50% of children and adolescents with special health care needs have
nutrition related risk factors or health problems that require the attention or a registered dietitian,
nutritionist, or health care professional. Nutrition risk factors may be physical, biochemical,
psychological or environmental in nature. Physical conditions such as cleft lip or palate or a disease
process such as cystic fibrosis may limit an individual’s ability to feed, digest, or absorb food. Drug-
nutrient interactions may alter digestion, absorption or the bioavailability of nutrients in the diet.
Psychological factors play a role in an individual’s ability to accept and cope with a disability or
treatment plan. For example, depression may alter an individual’s appetite and motivation to follow a
specified diet plan. Environmental factors such as family and social support, finances and
reinforcements for following certain dietary regimens. One or more of these factors may put a child or
adolescent with special health care needs at risk for nutrition problems. Common nutrition problems for
the child or youth with special care needs may include the following:

 Altered energy and nutrient needs 

 Delayed or stunted linear growth  Elimination (bowel) problems
 Underweight  Drug-nutrient interactions
 Overweight or obesity  Appetite disturbances
 Feeding delays or oral-motor  Unusual food habits
dysfunction  Dental and gum disease

How Can Intervention Help?

Nutrition services for a child or youth with special health care needs may require more
specialized services to address complex nutrition issues and may involve an interdisciplinary team.
Examples of the problems that may impact feeding and the respective team members to address these
needs are outlined below:

 Medical issues—physicians, nurses

  Neuro-motor problems—physical
therapists, occupational therapists,
speech pathologists
 Behavior problems—psychologists
 Dental and oral health problems—
dentists
 Financial issues and—social workers
 Community resources—local health
education and information center

Quality and quantity of diet, growth—dietitian or nutritionist. All children and youth with
special health care needs should have a consistent plan across all the environments where they
live, study, play and work. To receive this benefit, children and youth in special education
programs must have a diet prescription from a physician. The prescription must include the
following information:

 A statement identifying the disability, and how the disability affects the child’s diet.
 A statement identifying the major life activity affected by the disability.
 A specific list of dietary changes, modifications or substitutions required for the diet.

Can Nutrition-Related Problems Be Prevented?

All health care professionals should be aware that children and youth with special health care
needs are at increased risk for nutrition problems. Nutrition screening, early identification of problems,
and nutrition education should become parts of routine medical care for children and youth with special
health care needs. Beginning early in childhood, children with special needs should be screened for
nutrition problems and caregivers should be provided with anticipatory guidance regarding the risk of
nutrition problems and practical interventions for prevention, so as to avoid chronic nutrition-related
problems.

ROLES & RESPONSIBILITIES OF FITNESS PROFESSIONALS VS DIETITIANS

Critical Aspects
knowledge of the general nutritional principles ability to provide accurate and current information about
nutrition and healthy eating in accordance with recommended guidelines:
- provide advice about dietary recommendations to assist the management of body composition.
- support clients to adopt a positive attitude towards body image
- recognize the limitations of the roles of a fitness instructor according to industry standards & refer
client on

1. Explain the relationship between nutrition, health and fitness to clients.

General principles of · carbohydrates: . recommended daily

nutrition . role of carbohydrates intake
- food groups: . recommended daily . essential fatty acids
· fats, oils, sweets intake polyunsaturated
· dairy . simple sugars fatty acids
· meat, poultry, fish, eggs, . complex . cholesterol:
nuts, legumes fibre high density
· fruit and vegetables resistant starch lipoproteins
· breads and cereals . glycemic index low density
- dietary guidelines · lipids: lipoproteins
- essential nutrients: . role of triglycerides · protein:
 . role of protein - intake of nutrients: hygiene practices
. recommended daily - healthy dietary pyramid - myths and fallacies
intake - balanced diet - nutritional supplementation
. essential amino acids - food labelling: General features of balanced
. non-essential amino · legislative requirements nutrition
acids · ingredient list - energy balance
. sources · ingredient order - recommended daily intake
. plant proteins · interpretation of label of nutrients
· minerals: · preservatives - fuel for exercise
. types · additives - fuel for minimising post-
· vitamins: - food preparation: exercise fatigue and
. water soluble · methods of cooking maximising recovery
. fat soluble · effect on nutrient value of - hydration levels
. vitamin-mineral food
interactions · modification of recipes
· fluid and electrolytes · safe food handling and

2. Provide basic advice to clients about the fundamental principles of healthy eating.

Fundamental principles of - relationship between - nutritional supplementation

healthy eating energy intake and energy - nutritional ergogenic aids
- balanced diet expenditure
- low in saturated fat and - recommended intake of Industry standards
cholesterol nutrients - professional associations
- moderate intake of refined - relative proportion of - government legislation
sugars nutrient intake - fitness industry regulations
- moderate intake of alcohol - variety Dietary recommendations
- meal size
Dietary trends - government organizations
- meal frequency
- 'fad' diets - health organizations, -
- spread of kilojoules over
- 'popular' diets dietician peak bodies,
day

3. Provide nutritional information to clients regarding body composition management.

Body composition - metabolism - energy intake:

measures
- 'ideal weight' -
height/weight charts
- body mass index
- girths
- girth ratios such as
waist/hip ratio,
waist/height ratio
- skin folds
Management of body
composition
- balance between · kilojoule value of
energy intake and nutrients
energy expenditure - body fat changes and
- energy expenditure: body composition
· resting metabolic rate - changes to body
· thermogenesis composition:
· thermic effect of food · fat loss
· thermic effect of · muscle gain
exercise
· adaptive Energy substrates
thermogenesis - lipids
 - carbohydrate Energy systems - lactic
- protein - alactic - aerobic

4. Support fitness clients with body image issues.

 Implement strategies to promote body satisfaction when providing advice about exercise,
fitness testing and nutrition.
 Provide information about diet and nutrition that fosters a positive attitude towards food
and eating.
 Recognize indicators of poor body image and discuss body satisfaction with clients,
providing referral to an appropriate health professional, if required.
5. Refer clients to allied health professionals or medical professionals for further information or
consultation.

 Recognize and acknowledge the current legal and ethical limitations of a fitness
instructor in providing nutritional information.
 Identify gastrointestinal disorders or other medical conditions, disclosed by the clients
during a screening process, which may affect nutritional intake, and refer clients to a
suitably qualified medical professional.
 Identify nutritional or dietary concerns and refer clients to contact suitably qualified
allied health professionals and medical professionals in accordance with organizational
policies and procedures maintaining confidentiality of clients.
Medical professional Medical conditions
- general practitioners - diabetes
- medical specialists - gallstones
- cancer
Allied health professionals - gout
- Physiotherapists Gastrointestinal disorders
- Chiropractors - gastrointestinal reflux
- Exercise Physiologist - ulcers
- Occupational Therapists - inflammatory bowel disease
- Osteopaths - irritable bowel syndrome
- Massage Therapists - celiac disease
- Sports Physicians - lactose intolerance
- Medical Practitioners Nutritional or dietary concerns
- Podiatrists - anorexia
- Dietitians - bulimia
- obesity
Chronic diseases
- nutritional deficiencies including iron, calcium
- coronary heart disease
- dehydration
- hypertension
- diabetes
- gallstones
- bowel cancer
- obesity
- stroke