Preventing Overweight in Children Preventing Overweight in Children with Special Needswith Special Needs

Trudi Bellou MS RD LDTrudi Bellou MS RD LDCommission for Children with Special Health Commission for Children with Special Health

Care NeedsCare Needs

Overweight Increasing in Overweight Increasing in U.S. U.S.

Children ChildrenYear %Overweight 6-11Year OldsYear %Overweight 6-11Year Olds1963-l9701963-l970 04% 04% 1976-1980 07%1976-1980 07%1988-19941988-1994 11% 11%1999 12%1999 12%

Troiano, R and Flegal, KM, Overweight children and Troiano, R and Flegal, KM, Overweight children and adolescents: Description, epidemiology, and adolescents: Description, epidemiology, and demographics. demographics. PediatricsPediatrics 1998; 101(3): 497-504 1998; 101(3): 497-504

Increase in Childhood Increase in Childhood Overweight 1999-2004Overweight 1999-2004

2-5 year olds: ↑ from 7.2-13.9% (+ 2-5 year olds: ↑ from 7.2-13.9% (+ 6.7%)6.7%)

6-11 year olds ↑ from 11-19% (+8%)6-11 year olds ↑ from 11-19% (+8%)

12-19 year olds ↑ from 11-17% (+6%) 12-19 year olds ↑ from 11-17% (+6%)

Source: Source: www.cdc.gov/nchs/products/pubs/hestats/overweight/overwght_child.. www.cdc.gov/nchs/products/pubs/hestats/overweight/overwght_child.. Prevalence of Overweight Among Children and Adolescents: United Prevalence of Overweight Among Children and Adolescents: United States, 2003-2004States, 2003-2004

Increases in Blood Pressure Increases in Blood Pressure of Children 1994-2002of Children 1994-2002

YEARSYEARS Systolic Blood Systolic Blood Pressure Pressure (Avg. (Avg. male/female)male/female)

Diastolic Diastolic Blood Blood Pressure Pressure (Avg. (Avg. male/femalemale/female

NHANESNHANES

1988-19941988-1994104.6 mm Hg104.6 mm Hg 58.4 mm Hg58.4 mm Hg

NHANESNHANES

1999-20021999-2002106.0 mm Hg106.0 mm Hg 61.7 mm Hg61.7 mm Hg

ChangeChange +1.4 mm Hg+1.4 mm Hg +3.3 mm Hg+3.3 mm Hg

How Prevalent is How Prevalent is Overweight in Children Overweight in Children

With Special Needs?With Special Needs? Bandini et al analyzed data from the Bandini et al analyzed data from the

National Health and Nutrition National Health and Nutrition Examination Survey from 1999-2002 Examination Survey from 1999-2002 and found that children with limitations and found that children with limitations in physical actvity and girls with in physical actvity and girls with learning disabilities were more likely to learning disabilities were more likely to be overweight or at risk of overweight.be overweight or at risk of overweight.

Bandini LG, Curtin C, Hamad C, Tybor DJ, Must A. Bandini LG, Curtin C, Hamad C, Tybor DJ, Must A. Journal of Pediatrics. Journal of Pediatrics. 2005; 146 (6): 738-432005; 146 (6): 738-43

Children With Intellectual Children With Intellectual DisabilitiesDisabilities

Murphy et al compared BMI’s of 110 Murphy et al compared BMI’s of 110 children with ID and 107 without ID children with ID and 107 without ID between 11 months and 20 years of age between 11 months and 20 years of age and found no significant difference in and found no significant difference in BMI. In another study of 20 children BMI. In another study of 20 children with ID, they found no significant with ID, they found no significant difference in BMI or skinfolds with difference in BMI or skinfolds with reference data from NHANES II.reference data from NHANES II.

Murphy CM,Allison DB, Babbitt RL, Patterson HL. Murphy CM,Allison DB, Babbitt RL, Patterson HL. International Journal of International Journal of

Obesity Related Metabolic Disorders. Obesity Related Metabolic Disorders. 1992. Sep;16 (9): 633-81992. Sep;16 (9): 633-8

Children With ADHD or Children With ADHD or AutismAutism

Curtin et al calculated BMI’s from medical Curtin et al calculated BMI’s from medical records of children 3-18 years of age records of children 3-18 years of age with ADHD and with autism spectrum with ADHD and with autism spectrum disorders. The prevalence of overweight disorders. The prevalence of overweight or at risk for overweight was similar to or at risk for overweight was similar to the typical population of children for the typical population of children for each diagnosis.each diagnosis.

Curtin C, Bandini LG, Perrin EC, Tybor DJ, Must A. 2005. Curtin C, Bandini LG, Perrin EC, Tybor DJ, Must A. 2005. Pediatrics; 5:48 Pediatrics; 5:48

How Prevalent is How Prevalent is Overweight in Adults With Overweight in Adults With

Disabilities?Disabilities?

Data from the National Health Interview Data from the National Health Interview Survery showed that 34.6% of persons Survery showed that 34.6% of persons with I.D. were obese in the 1997-2000 with I.D. were obese in the 1997-2000 periods compared with 30.6% of persons periods compared with 30.6% of persons without I.D.without I.D.

The proportion of obese adults with I.D. The proportion of obese adults with I.D. increased from 29.4% to 34.6 percent increased from 29.4% to 34.6 percent from 1985-1988 to the 1997-2000 study from 1985-1988 to the 1997-2000 study periods.periods.

Adults with I.D.Adults with I.D. A review of medical records of adults with I.D. A review of medical records of adults with I.D.

attending a specialty medical practice in New York attending a specialty medical practice in New York City by Sohler, Levy, Lubetkin, Soghomonian, and City by Sohler, Levy, Lubetkin, Soghomonian, and Botuck found that 41.9% were obese and 27.4% were Botuck found that 41.9% were obese and 27.4% were overweight. A total of 63.9% were either overweight overweight. A total of 63.9% were either overweight or obese compared with 53% in the general or obese compared with 53% in the general population.population.

Persons with psychiatric disorders in addition to I.D Persons with psychiatric disorders in addition to I.D were more likely to be overweight or obese(75.2%). were more likely to be overweight or obese(75.2%). Persons with a seizure disorder in addition to I.D. Persons with a seizure disorder in addition to I.D. were slightly less likely to be overweight or obese were slightly less likely to be overweight or obese (63.3%) but still more likely than the general (63.3%) but still more likely than the general population.population.

Sohler N, Levy J, Lubetkin E, Soghomonian C, Botuck S. Paper presented at the 134Sohler N, Levy J, Lubetkin E, Soghomonian C, Botuck S. Paper presented at the 134thth Annual Annual Meeting & Exposition (November 4-8, 2006) of the American Public Health Association, Meeting & Exposition (November 4-8, 2006) of the American Public Health Association,

Boston, MABoston, MA

Adults With Down Adults With Down SyndromeSyndrome

Study by Bell and Bhate: Study by Bell and Bhate: 70.58% of males and 95.82% of females 70.58% of males and 95.82% of females

with Down syndrome were either with Down syndrome were either overweight or obeseoverweight or obese

49.29% of males and 62.96% of females 49.29% of males and 62.96% of females with intellectual disabilities due to other with intellectual disabilities due to other causes were either overweight or obese.causes were either overweight or obese.

40% of males and 32% of females in the 40% of males and 32% of females in the general population in Northumberland, general population in Northumberland, England were overweight or obese.England were overweight or obese.

Bell AJ, Bhate MS. 1992. Bell AJ, Bhate MS. 1992. Journal of Intellectual Disability Research; Journal of Intellectual Disability Research;

36(4):359-6436(4):359-64

Adults With Physical & Adults With Physical & Intellectual DisabilitiesIntellectual Disabilities

A telephone survey of adults in A telephone survey of adults in Kentucky usng the Behavioral Risk Kentucky usng the Behavioral Risk Surveillance Questionnaire found Surveillance Questionnaire found that 35% of persons reporting either that 35% of persons reporting either a physical or intellectual disability a physical or intellectual disability were overweight or obese compared were overweight or obese compared with 21.8% of persons without a with 21.8% of persons without a disability.disability.

Why Are Children With Why Are Children With Special Needs At Risk For Special Needs At Risk For

Overweight?Overweight? Differences in body composition (muscle Differences in body composition (muscle

mass vs fat mass)mass vs fat mass) Lack of physical activityLack of physical activity Medications that increase appetiteMedications that increase appetite Parents may be over-permissive or over-Parents may be over-permissive or over-

restrictive regarding food and exerciserestrictive regarding food and exercise U.S. U.S. lifestyle—media messages telling us to lifestyle—media messages telling us to

increase consumption of calorie dense foods, increase consumption of calorie dense foods, labor saving deviceslabor saving devices

Differences in Muscle Differences in Muscle ToneTone

Hypotonia (low muscle tone, floppiness)Hypotonia (low muscle tone, floppiness) Results in a lower resistance to muscle movement. Results in a lower resistance to muscle movement.

The lower the resistance, the fewer calories burned The lower the resistance, the fewer calories burned during movement. Children with low muscle tone during movement. Children with low muscle tone may also have more difficulty initiating movements may also have more difficulty initiating movements against gravity.against gravity.

Hypertonia (high muscle tone, spasticity) Hypertonia (high muscle tone, spasticity) Both types of muscle tone may lower caloric needs Both types of muscle tone may lower caloric needs

by limiting muscle movement. Lack of movement by limiting muscle movement. Lack of movement results in muscle atrophy and a lower lean body results in muscle atrophy and a lower lean body mass, which in turn reduces the number of calories mass, which in turn reduces the number of calories burned even at rest.burned even at rest.

Differences in Muscle Differences in Muscle ToneTone

Touwen found that 11% of 6 year old Touwen found that 11% of 6 year old children born full term but SGA and 11% children born full term but SGA and 11% of children born premature and AGA had of children born premature and AGA had hypotonia without any other neurological hypotonia without any other neurological dysfunction.dysfunction.

Touwen BC, Hadders-Algra M, Huisjes HJ. Touwen BC, Hadders-Algra M, Huisjes HJ. Early Human Development. Early Human Development.

1998; 17:79-881998; 17:79-88

Differences in Body Differences in Body CompositionComposition

Hediger et al also analyzed NHANES III Hediger et al also analyzed NHANES III data on 3-6 year old children born SGA data on 3-6 year old children born SGA and compared with reference data. and compared with reference data.

Results showed that children born small Results showed that children born small for gestational age were lighter, shorter, for gestational age were lighter, shorter, with smaller arm circumferences but with smaller arm circumferences but normal arm fatness except for the 6 year normal arm fatness except for the 6 year old group.old group.

Hediger ML, Overpeck MD, McGlynn A, Kuczmarski RJ, Maurer KR, Davis Hediger ML, Overpeck MD, McGlynn A, Kuczmarski RJ, Maurer KR, Davis WW. Growth and fatness at three to six years of age of chidlren born WW. Growth and fatness at three to six years of age of chidlren born small-or large-for gestational age. small-or large-for gestational age. Pediatrics. Pediatrics. 1999;104:331999;104:33

Differences in Body Differences in Body CompositionComposition

Children born prematurely have a lower Children born prematurely have a lower lean body mass up to 47 months after lean body mass up to 47 months after birth.birth. Hediger et al found that the arm muscle Hediger et al found that the arm muscle

mass of children born small for gestational mass of children born small for gestational age is lower than that of term born children age is lower than that of term born children from 2-47 months of age with no significant from 2-47 months of age with no significant difference in arm fatness measures in spite difference in arm fatness measures in spite of lighter weights.of lighter weights.

Hediger M, Overpeck M, Kuczmarski R, McGlynn A, Maurer K, Davis Hediger M, Overpeck M, Kuczmarski R, McGlynn A, Maurer K, Davis

W. W. Pediatrics. Pediatrics. 1998;102(5):E60 1998;102(5):E60

Differences in Body Differences in Body CompositionComposition

Children born prematurely and those Children born prematurely and those born small for gestational age both have born small for gestational age both have more abdominal fatness as teens and more abdominal fatness as teens and adults than children born at term with adults than children born at term with normal birth weights.normal birth weights.

Children born prematurely and those Children born prematurely and those born small for gestational age have a born small for gestational age have a higher risk for high blood pressure and higher risk for high blood pressure and type II diabetes as adults than those type II diabetes as adults than those born at term with appropriate weights born at term with appropriate weights for gestation.for gestation.

Differences in Body Differences in Body CompositionComposition

Eiholzer et al measured skinfolds of 10 young Eiholzer et al measured skinfolds of 10 young underweight and 13 older overweight children with underweight and 13 older overweight children with Prader Willi Syndrome. Prader Willi Syndrome.

Underweight children as well as the overweight Underweight children as well as the overweight children had high skinfold scores relative to their body children had high skinfold scores relative to their body mass index, showing that body fatness may be high mass index, showing that body fatness may be high even when children with Prader Willi are underweight even when children with Prader Willi are underweight by body mass index percentile on the growth chart.by body mass index percentile on the growth chart.

Eiholzer U, Blum WF, Molinar L. Eiholzer U, Blum WF, Molinar L. Journal of Pediatrics. Journal of Pediatrics. 1999;134(2):222-51999;134(2):222-5

Differences in Body Differences in Body CompositionComposition

Spina Bifida:Spina Bifida: Mita et al measured body fat of 35 Mita et al measured body fat of 35

Japanese children with spina bifida and 129 Japanese children with spina bifida and 129 control children with underwater weighing control children with underwater weighing and skinfold thicknesses. No difference and skinfold thicknesses. No difference between children with spina bifida and between children with spina bifida and controls were found in children below age controls were found in children below age 5 but children above age 6 had a higher 5 but children above age 6 had a higher percentage of body fat than controls. percentage of body fat than controls. Hydrocephalus was highly correlated with Hydrocephalus was highly correlated with body fat.body fat.

Mita K, Akataki K, Itoh K, Ono Y, Ishida N, Oki T. 1993. Mita K, Akataki K, Itoh K, Ono Y, Ishida N, Oki T. 1993. Developmental Medicine and Child Neurology; 35(4): 305-11Developmental Medicine and Child Neurology; 35(4): 305-11

Differences in Body Differences in Body CompostionCompostion

Shepherd et al measured body water, Shepherd et al measured body water, body fat, and lean body mass of 59 body fat, and lean body mass of 59 children and adults ages 4 months to 29 children and adults ages 4 months to 29 years with myelomeningocele. They years with myelomeningocele. They found that body fatness and lean body found that body fatness and lean body mass were within normal limits until mass were within normal limits until age 3-4 yr. After this age, body fatness age 3-4 yr. After this age, body fatness was higher than expected and lean body was higher than expected and lean body mass was lower than expected.mass was lower than expected.

Shepherd K, Roberts D, Golding S, Thomas BJ, Shepherd RW. 1991. Shepherd K, Roberts D, Golding S, Thomas BJ, Shepherd RW. 1991. American Journal of Clinical Nutrition; American Journal of Clinical Nutrition; 53(1): 1-653(1): 1-6

Differences in Body Differences in Body CompositionComposition

Liusuwan et al measured lean body mass, Liusuwan et al measured lean body mass, percent body fat and resting metabolic percent body fat and resting metabolic rate of children with spinal cord injury rate of children with spinal cord injury and controls.and controls.

Children with SCI had 9.1kg less lean Children with SCI had 9.1kg less lean body mass and 6.2% more body fat than body mass and 6.2% more body fat than controls even though mean BMI of controls even though mean BMI of children with SCI was lower (18.9 vs children with SCI was lower (18.9 vs 21.2) than controls.21.2) than controls.

Liusuwan A, Widman L, Abrescer RT, McDonald CN. 2004. Journal of Spinal Liusuwan A, Widman L, Abrescer RT, McDonald CN. 2004. Journal of Spinal Cord Medicine;27 Supple 1:S24-8Cord Medicine;27 Supple 1:S24-8

Lack of Physical ActivityLack of Physical Activity

Children with special needs Children with special needs may have fewer opportunities may have fewer opportunities for physical activity because of for physical activity because of a need for constant supervision a need for constant supervision or for adaptive equipment.or for adaptive equipment.

Children who are unable to Children who are unable to walk burn fewer calories than walk burn fewer calories than those who walk.those who walk.

Children who walk with braces Children who walk with braces and crutches or walkers and crutches or walkers actually burn more calories actually burn more calories than typical children during than typical children during actual periods of walking. actual periods of walking.

Over-Permissive or Over-Over-Permissive or Over-Restrictive Parenting Restrictive Parenting

Parents may try to compensate their child for Parents may try to compensate their child for his/her medical or physical problem by his/her medical or physical problem by allowing whatever they want to eat.allowing whatever they want to eat.

Parents may be afraid to allow their child to do Parents may be afraid to allow their child to do things for him/herself because of seizures, things for him/herself because of seizures, asthma.asthma.

Parents may be confused about how and when Parents may be confused about how and when to set limits for a child with physical or mental to set limits for a child with physical or mental disabilities.disabilities.

Medications That May Medications That May Increase The AppetiteIncrease The Appetite

Anticonvulsant medications: DepakeneAnticonvulsant medications: Depakene Anti-inflammatory medications:Anti-inflammatory medications:

Prednisone, Naprosyn, TolectinPrednisone, Naprosyn, Tolectin Antidepressant/antipsychotic medications:Antidepressant/antipsychotic medications:

Melloril, Valium, Zyprexa, Seroquel, Risperdol, Melloril, Valium, Zyprexa, Seroquel, Risperdol, ClozapineClozapine

Antihistamine:Antihistamine: PeriactinPeriactin

Hormones: Birth control pills, Depoprovera, Hormones: Birth control pills, Depoprovera, Megace, growth hormoneMegace, growth hormone

What Are the What Are the Consequences of Consequences of

Overweight for the Child Overweight for the Child with Special Needs?with Special Needs?

Overweight Affects Quality Overweight Affects Quality of Life and Self Esteemof Life and Self Esteem

Research has shown that overweight children Research has shown that overweight children are more likely to be teased and to be targets of are more likely to be teased and to be targets of bullies.bullies.

Research on Health Related Quality of Life and Research on Health Related Quality of Life and children with developmental disabilities has children with developmental disabilities has shown progressive decreases in quality of life shown progressive decreases in quality of life scores as BMI’s rise.*scores as BMI’s rise.*

Overweight may lower self esteem by Overweight may lower self esteem by interfering with independence.interfering with independence.

*Williams J, Wake M, Hesketh K, Maher E, Waters E. Health Related Quality *Williams J, Wake M, Hesketh K, Maher E, Waters E. Health Related Quality of Life of Overweight and Obese Children. of Life of Overweight and Obese Children. JAMA. JAMA. 2005; 293: 70-762005; 293: 70-76

Overweight Promotes Overweight Promotes DependenceDependence

Overweight reduces mobility by:Overweight reduces mobility by: Causing braces and prostheses to be Causing braces and prostheses to be

quickly outgrown quickly outgrown Causing a need for larger and heavier Causing a need for larger and heavier

braces or wheelchairs with wider wheel braces or wheelchairs with wider wheel basesbases

Overweight Becomes An Overweight Becomes An AdditionalAdditional DisabilityDisability

Overweight Interferes with self care :Overweight Interferes with self care :

Dressing oneself becomes difficult or Dressing oneself becomes difficult or impossibleimpossible

It’s hard to tie shoesIt’s hard to tie shoes Transfers from wheelchairs become Transfers from wheelchairs become

much more difficultmuch more difficult Catheterizing oneself or using the Catheterizing oneself or using the

restroom by oneself may be impossiblerestroom by oneself may be impossible

Obesity Results in Health Obesity Results in Health Risks and ComplicationsRisks and Complications

Increased risk of :Increased risk of : High blood pressureHigh blood pressure Heart diseaseHeart disease ArteriosclerosisArteriosclerosis DiabetesDiabetes Post surgical complicationsPost surgical complications Pressure soresPressure sores Joint problems (foot, knee and hip)Joint problems (foot, knee and hip) Blount’s diseaseBlount’s disease Fatty liver disease Fatty liver disease Sleep apneaSleep apnea

Consequences of Consequences of Overweight Overweight

Cardiovascular disease occurs at an earlier Cardiovascular disease occurs at an earlier age in persons with spinal cord disease.age in persons with spinal cord disease.

Persons with spinal cord injuries are more Persons with spinal cord injuries are more likely to have insulin resistance, abnormal likely to have insulin resistance, abnormal glucose tolerance tests, high LDL glucose tolerance tests, high LDL cholesterol and low HDL cholesterol levels.cholesterol and low HDL cholesterol levels.

Bauman WA, Spungen AM. 2001. Journal of Spinal Cord Medicine; 24(4): 266-Bauman WA, Spungen AM. 2001. Journal of Spinal Cord Medicine; 24(4): 266-7777

Identifying Children At Identifying Children At Risk For OverweightRisk For Overweight

Children With Certain Children With Certain Medical ConditionsMedical Conditions

Spina bifida(myelomeningocele)Spina bifida(myelomeningocele) Down SyndromeDown Syndrome Prader-Willi SyndromePrader-Willi Syndrome Osteogenesis ImperfectaOsteogenesis Imperfecta Overgrowth Syndromes—Beckwith Overgrowth Syndromes—Beckwith

Wiedemann Syndrome, Simpson Golabi Wiedemann Syndrome, Simpson Golabi Behmel SyndromeBehmel Syndrome

Some types of dwarfismSome types of dwarfism CraniopharyngiomaCraniopharyngioma

Children With Limited Children With Limited MobilityMobility

Children using wheelchairs or braces Children using wheelchairs or braces who do not have feeding problemswho do not have feeding problems

Children needing to be in cast or Children needing to be in cast or immobile after surgery for a long immobile after surgery for a long period of timeperiod of time

How Do We Know If A Child How Do We Know If A Child Is Overweight?Is Overweight?

Weight and length or height are plotted on Weight and length or height are plotted on the CDC standard growth charts to the CDC standard growth charts to compare with reference data from the compare with reference data from the National Health and Nutrition Examination National Health and Nutrition Examination Survey (NHANES III). Survey (NHANES III).

Weight for length percentile is plotted on Weight for length percentile is plotted on the growth chart for children birth to 3 the growth chart for children birth to 3 years. A weight for length percentile at or years. A weight for length percentile at or above the 95above the 95thth percentile is considered percentile is considered overweight. overweight.

OK135S058

How Do We Know If A How Do We Know If A Child Is Overweight?Child Is Overweight?

Body Mass index (BMI) is calculated Body Mass index (BMI) is calculated for children over 2 yr. who are able to for children over 2 yr. who are able to stand to be measured. stand to be measured.

Body Mass index can then be plotted Body Mass index can then be plotted on the CDC growth chart for the 2-20 on the CDC growth chart for the 2-20 year old.year old.

A BMI at or above the 95A BMI at or above the 95thth percentile percentile indicates overweight.indicates overweight.

A BMI at or above the 85A BMI at or above the 85thth percentile percentile indicates at risk for overweight.indicates at risk for overweight.

OK135S060

How To Calculate BMIHow To Calculate BMI

BMI= wt in kg ÷ ht in meters BMI= wt in kg ÷ ht in meters ²²

oror

BMI= wt in lb ÷ ht in inches² BMI= wt in lb ÷ ht in inches² X 703 X 703

Children With Abnormal Children With Abnormal Weight Gain Relative To Weight Gain Relative To

HeightHeight Infants who are gaining over 1 lb. per Infants who are gaining over 1 lb. per

month after the 1st 3 months of lifemonth after the 1st 3 months of life Children who are gaining over 2-3 lb. every Children who are gaining over 2-3 lb. every

6 months6 months Children whose weight for length percentile Children whose weight for length percentile

or body mass index is at or above the 85th or body mass index is at or above the 85th percentile on the CDC growth charts.percentile on the CDC growth charts.

Children whose body mass index percentile Children whose body mass index percentile is rising prior to the age of 5 years (age of is rising prior to the age of 5 years (age of adipose tissue rebound).adipose tissue rebound).

Other Ways Of Detecting Other Ways Of Detecting OverweightOverweight

Skinfold and Skinfold and circumference circumference measurements: Arm fat measurements: Arm fat area and muscle fat area and muscle fat area can be calculated area can be calculated from tricep skinfold and from tricep skinfold and midarm circumference.midarm circumference.

Waist circumference Waist circumference percentilespercentiles

Bioimpedence analysisBioimpedence analysis DEXADEXA Underwater weighingUnderwater weighing

How To Help The Child With How To Help The Child With Special Needs Develop Healthy Special Needs Develop Healthy

Eating HabitsEating Habits

Let The Child Self Let The Child Self RegulateRegulate

If healthy foods are served most children If healthy foods are served most children will eat according to their metabolic needs.will eat according to their metabolic needs.

Remember that some children with special Remember that some children with special needs will have lower weights and calorie needs will have lower weights and calorie needs due to low muscle mass.needs due to low muscle mass.

Forcing or trying to persuade children to Forcing or trying to persuade children to eat more can interfere with self regulation.eat more can interfere with self regulation.

Access to many low nutrient fat and sugar Access to many low nutrient fat and sugar rich foods causes some children to ignore rich foods causes some children to ignore self regulatory messages.self regulatory messages.

Set A Good Example!Set A Good Example!

Get the whole family involved in Get the whole family involved in following a healthy lifestyle.following a healthy lifestyle.

The diet and lifestyle changes that The diet and lifestyle changes that benefit the child also benefit the benefit the child also benefit the entire family.entire family.

Serve Meals and Snacks Serve Meals and Snacks at Regular Timesat Regular Times

Avoid constant eating or drinking Avoid constant eating or drinking (other than water) between regular (other than water) between regular meal and snack times.meal and snack times.

Cupboards and refrigerators should Cupboards and refrigerators should be off limits to the child except for be off limits to the child except for designated foods allowed.designated foods allowed.

Encourage family mealtimes as much Encourage family mealtimes as much as possible.as possible.

Avoid Being A Short Avoid Being A Short Order CookOrder Cook

Avoid replacing foods the child Avoid replacing foods the child refuses to eat with other foods.refuses to eat with other foods.

If the child refuses to eat, calmly If the child refuses to eat, calmly take the food away and have the take the food away and have the child wait until the next meal or child wait until the next meal or snack time (at least 1 1/2 hour).snack time (at least 1 1/2 hour).

Limit Screen TimeLimit Screen Time

Limit TV and computer/video time Limit TV and computer/video time to 1-2 hours per day.to 1-2 hours per day.

Provide Physical Provide Physical ActivitiesActivities

Adapt games and Adapt games and playground equipment for playground equipment for the child’s special needs the child’s special needs and abilities.and abilities.

Use community resources Use community resources for adaptive recreational for adaptive recreational activities (wheelchair activities (wheelchair hockey or basketball, hockey or basketball, horseback riding, Special horseback riding, Special Olympics, swimming.Olympics, swimming.

Assign jobs suited to the Assign jobs suited to the child’s developmental age child’s developmental age and abilities.and abilities.

Resources for Physical Resources for Physical Activity Activity

National Center for Physical Activity National Center for Physical Activity and Disability website: and Disability website: www.ncpad.orgwww.ncpad.org

www.dsusa.orgwww.dsusa.org (Disabled Sports USA) (Disabled Sports USA) www.blazesports.comwww.blazesports.com www.wsusa.orgwww.wsusa.org (Wheelchair Sports (Wheelchair Sports

USA)USA) www.quadrugby.comwww.quadrugby.com www.soky.orgwww.soky.org (Special Olympics (Special Olympics

Kentucky) Kentucky)

Include Child in Fun Include Child in Fun Activities That Do Not Activities That Do Not

Involve FoodInvolve Food Story reading, acting out storyStory reading, acting out story Singing/playing musical instrumentsSinging/playing musical instruments Board games or card gamesBoard games or card games Arts and craftsArts and crafts Trips to a farm, zoo, or parkTrips to a farm, zoo, or park Water fun in wading poolWater fun in wading pool

Activities That Teach Activities That Teach Positive Attitudes Positive Attitudes

Toward FoodToward Food Let child help with food Let child help with food

preparation--pouring, preparation--pouring, mixing, spreading, mixing, spreading, measuring.measuring.

Talk about different Talk about different foods: where they come foods: where they come from, different tastes, from, different tastes, colors and textures of colors and textures of food.food.

Have a tasting party to Have a tasting party to try new foods.try new foods.

Help child plant a garden.Help child plant a garden. Let child help shop for Let child help shop for

fruits and vegetables at fruits and vegetables at the market.the market.

Meal Planning Tips For Meal Planning Tips For Children Who Are Gaining Children Who Are Gaining

Weight Too FastWeight Too Fast

Prepare Foods With Less Prepare Foods With Less FatFat

Broil, bake on rack, grill or stew meatsBroil, bake on rack, grill or stew meats Season vegetables with low fat margarine, Season vegetables with low fat margarine,

bouillon, or lemon (or just use less regular bouillon, or lemon (or just use less regular margarine)margarine)

Trim fat from meat, remove skin from Trim fat from meat, remove skin from chicken or turkeychicken or turkey

Prepare cream sauces with skim milkPrepare cream sauces with skim milk Prepare gravies with less fatPrepare gravies with less fat

Buy and Serve Foods Buy and Serve Foods With Less Fat And SugarWith Less Fat And Sugar

Buy 1% or 2% milk-if child is over 2 yrs.Buy 1% or 2% milk-if child is over 2 yrs. Buy lean meats (limit sausage, hot dogs, Buy lean meats (limit sausage, hot dogs,

bologna unless reduced fat).bologna unless reduced fat). Buy fat free or reduced fat cheeses.Buy fat free or reduced fat cheeses. Buy low fat ice cream or frozen yogurt.Buy low fat ice cream or frozen yogurt. Buy sugar free hot cocoa mix and gelatin, Buy sugar free hot cocoa mix and gelatin,

canned fruit in natural juices.canned fruit in natural juices. Balance high fat foods with low fat foods at Balance high fat foods with low fat foods at

meals.meals.

Serve Healthy Moderate Serve Healthy Moderate Calorie SnacksCalorie Snacks

Cereal and milk (Cheerios, Kix, Chex)Cereal and milk (Cheerios, Kix, Chex) Pretzels or saltine crackers and juicePretzels or saltine crackers and juice Snack mix of cereals and pretzelsSnack mix of cereals and pretzels Graham crackers or animal crackersGraham crackers or animal crackers Fat free pudding or yogurtFat free pudding or yogurt Fruit juice popsiclesFruit juice popsicles Fresh fruit slices or canned fruit in natural Fresh fruit slices or canned fruit in natural

juicesjuices Raw vegetables with salsa or reduced fat Raw vegetables with salsa or reduced fat

ranch dressingranch dressing Reduced fat cheese or string cheeseReduced fat cheese or string cheese

Children With Very Low Children With Very Low Calorie NeedsCalorie Needs

Parents may need more specific guidelines of Parents may need more specific guidelines of calorie needs, portion sizes, and number of calorie needs, portion sizes, and number of servings needed for children with very low servings needed for children with very low calorie needs.calorie needs.

For example, children with Prader Willi For example, children with Prader Willi Syndrome need only 60-70% of the typical Syndrome need only 60-70% of the typical calorie intake for normal weight gain unless calorie intake for normal weight gain unless they are on growth hormone.they are on growth hormone.

Children with myelomeningocele usually Children with myelomeningocele usually need only 50% of the typical calorie intake need only 50% of the typical calorie intake for age and size.for age and size.

Calorie Needs With Certain Calorie Needs With Certain ConditionsConditions

Prader Willi Syndrome: 8-10 Prader Willi Syndrome: 8-10 Kcal/cm of height for normal weight Kcal/cm of height for normal weight gain; 7Kcal/cm for weight lossgain; 7Kcal/cm for weight loss

Down Syndrome: 85-90% of the DRI Down Syndrome: 85-90% of the DRI for age and sizefor age and size

Myelomeningocele: 50-75% of the Myelomeningocele: 50-75% of the DRI for age and size DRI for age and size

SummarySummary Children with physical and mental disabilities Children with physical and mental disabilities

may be at higher risk for becoming may be at higher risk for becoming overweight by adulthood.overweight by adulthood.

Consequences of excessive weight gain Consequences of excessive weight gain include problems with mobility, self esteem, include problems with mobility, self esteem, and self care, as well as health risks such as and self care, as well as health risks such as sleep apnea, asthma, and cardiovascular sleep apnea, asthma, and cardiovascular disease.disease.

Promoting appetite self regulation, healthy Promoting appetite self regulation, healthy eating habits, and physical activities adapted eating habits, and physical activities adapted to the child’s special needs are important to to the child’s special needs are important to prevent excessive weight gains.prevent excessive weight gains.