Developmental Disability and Nutrition
For the purposes of this article, developmental disability includes, but is not limited to:
- Mental retardation
- Autism
- Cerebral palsy
- Down’s syndrome
- Epilepsy
- Neurological impairment
With regard to nutrition, these populations are impacted in various ways by substantial functional limitations in:
- Self-care
- Receptive and expressive language
- Learning
- Mobility
- Self-direction
- Capacity for independent living
- Economic self-sufficiency
These populations may face severe social misunderstanding, limitations in educability, and unhealthy behaviors secondary to their conditions. For this reason, both caregivers and patients should receive nutrition education and instructions on proper care and management of diet.
Eating problems may stem from neuromuscular dysfunction—sensitive gag reflex, poor lip closure, inability to chew and swallow, tongue thrust, and psychological factors. These patients sometimes are unable to normally translate sensory input needed for chewing and swallowing. These forms of neuromuscular dysfunction are most commonly found in Prader-Willi syndrome, Down’s syndrome, and cerebral palsy.
Behavioral issues, such as tantrums, agitation, rocking, and flailing of limbs are associated with aspiration of food and fluids, esophagitis, dehydration, and malnutrition. Food stealing and pica also are common in those who have behavioral issues. Long-term use of psychotropic medications used to manage symptoms may result in anorexia or appetite stimulation. Long-term use of anticonvulsants can lead to abnormal nutrient and bone metabolism, and folate deficiencies.
Successful feeding of developmentally disabled individuals requires a detailed nutrition assessment. In feeding patients for best health, the registered dietitian should consider:
- The appropriate dietary prescription
- Need for assistance
- Positioning of the patient
- Method of feeding
- Appetite
- Prior food experiences
- Alertness
- Sensorial functioning
- Eating skills
- Oral functioning
- Motor deficits that may affect self-feeding
- Dental care
- Weight status and change
Prior to developing a dietary prescription, it is necessary to assess and take into consideration the following:
- Whether the patients can close their lips to remove food from a utensil
- Deficits of tongue mobility, drooling, and acceptance of taking food by mouth
Assistive feeding devices sometimes are necessary for independent feeding. A medical team, including a speech pathologist, occupational therapist, and physical therapist, is essential to obtain proper assessment of feeding potential.
In prescribing a diet for management of a developmental disability, the dietitian should consider:
- Food consistency and modification of texture
- Vitamin and mineral supplementation
- Frequency of meals with regard to lifestyle and medications
- Provision of assistive devices for meals and snacks (straws, special utensils, and adaptive devices)
- Encouragement and reminders to eat food and drink fluids
- Feeding techniques or assistance needed to aid in execution of dietary recommendations
The registered dietitian’s recommendations must take into account that facilities that board developmentally disabled populations may not meet the standards in care for physical activity and good nutrition. Registered dietitians should make sure that all recommendations are realistic and attainable to prevent secondary conditions, such as obesity, diabetes, and diseases of the cardiovascular system. In these populations, education sometimes is inappropriate or inaccessible. The primary points of intervention to best meet the nutritional requirements of the developmentally disabled are most likely advocacy to refine the institutional systems in order to cater to individual needs and provider training.
References
Peckenpaugh NJ, Poleman CM. Nutrition Essentials and Diet Therapy. 8th ed. Philadelphia, PA: WB Saunders; 1999.
Hennepin County Human Services and Public Health Department. Health promotion for individuals with intellectual and developmental disabilities (IDD). Available at: http://www.mnaging.org/odyssey/ppt/tues/3.30%20Tuesday/Tuesday%20-%20Geber%20-%20%20Health%20Promotion%20and%20Developmental%20Disabilities.ppt. Accessed October 20, 2008.
Review Date 11/08
G-0857
