Ensuring a balanced diet that meets individual needs for nutrients for children with special needs can be challenging for the child, parent, and caregiver. However, eating a healthy diet is a vital component to achieving both oral and general health. Registered dietitians (RDs) are THE credentialed health professional who can help devise a balanced diet and plan meals and snacks. Although the Food Guide Pyramid and USDA Dietary Guidelines provide the "infrastructure" for diet planning there are other factors that influence food choices, habits, and needs.

DIET/HEALTH CHALLENGES

The child with special needs, like all children in the US, must balance diet with physical activity in order to maintain a healthful weight. Obesity in adults and children is increasing at alarming rates in this country. Twenty percent of children are at risk of becoming overweight and obese. Eating disorders are also a concern in children and adolescents and include binge eating, bulimia, and anorexia

At the 1999 Summer Special Olympic Games in New Jersey, the height, weight, and incidence of dental caries (cavities) of athletes were assessed. Almost two thirds (64.4%) of the child athletes were overweight (based on body mass index values using the CDC growth charts). The majority of boys (62.4%) and girls (67.7%) were overweight or obese. Overweight and obese children were much more likely to have cavities than those who were not overweight.

The diet/health challenges of the individual with special needs include: oral health, exercise, medications, living environment, disability, and the caregiver's and child's level of knowledge regarding nutrition.

Oral health

Oral health problems often include infections in the gums and cavities. Other problems arise when the child has difficulty biting and chewing food, difficulty with swallowing, too much or too little saliva, and/or experiences changes in how foods taste due to medications. Communication with and frequent visits to the dentist is critical to normal eating ability.

Exercise

Physical activity is very important for growth and development as well as "burning" energy or calories. Regular fitness programs can reduce risk for diseases such as heart disease, diabetes, and obesity later in life. Walking, skating, swimming, playing soccer, baseball and other sports on a daily basis will make it routine.

Medications

Many medications can affect saliva, taste, and appetite as well as bowel habits. Some can also affect nutrient needs. Over 400 drugs affect saliva. It is important for parents to check with their physician about the possible side effects of any medications and how they might influence their child's eating habits, appetite, and willingness to eat.

Living Environment

Living environment and the nutrition knowledge of the various care providers including parents, teachers, aides, etc. can also influence eating habits, food choices, and activity. Food is often a major component of social gatherings and celebrations. However, when it is frequently used as a reward for good behavior or an outlet for emotions, caloric consumption is bound to rise. If a child realizes the way to get a "treat" is with behavior, he or she will look for that treat consistently. Whereas if rewards are varied and include opportunities to do favorite activities or get a non-food reward, the child will not associate food only with that response. In any culture, various foods have special meanings and the emphasis is on the word "special." If sweet rewards become a daily expectation they lose their "special" quality.

Attitude, Diet, and Excercise

All individuals, adults, and children need to address diet and health with ADE: Attitude, Diet, and Exercise. A positive attitude on the part of the child and caregivers toward maintaining a healthful weight is very important. Any activities focused on weight control should be positive and not punitive. Vary preparations of fruits, vegetables, grains, and dairy products to increase their eye and taste appeal to children. Encourage them as foods for health, not "diet" foods. Diet habits should be guided by the food guide pyramid and dietary guidelines. Exercise should be part of all daily routines.

THE BASICS OF A HEALTHFUL DIET

The 2000 US Department of Health and Human Services Dietary Guidelines focus on diet and physical activity. These guidelines are: * AIM for FITNESS

* Aim for a Healthy Weight

* Be Physically Active

* BUILD a HEALTHY BASE

* Let the pyramid (see next page) guide your food choices

* Choose a variety of grains daily, especially whole grains

* Choose a variety of fruits and vegetables daily

* Keep foods safe to eat

* CHOOSE SENSIBLY

*Choose a diet low in saturated fat and cholesterol and moderate in sugar

*Choose beverages and foods to moderate sugar intake

* Choose and prepare foods with less salt

* If you drink alcohol, do so in moderation

The Guidelines are for consumers of all ages. Healthful food choices balanced with physical activity will help adults and children maintain health and provide a mix and balance of nutrients for optimal health and growth.

Food choices are the focus of the Food Guide Pyramid (above). This Pyramid is now available in formats for various ethnicities and age groups. There are Food Guide Pyramids for children, adults, and senior adults. Many versions of the pyramid can be found at http://www.usda.gov/cnpp/pyramid.htm. Individuals are encouraged to choose the recommended number of servings daily from each group of the Pyramid.

Individuals need a balance of nutrients in their diet. Typically, an RD would recommend that children and adults who are healthy without any special diet requirements need 50% of their calories from carbohydrates, 20% of their calories from proteins, and 30% of their calories from fats. Fat calories should be monitored to ensure that the majority of fats are vegetable oils (monounsaturated and polyunsaturated) with less than 10% of calories coming from saturated fats. Using the Food Guide Pyramid, encourage a `bottom up' approach, choosing the majority of calories from the bottom half of the Pyramid: grains, fruits, and vegetables. Following that, a moderate amount can be chosen from dairy products and protein sources; choices from the fats, sweets, and oils group should be made sparingly.

DIET AND WEIGHT MANAGEMENT

Parents can determine if their child's diet is adequate by answering some simple questions. First and foremost, are they eating meals? How many snacks are they eating, and what foods are used in the snacks? Between meals and snacks, do they meet the minimum number of servings for all the food groups? And finally, are they getting any vitamin, mineral, or other supplements? If yes, have you discussed this with your physician and/or an RD? In most cases, individuals can meet all their nutrient needs from food, and supplements are not needed. If your child is not meeting the minimum number of servings from all the food groups, try to figure out why. Is it due to allergies? Food preferences? Difficulty eating certain foods because of texture? Are healthy foods usually available in your home?

A good way to introduce a healthy selection of fresh fruits and vegetables in the home is to serve them cut up as "finger foods." Combining raw vegetables with a dip made from yogurt and onion soup mix or a mild salsa may be a new tasty treat for your child as well Fruit smoothies made with frozen fruits and milk or yogurt are a dessert-like beverage that combines two food groups.

GOOD NUTRITION STARTS AT HOME

Encourage healthful eating by keeping fruits in a very visible place in the kitchen. Partner with your child for exercise, making it a family time. Parents and caregivers can learn about food and diet from the American Dietetic Association (http:// www.eatright.org) and the federal government (http://www.nutrition.gov), which offer several nutrition tips, fact sheets, and guides for consumers.

Parents and caregivers can set an example for good eating habits by eating healthy themselves. It is also important to be flexible in planning meals and supportive in individualizing diets to the tastes of your child. When you are managing a child who is overweight or obese, try to be realistic in setting weight and diet goals, and remain somewhat neutral to occasssional diet indiscretions. Never use the terms "should you be eating that?" or "eat too much and you'll get fat."

Help your child learn about diet basics and the Food Guide Pyramid using your own meals and snacks. Continued understanding of where foods fit into the Pyramid and how to make choices can result in structured independence in food choices and positive eating behaviors. In the long run, it may reduce the incidence and degree of obesity and oral health problems.

From Healthy.net