Chapter 13: Child and Preadolescent Nutrition: Conditions and Interventions

Children with conditions including cystic fibrosis, cerebral palsy, diabetes mellitus, and phenylketonuria present markedly different nutritional requirements that demand individualized assessment and intervention planning. Those with cystic fibrosis or cerebral palsy frequently need elevated caloric and lipid intake to support appropriate weight gain and development, while children with reduced functional mobility or muscle tone, such as those with spina bifida, require cautious caloric management to prevent excessive weight accumulation that could further compromise mobility and health outcomes. Growth monitoring in these populations necessitates specialized approaches beyond standard growth charts, including condition-specific reference standards and documentation of medical interventions such as growth hormone administration. Feeding difficulties represent a common challenge across multiple conditions, sometimes requiring advanced nutritional support modalities including tube feeding via gastrostomy, frequently implemented as overnight continuous infusion to maximize tolerance and minimize feeding time impact on daily activities. Diabetes management in children demands meticulous carbohydrate quantification coupled with careful synchronization between meal timing, snack composition, and insulin or oral medication administration to maintain stable blood glucose levels. Phenylketonuria demands lifelong adherence to a restricted phenylalanine diet supported by specialized medical food formulas, as dietary lapses pose serious risk for progressive neurological damage and cognitive impairment. Children prescribed psychostimulant medications for attention-deficit hyperactivity disorder or related neurobehavioral conditions benefit from strategic meal timing adjustments designed to avoid periods of maximum medication action, thereby preserving appetite and nutritional intake. Educational institutions play a vital role in supporting child nutrition through federal nutrition programs and implementing legally required accommodations, including individualized education plans and Section 504 plans, which address severe food allergies and other nutrition-related medical needs within the school environment.