Nutrition and Nutrition and Intellectual and Intellectual and Developmental Developmental Disabilities (IDD)Disabilities (IDD)Jenna Moore, MS, RD, LDJenna Moore, MS, RD, LDOctober 10, 2014October 10, 2014

ObjectivesObjectives To distinguish the difference between an To distinguish the difference between an

intellectual disability and a developmental intellectual disability and a developmental disabilitydisability

To list the components of the nutritional To list the components of the nutritional assessment that determine a person’s assessment that determine a person’s nutritional needsnutritional needs

ObjectivesObjectives To list the factors that determine a To list the factors that determine a

person’s meal planperson’s meal plan To name the three components of food To name the three components of food

safety from the standpoint of a dietitian safety from the standpoint of a dietitian that serves individuals with IDD that serves individuals with IDD

What is an Intellectual What is an Intellectual Disability?Disability?

Disability characterized by Disability characterized by considerable limitations in adaptive considerable limitations in adaptive functioning and adaptive behaviorfunctioning and adaptive behavior

Begins before 18 years of ageBegins before 18 years of age An I.Q. of 70 to 75 or belowAn I.Q. of 70 to 75 or below

What is an Intellectual What is an Intellectual Disability?Disability?

Common causes:Common causes: Genetic conditions (Down syndrome, Fragile Genetic conditions (Down syndrome, Fragile

X syndrome, and Prader-Willi syndrome)X syndrome, and Prader-Willi syndrome) Problems during pregnancy (Possible FAS) Problems during pregnancy (Possible FAS) Difficulties at the time of birth Difficulties at the time of birth Health issues such as whooping cough, Health issues such as whooping cough,

measles or meningitismeasles or meningitis Exposure to environmental toxins such as Exposure to environmental toxins such as

lead or mercurylead or mercury

What is a Developmental What is a Developmental Disability?Disability?

An inclusive term that consists of An inclusive term that consists of intellectual disabilities and other intellectual disabilities and other disabilities that are obvious during disabilities that are obvious during childhood childhood

Severe, chronic disabilities that can be Severe, chronic disabilities that can be cognitive or physical or bothcognitive or physical or both

Appear before the age of 22 Appear before the age of 22 Are likely to be lifelongAre likely to be lifelong

What is a Developmental What is a Developmental Disability?Disability?

Examples of developmental disabilities:Examples of developmental disabilities: Autism spectrum disorders (ASD)Autism spectrum disorders (ASD) Epilepsy Epilepsy Cerebral palsyCerebral palsy Developmental delayDevelopmental delay Fetal alcohol syndrome (or FAS)Fetal alcohol syndrome (or FAS) Any other disorders that occur during the Any other disorders that occur during the

developmental period (birth to age 18) developmental period (birth to age 18)

Down syndromeDown syndrome Prader-Willi syndromePrader-Willi syndrome

Cerebral palsyCerebral palsy

Common Nutritional Concerns Common Nutritional Concerns in Individuals with IDDin Individuals with IDD

AspirationAspiration Gastroesophageal Gastroesophageal

Reflux Disease Reflux Disease (GERD)(GERD)

Chronic Chronic constipationconstipation

ObesityObesity PicaPica

Rumination Rumination Oral healthOral health Vision and Vision and hearinghearing ChewingChewing SwallowingSwallowing Oral sensitivityOral sensitivity

Other Nutritional Concerns Other Nutritional Concerns that Affect Those with IDDthat Affect Those with IDD

Chronic diseases such as diabetes, Chronic diseases such as diabetes, cancer, hypertension, and chronic kidney cancer, hypertension, and chronic kidney diseasedisease

Food allergies, sensitivities, and/or Food allergies, sensitivities, and/or intolerancesintolerances

Inherited metabolic disorders such as Inherited metabolic disorders such as galactosemia and phenylketonuria (PKU)galactosemia and phenylketonuria (PKU)

Nutritional AssessmentNutritional Assessment Components that determine the Components that determine the

individual’s nutritional needs:individual’s nutritional needs: HeightHeight WeightWeight Laboratory studiesLaboratory studies Medication-nutrient interactionsMedication-nutrient interactions

Height and WeightHeight and Weight Methods used to determine the person’s Methods used to determine the person’s

height:height: StandingStanding Supine: lying flat on the backSupine: lying flat on the back Arm spanArm span Segmental height measurementsSegmental height measurements

Methods used to determine the person’s Methods used to determine the person’s weight:weight: Standing scalesStanding scales Wheelchair scalesWheelchair scales

Desirable Body WeightDesirable Body Weight Methods used to determine the individual’s Methods used to determine the individual’s

desirable body weight: desirable body weight: Hamwi method:Hamwi method:

Men: 106 for 1Men: 106 for 1stst 5 feet + 6 inches for every inch over 5 feet + 6 inches for every inch over ± 10%± 10%

Women: 100 for 1Women: 100 for 1stst 5 feet + 5 inches for every inch 5 feet + 5 inches for every inch over over ± 10%± 10%

CDC growth chartsCDC growth charts Growth charts specific to genetic disorders such Growth charts specific to genetic disorders such

as Prader-Willi syndrome and Down syndromeas Prader-Willi syndrome and Down syndrome Using clinical judgmentUsing clinical judgment

Laboratory StudiesLaboratory Studies Labs that are commonly followed:Labs that are commonly followed:

Hgb/HctHgb/Hct AlbuminAlbumin BUNBUN CreatinineCreatinine GlucoseGlucose SodiumSodium PotassiumPotassium

Total cholesterolTotal cholesterol HDL cholesterolHDL cholesterol LDL cholesterolLDL cholesterol TriglyceridesTriglycerides If available: If available: HgbA1c, TSH, HgbA1c, TSH, Free T4Free T4

Laboratory StudiesLaboratory Studies Contact the nurse and/or physician if any Contact the nurse and/or physician if any

of the lab levels are of concern (too high of the lab levels are of concern (too high or low) with follow-up contact made as or low) with follow-up contact made as needed. needed.

Medication-Nutrient Medication-Nutrient InteractionsInteractions

List each medication taken by mouth or List each medication taken by mouth or I.V.I.V.

Take note of the side effects that have Take note of the side effects that have nutrient and oral/gastrointestinal (GI) nutrient and oral/gastrointestinal (GI) implications.implications.

Medication-Nutrient Medication-Nutrient InteractionsInteractions

The most frequent implications includeThe most frequent implications include:: ConstipationConstipation Gastroesophageal reflux and other GI Gastroesophageal reflux and other GI

conditionsconditions DysphagiaDysphagia Dry mouthDry mouth Increase or decrease in appetite or weightIncrease or decrease in appetite or weight Increased need for specific nutrientsIncreased need for specific nutrients

Nutritional AssessmentNutritional Assessment Other items included:Other items included:

Meal planMeal plan PreferencesPreferences AppetiteAppetite Food allergies Food allergies and/or intolerancesand/or intolerances Feeding skillsFeeding skills

Mechanical issuesMechanical issues Adaptive equipmentAdaptive equipment Dental statusDental status Mealtime behaviorsMealtime behaviors Dominant handDominant hand

Individual Meal PlansIndividual Meal Plans Factors that influence an individual’s Factors that influence an individual’s

meal plan:meal plan: Energy needsEnergy needs Medical conditions and/or needsMedical conditions and/or needs Food texture needsFood texture needs Liquid consistency needsLiquid consistency needs Individual preferencesIndividual preferences

Determining Energy Determining Energy NeedsNeeds

Methods used to determineMethods used to determine the individual’s the individual’s energy needs: energy needs: Harris-Benedict equation:Harris-Benedict equation:

Men: 66 + (13.7 x wt. in kg.) + (5 x ht. in cm) – (6.8 x age in Men: 66 + (13.7 x wt. in kg.) + (5 x ht. in cm) – (6.8 x age in years)years)

Women: 655 + (9.6 x wt. in kg.) + (1.7 x ht. in cm) – (4.7 x Women: 655 + (9.6 x wt. in kg.) + (1.7 x ht. in cm) – (4.7 x age in yearsage in years

Adjusted body weight:Adjusted body weight: (Actual body wt. – IBW) * 0.25 + IBW(Actual body wt. – IBW) * 0.25 + IBW

Very low calorie intakesVery low calorie intakes Estimated calorie requirements for specific Estimated calorie requirements for specific

developmental disabilitiesdevelopmental disabilities

Energy NeedsEnergy Needs Possible items needed after Possible items needed after

determining energy needs and food determining energy needs and food intake:intake: Extra snacksExtra snacks High-calorie nutritional supplementsHigh-calorie nutritional supplements Weight control measures (1200, 1500, Weight control measures (1200, 1500,

or 1800-calorie meal plan; skim milk, or 1800-calorie meal plan; skim milk, diet beverages, and/or no seconds)diet beverages, and/or no seconds)

Medical conditions and/or Medical conditions and/or needsneeds

Certain medical Certain medical conditionsconditions will affect a will affect a person’s meal plan such as cancer, renal person’s meal plan such as cancer, renal disease, diabetes, hypertension, disease, diabetes, hypertension, hyperlipidemia, etc.hyperlipidemia, etc.

Pre-plated, individualized meal planPre-plated, individualized meal plan

Medical conditions and/or Medical conditions and/or needsneeds

Special needs:Special needs: Limit concentrated sweetsLimit concentrated sweets Low fat/Low cholesterolLow fat/Low cholesterol Modified for food intolerancesModified for food intolerances Low sodium Low sodium DiabeticDiabetic No added saltNo added salt Low potassiumLow potassium

Food TextureFood Texture

Feeding and/or mechanical issues:Feeding and/or mechanical issues: High or low muscle High or low muscle tonetone DroolingDrooling Pocketing foodPocketing food Tongue thrustTongue thrust Dental statusDental status Delayed swallowDelayed swallow

Choking or Choking or coughing on solids coughing on solids RuminationRumination Inability to form a Inability to form a bolusbolus Prolonged chewingProlonged chewing Fast eating paceFast eating pace

Food TextureFood Texture

Follow-up made on the possible Follow-up made on the possible chewing / swallowing issuechewing / swallowing issue

Final decision made by the speech-Final decision made by the speech-language pathologist unless the order language pathologist unless the order is made by a physicianis made by a physician

Liquid ConsistencyLiquid Consistency

Possible difficulty consuming thin liquids Possible difficulty consuming thin liquids normallynormally

Possible use of thin liquids as a means Possible use of thin liquids as a means for ruminationfor rumination

Ordering thickened liquids Ordering thickened liquids Thickened liquid consistenciesThickened liquid consistencies

Tube FeedingsTube Feedings

Reasons for the required use of a Reasons for the required use of a feeding tube:feeding tube: Possible disorders of the digestive tractPossible disorders of the digestive tract MalnutritionMalnutrition Specific types of surgerySpecific types of surgery Neurological disorders that interfere with Neurological disorders that interfere with

the ability to safely swallowthe ability to safely swallow

Tube FeedingsTube Feedings Decision to place someone on a tube Decision to place someone on a tube

feeding made after careful consideration feeding made after careful consideration of the person’s quality of livingof the person’s quality of living

Decision is made by the person’s Decision is made by the person’s guardian, physician, and medical team guardian, physician, and medical team including the dietitianincluding the dietitian

Tube FeedingsTube Feedings

G-tube (stomach) or J-tube (small G-tube (stomach) or J-tube (small intestine) feedingintestine) feeding

Selection of the tube feeding formulaSelection of the tube feeding formula Additional water Additional water

Tube FeedingsTube Feedings Weights and lab values require regular Weights and lab values require regular

monitoring.monitoring. Communication between the dietitian, Communication between the dietitian,

physician, nurses, and direct care staff is physician, nurses, and direct care staff is critical.critical.

Report any problems to the physician.Report any problems to the physician.

Adaptive Feeding Adaptive Feeding EquipmentEquipment

Helps individuals feed themselves in a safe Helps individuals feed themselves in a safe mannermanner

Helps to maximize food intakeHelps to maximize food intake Helps to increase independenceHelps to increase independence

NEVER feed a person lying down UNLESS NEVER feed a person lying down UNLESS it is specified.it is specified.

NEVER tilt the person’s head back due to NEVER tilt the person’s head back due to possible aspiration.possible aspiration.

Angled, built-up Angled, built-up handle spoonhandle spoon

Built-up handle spoonBuilt-up handle spoon

Dycem matDycem mat Scoop plateScoop plate Weighted, built-Weighted, built-up handle spoonup handle spoon

Individual PreferencesIndividual Preferences

Specific food and beverage Specific food and beverage preferencespreferences

Examples: ‘preferences daily’ or Examples: ‘preferences daily’ or ‘chocolate milk if desired’‘chocolate milk if desired’

Food substitutionsFood substitutions Proper portioning of snacks received Proper portioning of snacks received

from homefrom home

Nutritional IssuesNutritional Issues

Non-compliance with prescribed meal Non-compliance with prescribed meal planplan

Taking food from other people or Taking food from other people or places inappropriatelyplaces inappropriately

Sneaking or hoarding foodSneaking or hoarding food

Nutritional InterventionNutritional Intervention Notify the dietitian. Notify the dietitian. Consult with the individual’s Consult with the individual’s

interdisciplinary team. interdisciplinary team. Implement the interventions when Implement the interventions when

possible.possible.

Nutritional NeedsNutritional Needs We have a 4-week menu cycle to provide We have a 4-week menu cycle to provide

variety for our individuals.variety for our individuals. Our menu is based on standard nutrition Our menu is based on standard nutrition

recommendations required by federal recommendations required by federal regulations. regulations.

ChooseMyPlate.govChooseMyPlate.gov

Food SafetyFood Safety Integral part of meal preparation and Integral part of meal preparation and

serviceservice Reduces the risk of cross-contamination Reduces the risk of cross-contamination

and foodborne illnessand foodborne illness Includes the proper procedures for hand Includes the proper procedures for hand

washing, sanitation, and checking of food washing, sanitation, and checking of food and beverage temperaturesand beverage temperatures

Hand Washing Hand Washing ProceduresProcedures

Wash your hands with hot, Wash your hands with hot, soapy water BEFORE and soapy water BEFORE and AFTER handling food and AFTER handling food and any time you step away from any time you step away from the food.the food.

Wash your hands before and Wash your hands before and after feeding or assisting after feeding or assisting persons with their food.persons with their food.

Wear gloves when you are Wear gloves when you are serving food. Wash your serving food. Wash your hands every time you change hands every time you change your gloves. Keep hand your gloves. Keep hand sanitizer handy.sanitizer handy.

Sanitation ProceduresSanitation Procedures

Extremely important for preventing food Extremely important for preventing food poisoning and the spread of infections/illnesspoisoning and the spread of infections/illness

Keep countertops, dishes, and appliances Keep countertops, dishes, and appliances clean.clean.

TemperaturesTemperatures Steam tables must be on at least 45 minutes Steam tables must be on at least 45 minutes

before the food arrives.before the food arrives. Individuals should receive their food within 15 Individuals should receive their food within 15

minutes after the food is removed from the minutes after the food is removed from the heat/cold source.heat/cold source.

Checking TemperaturesChecking Temperatures Check the temperature of all Check the temperature of all

foods before serving it to the foods before serving it to the individuals. individuals.

Proper temperatures for foods Proper temperatures for foods and beverages served to the and beverages served to the individuals:individuals: Hot items: 140 to 145Hot items: 140 to 145°F°F Cold items:Cold items:

Refrigerated: 32 to 40Refrigerated: 32 to 40°F°F Frozen: 0°F or belowFrozen: 0°F or below

How to Check How to Check TemperaturesTemperatures

CleanClean CalibrateCalibrate Take temperaturesTake temperatures CleanClean

Keep cold foods cold and hot foods hot!Keep cold foods cold and hot foods hot!

Promote a Positive Promote a Positive AttitudeAttitude

Do not let your food dislikes influence the Do not let your food dislikes influence the individuals.individuals.

Textured modified food looks different, Textured modified food looks different, but tastes good.but tastes good.

Always offer/encourage the individuals to Always offer/encourage the individuals to eat a variety of foods.eat a variety of foods.

ReferencesReferences American Association on Intellectual and American Association on Intellectual and

Developmental Disabilities. Definition of Developmental Disabilities. Definition of Intellectual Disability. Intellectual Disability. http://aaidd.org/intellectual-disability/definition. Accessed . Accessed September 12, 2014.September 12, 2014.

The Arc. Intellectual Disability. The Arc. Intellectual Disability. http://www.thearc.org/page.aspx?pid=253. . Accessed September 12, 2014.Accessed September 12, 2014.

ReferencesReferences Behavioral Health Nutrition Dietetic Practice Group Behavioral Health Nutrition Dietetic Practice Group

of the American Dietetic Association. The Adult of the American Dietetic Association. The Adult with Intellectual and Developmental Disabilities: A with Intellectual and Developmental Disabilities: A Resource Tool for Nutrition Professionals. 2008.Resource Tool for Nutrition Professionals. 2008.

Frazier M. Frazier M. Nutritional Needs for Individuals with Nutritional Needs for Individuals with Intellectual and Developmental DisabilitiesIntellectual and Developmental Disabilities [PowerPoint slides]. April 2, 2013. [PowerPoint slides]. April 2, 2013.

North Mississippi Regional Center Nutrition North Mississippi Regional Center Nutrition Services. Services. General Orientation – Revised 9-27-General Orientation – Revised 9-27-1414 [PowerPoint slides]. [PowerPoint slides].

ANY QUESTIONS???ANY QUESTIONS???