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Children's Medical Services - Special services for children with special needs
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Infant Toddler Development Training
Module 6, Lesson 2



The overall prevalence of nutritional disorders for children eighteen years of age or less in America includes obesity at a rate of 25% and undernourishment at a rate of 10%. Of particular note is that 70% of infants and toddlers who have been diagnosed with special health care needs demonstrate at least one of the risk factors for a nutritional disorder and 40% have a diagnosed nutritional disorder. The ITDS can find information about nutrition in children including data from the National Health and Nutrition Examination Survey

baby eatingWhen the ITDS, as part of the early intervention team, encounters a child who appears undernourished or obese, the ITDS must first determine whether the child has a primary medical provider. If there is no primary medical provider, the family should be connected to a primary medical home as well as a pediatric nutritionist as indicated to develop a collaborative nutritional plan of care that includes ongoing follow-up with medical providers. The Plan of Care, as part of Florida's Individualized Family Support Plan (IFSP) must be written with the family so that they may integrate or generalize activities into mealtime routines and other community and social and cultural activities.


Infants who are undernourished follow a growth trajectory that shows decreased linear growth and an increased susceptibility to infections. Sometimes it is hard to determine if the undernourishment is due to an organic condition or if it is related to developmental and behavioral delays associated with poverty or neglect.

Infants who are undernourished demonstrate slightly decreased differences in cognition and in motor development. If the undernourishment is associated with iron deficiency anemia, then the child becomes significantly at risk for possible cognitive delays. If an adequate nutritional source can be established and if the relationship between the infant and caregiver can be optimized then often the undernourished infant can thrive. The ITDS should be alert to this important relationship and be prepared with strategies to positively enhance the feeding time environment.

Undernourishment is also seen when calories are used faster than for typically developing children of the same age. Being active as a toddler is not a cause of weight loss because this is typical behavior at this age. Some causes that may be associated with excess utilization of nutrients include:

  • recurrent infections
  • chronic respiratory insufficiency
  • congenital or acquired heart disease
  • malignancy
  • toxins such as lead and drugs
  • endocrinology disorders such as hyperthyroidism

Low Birth Weight and Nutritional Status

mother and baby on bedLow birth weight, especially at full term, as a single factor may not be indicative of nutritional risk. A smaller maternal size has been related to smaller infants. This does not necessarily mean that the infant has low birth weight. The infant must be assessed in the context of cultural factors or accompanying growth and nutritional risk factors. The smaller size of the infant may only be indicative of the genetic endowment. The primary medical provider will monitor the growth of the infant closely to ensure that the length for weight index documents proper growth. Infants born with low or very low birth weight due to prematurity or other pre- or post-natal conditions must have their nutritional needs assessed in context with their specific medical needs.


Obesity or the condition of being overweight is associated with an increased risk of cardiovascular concerns, diabetes, decreased mobility, and social implications as the child grows. There is also an associated challenge for the caregivers if the child is non-ambulatory past the age in which typical peers would be walking. As mentioned earlier, the child must be in the care of a primary medical provider and also with a pediatric nutritionist if indicated.

There are certain syndromes that have associated risks for obesity and require monitoring often by a developmental pediatrician and a pediatric nutritionist. Two of these are Down syndrome and Prader-Willi syndrome. These will be discussed in this lesson in a section relating to genetic and endocrine disorders.


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