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Infant Toddler Development Training
Module 6, Lesson 2

Inadequate Caloric Intake and Excessive Losses

Conditions associated with nutritional disorders often interfere with the intake of adequate calories to maintain a healthy body. Poor caloric intake can be caused by a variety of factors. These include poor appetite, chaotic daily routines and lack of structure in the home. A nutritional disorder can change the metabolic process for digesting carbohydrates, fats or proteins.

Caloric loss may be associated with reflux, vomiting, diarrhea or constipation that accompanies a disease condition. The body needs a certain amount of calories to survive and maintain function. The metabolism or processing of food (nutrients) produces energy that is then expended on cell growth and maintenance.

The metabolism of food creates energy and then the body expends energy. A balance between what goes in and what is expended must be maintained. Simply put, in order to grow, more calories must go in than are expended.

Causes of Poor Caloric Intake

Poor caloric intake can be caused by a variety of factors including poor appetite caused by poor daily routines and lack of structure in the home or stresses that have created anxiety. Poor caloric intake can be associated with central nervous system (CNS) disorders and also with chronic or recurrent infections. Medications such as decongestants can also suppress the appetite.

baby in high chairImpairment of oromotor or swallow functions can impede adequate intake and are referred to as neuro-muscular. The cause may be organic with muscle involvement for many infants and toddlers who have cerebral palsy. The child may have low muscle tone and also the inability to chew properly as is often seen in infants with Down syndrome. There may be cranio-facial anomalies that prevent intake such as with cleft lip or palate and surgical repairs. In these cases, other methods to ensure nutrition must be explored that may include oral muscle strengthening exercises. Alternative routes for nutrition are sometimes necessary such as gastrostomy tube feeding, as defined earlier in this lesson. There also can be an inability to coordinate breathing and feeding which results in dyspnea (difficulty in breathing) and poor caloric intake. The need to address multiple issues may necessitate involvement from a variety of disciplines.

Food Insecurities

The issue related to food insecurities must be taken into account. A food insecurity is the lack of needed food to meet the body's nutritional needs. Food insecurities may be related to psychosocial issues including the lack of finances to support a healthy diet. The team for the family may include a social worker to help the family obtain the food that is needed. The ITDS should be aware of programs such as the Women, Infants, and Children (WIC) program that provide food supplements to low income mothers and children. WIC is a federally funded program that provides healthy foods, nutritional education and counseling, breastfeeding support and referrals to needed healthcare services. Information about the program in Florida including referral forms is available through the Florida WIC Program.

Food insecurities related to behavior may not simply be the unavailability of food. It may also refer to inappropriate feeding techniques by the caregiver, insufficient volumes of the needed nutrients, inappropriate food for the age of the child, or the withholding of food by the caregiver that is considered to be a form of abuse or neglect.


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