Nutrition and Intellectual and Developmental Disabilities (IDD)

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

2. ObjectivesObjectives
To distinguish the difference between an To distinguish the difference between an
intellectual disability and a intellectual disability and a
developmental disabilitydevelopmental disability
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

3. 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

4. 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

5. 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

6. What is a What is a
Developmental 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

7. What is a What is a
Developmental 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)

8. Down syndromeDown syndrome Prader-Willi syndromePrader-Willi syndrome
Cerebral palsyCerebral palsy

9. Common Nutritional Common Nutritional
Concerns in Individuals Concerns in Individuals
with IDDwith 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

10. Other Nutritional Other Nutritional
Concerns that Affect Concerns that Affect
Those with IDDThose 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)

11. Nutritional Nutritional
AssessmentAssessment
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

12. 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

13. 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 1
stst
5 feet + 6 inches for every inch over 5 feet + 6 inches for every inch over
± 10%± 10%
Women: 100 for 1Women: 100 for 1
stst
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

14. 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

15. 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.

16. 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.

17. 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

18. Nutritional Nutritional
AssessmentAssessment
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

19. 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

20. 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

21. 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)

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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.

31. 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.

32. 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

33. 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

34. 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

35. Nutritional Nutritional
InterventionIntervention
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.

36. 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

38. 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

39. 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.

40. 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.

41. Checking Checking
TemperaturesTemperatures
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

42. 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!

43. 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.

44. ReferencesReferences
American Association on Intellectual and American Association on Intellectual and
Developmental Disabilities. Definition of Developmental Disabilities. Definition of
Intellectual Disability. Intellectual Disability. http://http://aaidd.orgaaidd.org
/intellectual-disability/definition/intellectual-disability/definition. Accessed . Accessed
September 12, 2014.September 12, 2014.
The Arc. Intellectual Disability. The Arc. Intellectual Disability. http://http://
www.thearc.org/page.aspx?pidwww.thearc.org/page.aspx?pid=253=253. .
Accessed September 12, 2014.Accessed September 12, 2014.

45. 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].

46. ANY QUESTIONS???ANY QUESTIONS???