Nutrition Services for Children with Special Needs in Child Care Programs

Children with special needs are increasingly being served in community-based settings. Guidelines for out-of-home child care programs published by the American Public Health Association and the American Academy of Pediatrics recommend that child care facilities integrate children with disabilities and children without disabilities. The objectives of this study were to determine the nutrition services provided to children with special needs in child care programs and the continuing education needs of child care personnel related to providing these services. Pretested questionnaires were mailed to a random sample of 500 licensed day care homes and child care centers in a southeastern state. Two hundred forty-four programs (49%) serving 21,027 children completed questionnaires. Descriptive statistics were used to summarize data. Thirty-eight percent of programs reported serving children with special needs. A total of 403 children with special needs (an average of 4.3 children/program) were served. Programs reported serving children with special needs with food allergies/intolerances (55% of children served), growth problems (21%), feeding problems (8%), seizure disorders (7%), metabolic problems (3%), and a variety of other conditions including cystic fibrosis, Down syndrome, asthma, and extreme medical fragility requiring tube feeding. Thirty-three percent of programs responding reported making special nutritional provisions for children with special needs. Of 289 children for whom special provisions were made, menu changes were provided for 57%, recipe changes for 12%, texture changes for 9%, assistance with feeding for 9%, food provided by parents was served for 6%, special eating devices provided for 4%, and eating area modified for wheelchair access for 4%. Forty-eight percent of programs responding reported that they measured height and weight of children, and 96% reported that they monitored children\u27s eating. Continuing education needs identified included planning menus with more variety (48% reported moderate or high continuing education need), planning food and nutrition activities for the curriculum (44%), modifying recipes to decrease fat, sugar, and salt (44%), and planning menus that appeal to children (43%). The American Dietetic Association recommends that child care programs obtain consultation and guidance from a registered dietitian (RD) on a regular basis. Forty-five percent of child care programs in this study reported receiving consultation from a dietitian or nutritionist. The variety of nutritional needs of children with disabilities and chronic illnesses served by child care programs included in this study support the need for regular consultation and guidance by the RD. © 1995 American Dietetic Association