This document discusses nutrition and intellectual/developmental disabilities. It defines intellectual disability as beginning before age 18 and involving limitations in adaptive functioning and an IQ below 75. Developmental disability is a broader term including intellectual disabilities and other disabilities apparent in childhood. Common nutritional concerns for those with IDD include aspiration, GERD, constipation, obesity, and oral issues. A nutritional assessment considers height, weight, labs, medications, meal plans, and more. Food safety is also discussed.

1. Nutrition andNutrition and
Intellectual andIntellectual and
DevelopmentalDevelopmental
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 anTo distinguish the difference between an
intellectual disability and aintellectual disability and a
developmental disabilitydevelopmental disability
 To list the components of the nutritionalTo list the components of the nutritional
assessment that determine a person’sassessment that determine a person’s
nutritional needsnutritional needs

3. ObjectivesObjectives
 To list the factors that determine aTo list the factors that determine a
person’s meal planperson’s meal plan
 To name the three components of foodTo name the three components of food
safety from the standpoint of a dietitiansafety from the standpoint of a dietitian
that serves individuals with IDDthat serves individuals with IDD

4. What is an IntellectualWhat is an Intellectual
Disability?Disability?
 Disability characterized byDisability characterized by
considerable limitations in adaptiveconsiderable 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 IntellectualWhat is an Intellectual
Disability?Disability?
 Common causes:Common causes:
 Genetic conditions (Down syndrome, FragileGenetic 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 birthDifficulties 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 asExposure to environmental toxins such as
lead or mercurylead or mercury

6. What is aWhat is a
DevelopmentalDevelopmental
Disability?Disability?
 An inclusive term that consists ofAn inclusive term that consists of
intellectual disabilities and otherintellectual disabilities and other
disabilities that are obvious duringdisabilities that are obvious during
childhoodchildhood
 Severe, chronic disabilities that can beSevere, chronic disabilities that can be
cognitive or physical or bothcognitive or physical or both
 Appear before the age of 22Appear before the age of 22
 Are likely to be lifelongAre likely to be lifelong

7. What is aWhat is a
DevelopmentalDevelopmental
Disability?Disability?
 Examples of developmental disabilities:Examples of developmental disabilities:
 Autism spectrum disorders (ASD)Autism spectrum disorders (ASD)
 EpilepsyEpilepsy
 Cerebral palsyCerebral palsy
 Developmental delayDevelopmental delay
 Fetal alcohol syndrome (or FAS)Fetal alcohol syndrome (or FAS)
 Any other disorders that occur during theAny 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 NutritionalCommon Nutritional
Concerns in IndividualsConcerns in Individuals
with IDDwith IDD
 AspirationAspiration
 GastroesophagealGastroesophageal
Reflux DiseaseReflux Disease
(GERD)(GERD)
 ChronicChronic
constipationconstipation
 ObesityObesity
 PicaPica
 RuminationRumination
 Oral healthOral health
 Vision andVision and
hearinghearing
 ChewingChewing
 SwallowingSwallowing
 Oral sensitivityOral sensitivity

10. Other NutritionalOther Nutritional
Concerns that AffectConcerns that Affect
Those with IDDThose with IDD
 Chronic diseases such as diabetes,Chronic diseases such as diabetes,
cancer, hypertension, and chronic kidneycancer, hypertension, and chronic kidney
diseasedisease
 Food allergies, sensitivities, and/orFood allergies, sensitivities, and/or
intolerancesintolerances
 Inherited metabolic disorders such asInherited metabolic disorders such as
galactosemia and phenylketonuria (PKU)galactosemia and phenylketonuria (PKU)

11. NutritionalNutritional
AssessmentAssessment
 Components that determine theComponents 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’sMethods 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’sMethods 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’sMethods 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 over5 feet + 6 inches for every inch over
± 10%± 10%
 Women: 100 for 1Women: 100 for 1stst
5 feet + 5 inches for every inch5 feet + 5 inches for every inch
overover ± 10%± 10%
 CDC growth chartsCDC growth charts
 Growth charts specific to genetic disorders suchGrowth 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 anyContact the nurse and/or physician if any
of the lab levels are of concern (too highof the lab levels are of concern (too high
or low) with follow-up contact made asor low) with follow-up contact made as
needed.needed.

16. Medication-NutrientMedication-Nutrient
InteractionsInteractions
 List each medication taken by mouth orList each medication taken by mouth or
I.V.I.V.
 Take note of the side effects that haveTake note of the side effects that have
nutrient and oral/gastrointestinal (GI)nutrient and oral/gastrointestinal (GI)
implications.implications.

17. Medication-NutrientMedication-Nutrient
InteractionsInteractions
 The most frequent implications includeThe most frequent implications include::
 ConstipationConstipation
 Gastroesophageal reflux and other GIGastroesophageal 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. NutritionalNutritional
AssessmentAssessment
 Other items included:Other items included:
 Meal planMeal plan
 PreferencesPreferences
 AppetiteAppetite
 Food allergiesFood 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’sFactors 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 EnergyDetermining Energy
NeedsNeeds
 Methods used to determineMethods used to determine the individual’sthe 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 inMen: 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 xWomen: 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 specificEstimated calorie requirements for specific
developmental disabilitiesdevelopmental disabilities

21. Energy NeedsEnergy Needs
 Possible items needed afterPossible items needed after
determining energy needs and fooddetermining 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/orMedical conditions and/or
needsneeds
 Certain medicalCertain medical conditionsconditions will affect awill affect a
person’s meal plan such as cancer, renalperson’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/orMedical 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 sodiumLow 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 muscleHigh or low muscle
tonetone
 DroolingDrooling
 Pocketing foodPocketing food
 Tongue thrustTongue thrust
 Dental statusDental status
 Delayed swallowDelayed swallow
 Choking orChoking or
coughing on solidscoughing on solids
 RuminationRumination
 Inability to form aInability to form a
bolusbolus
 Prolonged chewingProlonged chewing
 Fast eating paceFast eating pace

25. Food TextureFood Texture
 Follow-up made on the possibleFollow-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 orderlanguage pathologist unless the order
is made by a physicianis made by a physician

26. Liquid ConsistencyLiquid Consistency
 Possible difficulty consuming thin liquidsPossible difficulty consuming thin liquids
normallynormally
 Possible use of thin liquids as a meansPossible use of thin liquids as a means
for ruminationfor rumination
 Ordering thickened liquidsOrdering thickened liquids
 Thickened liquid consistenciesThickened liquid consistencies

27. Tube FeedingsTube Feedings
 Reasons for the required use of aReasons 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 withNeurological disorders that interfere with
the ability to safely swallowthe ability to safely swallow

28. Tube FeedingsTube Feedings
 Decision to place someone on a tubeDecision to place someone on a tube
feeding made after careful considerationfeeding made after careful consideration
of the person’s quality of livingof the person’s quality of living
 Decision is made by the person’sDecision is made by the person’s
guardian, physician, and medical teamguardian, physician, and medical team
including the dietitianincluding the dietitian

29. Tube FeedingsTube Feedings
 G-tube (stomach) or J-tube (smallG-tube (stomach) or J-tube (small
intestine) feedingintestine) feeding
 Selection of the tube feeding formulaSelection of the tube feeding formula
 Additional waterAdditional water

30. Tube FeedingsTube Feedings
 Weights and lab values require regularWeights and lab values require regular
monitoring.monitoring.
 Communication between the dietitian,Communication between the dietitian,
physician, nurses, and direct care staff isphysician, nurses, and direct care staff is
critical.critical.
 Report any problems to the physician.Report any problems to the physician.

31. Adaptive FeedingAdaptive Feeding
EquipmentEquipment
 Helps individuals feed themselves in a safeHelps 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 UNLESSNEVER feed a person lying down UNLESS
it is specified.it is specified.
 NEVER tilt the person’s head back due toNEVER tilt the person’s head back due to
possible aspiration.possible aspiration.

32. Angled, built-upAngled, 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 beverageSpecific food and beverage
preferencespreferences
 Examples: ‘preferences daily’ orExamples: ‘preferences daily’ or
‘chocolate milk if desired’‘chocolate milk if desired’
 Food substitutionsFood substitutions
 Proper portioning of snacks receivedProper portioning of snacks received
from homefrom home

34. Nutritional IssuesNutritional Issues
 Non-compliance with prescribed mealNon-compliance with prescribed meal
planplan
 Taking food from other people orTaking food from other people or
places inappropriatelyplaces inappropriately
 Sneaking or hoarding foodSneaking or hoarding food

35. NutritionalNutritional
InterventionIntervention
 Notify the dietitian.Notify the dietitian.
 Consult with the individual’sConsult with the individual’s
interdisciplinary team.interdisciplinary team.
 Implement the interventions whenImplement the interventions when
possible.possible.

36. Nutritional NeedsNutritional Needs
 We have a 4-week menu cycle to provideWe have a 4-week menu cycle to provide
variety for our individuals.variety for our individuals.
 Our menu is based on standard nutritionOur menu is based on standard nutrition
recommendations required by federalrecommendations required by federal
regulations.regulations.
 ChooseMyPlate.govChooseMyPlate.gov

38. Food SafetyFood Safety
 Integral part of meal preparation andIntegral part of meal preparation and
serviceservice
 Reduces the risk of cross-contaminationReduces the risk of cross-contamination
and foodborne illnessand foodborne illness
 Includes the proper procedures for handIncludes the proper procedures for hand
washing, sanitation, and checking of foodwashing, sanitation, and checking of food
and beverage temperaturesand beverage temperatures

39. Hand WashingHand Washing
ProceduresProcedures
 Wash your hands with hot,Wash your hands with hot,
soapy water BEFORE andsoapy water BEFORE and
AFTER handling food andAFTER handling food and
any time you step away fromany time you step away from
the food.the food.
 Wash your hands before andWash your hands before and
after feeding or assistingafter feeding or assisting
persons with their food.persons with their food.
 Wear gloves when you areWear gloves when you are
serving food. Wash yourserving food. Wash your
hands every time you changehands every time you change
your gloves. Keep handyour gloves. Keep hand
sanitizer handy.sanitizer handy.

40. Sanitation ProceduresSanitation Procedures
 Extremely important for preventing foodExtremely important for preventing food
poisoning and the spread of infections/illnesspoisoning and the spread of infections/illness
 Keep countertops, dishes, and appliancesKeep countertops, dishes, and appliances
clean.clean.
 TemperaturesTemperatures
 Steam tables must be on at least 45 minutesSteam tables must be on at least 45 minutes
before the food arrives.before the food arrives.
 Individuals should receive their food within 15Individuals should receive their food within 15
minutes after the food is removed from theminutes after the food is removed from the
heat/cold source.heat/cold source.

41. CheckingChecking
TemperaturesTemperatures
 Check the temperature of allCheck the temperature of all
foods before serving it to thefoods before serving it to the
individuals.individuals.
 Proper temperatures for foodsProper temperatures for foods
and beverages served to theand 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 CheckHow 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 PositivePromote a Positive
AttitudeAttitude
 Do not let your food dislikes influence theDo 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 toAlways offer/encourage the individuals to
eat a variety of foods.eat a variety of foods.

44. ReferencesReferences
 American Association on Intellectual andAmerican Association on Intellectual and
Developmental Disabilities. Definition ofDevelopmental 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 GroupBehavioral Health Nutrition Dietetic Practice Group
of the American Dietetic Association. The Adultof the American Dietetic Association. The Adult
with Intellectual and Developmental Disabilities: Awith 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 withNutritional 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 NutritionNorth 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???