Maternal Feeding Practices in Relation to Nutritional Status of the Mentally Challenged
Selected Special School in Batangas City
A Thesis Presented to the
Faculty of College of Nursing
In Partial Fulfillment of the
Requirements for the Degree
Bachelor of Science in Nursing
Shiela Mae De Chavez
THE PROBLEM AND ITS BACKGROUND
Children constitute a big and relevant part of the nation. They are well loved and
cared for by parents as they are the human symbols of their affection. Society on the hand
also protects children, as they are future of society. Therefore efforts are taken to have the
family, the school, and the community work together for them to be healthy.
During the preschool years, children take on their own unique personality and
strive for a greater independence. They are very active, playful and adventurous.
Preschool children have a high energy requirement for their size because they are
grieving and becoming more active. The amount of food they need depends on their age,
body size, growth rate and appetite. Foods contain similar nutrients are grouped into three
which are body building foods, energy giving foods and regulating foods. This three food
group serves as a guide for meal planning and good nutrition.
The vision statement of the Department of health Nutrition emphasizes that
proper nutrition is a basic human right of every Filipino and the basic nutrition values
entail that it is a basic human right of child.
Nutrition plays a vital role that will ensure a child’s proper growth, development
and maintenance of life. As defined, nutrition is the science of food nutrient and other
substances therein, action, interaction, and balance in relation to health and disease and
the process by which the organism ingest, transport, utilizes and excretes food
Anemia is a condition in which the body does not have enough healthy red blood
cells. Red blood cells provide oxygen to body tissues. Iron deficiency anemia is a
decrease in the number of red cells in the blood caused by too little iron. Chronic iodine
deficiency can lead to numerous health problems in children and adults, including thyroid
gland dysfunction (including goiter) and various neurologic, gastrointestinal, and skin
abnormalities. Iodine deficiency in pregnant or nursing mothers can lead to significant
neurocognitive deficits in their infants. "Cretinism" or severe mental retardation is a rare
outcome of severe iodine deficiency during early development. Growth stunting, apathy,
impaired movement, or speech/hearing problems may occur. Many individuals living in
developing countries may be at risk of iodine deficiency and its complications, and iodine
deficiency is considered to be a preventable cause of mental retardation. Vitamin A is a
vitamin which is needed by the retina of the eye in the form of a specific metabolite, the
light-absorbing molecule retinal.
Since proper diet is crucial during pre-school stages it is that at this level the brain
growth rapidly and nutrition is a critical factors. Failure to provide enough nutrients like
deficiency in iron may cause Anemia. Lack of iodine may cause Goiter and may lead to
mental retardation and vitamin A may cause blindness.
Mental retardation affects about 1 - 3% of the population. There are many causes
of mental retardation, but doctors find a specific reason in only 25% of cases.
Mentally retarded people are more prone to both physical and mental disorders
than the general population. Some of the conditions that cause mental retardation may
also be characterized by seizures, hearing problems, congenital heart defects, and other
symptoms. Mental disorders are much more common among the mentally retarded than
among the general population: an estimated one million. Feeding is not only essential for
growth, but is a primary context for interactions between infants and their mothers in
early infancy. Early identification of dyads at risk for poor feeding offers an opportunity
to intervene in the future health and wellbeing of the infant.
A family may suspect mental retardation if the child's motor skills, language
skills, and self-help skills do not seem to be developing, or are developing at a far slower
rate than the child's peers. Failure to adapt (adjust to new situations) normally and grow
intellectually may become apparent early in a child's life. In the case of mild retardation,
these failures may not become recognizable until school age or later.
The degree of impairment from mental retardation varies widely, from profoundly
impaired to mild or borderline retardation. Less emphasis is now placed on the degree of
retardation and more on the amount of intervention and care needed for daily life.
Based on this premises, this study aims to identify it the children with special
needs were given priority and the mothers were able to come with their needs especially
regarding their nutrition.
“Neuman’s System Model” Her theory is based on scales developed to measure
feeding teaching and environment with continuous research, she refined the theory
and provided a close link to practice, she model the role of researcher in clinical
practice as the advancement of nursing practice
The above theories stated by the theorist and were simply collaborating to the
different interpretation focus on our study like Kathlyn Bernard’s the “Parent-child
Interaction Theory”, it emphasized that the parent has more responsible in dealing with
their children from pregnancy up to the cycle of his/ her development as a human they
have the responsibility to nourish and to nurture their child’s physical, emotional and
psychological aspects of their growth development likewise when this growth develops
into mature life cycle of individuals, adaptation and adjustment is particularly exist and
disturb once stability if this process fails to stability, disharmony remain for too long is
consequently unable to satisfy its needs and illness may develops to Neuman System
Model, since the health of the children means the straight of its social and economic
structure in the future according to “Deckham Child Health Care Theory,” parents despite
limitations in their socioeconomic station in life must practice the health of the children.
Mentally Challenged Children
Nutritional status of mentally
Number o children
Maternal feeding practices
towards their mentally
The Paradigm shows that the Maternal Profile determines the feeding practices
towards Maternal feeding Practices Towards their Mentally Challenged Children since
Nutritional status of mentally challenged children is dependent on this practices on their
mother, any failure with the age, civil status, educational attainment, as well as the M.
income and number of children will result to poor feeding practices thereby sacrificing
the good outcome of nutritional status of mentally challenged children.
Statement of the Problem
This study aims to find out the Maternal Feeding Practices in Relation to
Nutritional Status of the Mentally Challenged Children in Selected Special School in
This study sought answer to the following problem:
1. What is the demographic profile of the mothers in terms of:
b. Civil status
c. Educational Attainment
e. Income/ month
f. Number of children
B. School- age children profile as affiliated by the mothers
2. What is the nutritional status of the mentally challenged children in relation to
their age and gender?
3. What are the feeding practices of respondents applied to their mentally challenged
4. Is there significant relation between maternal feeding practices and nutritional
status of mentally challenged children?
5. What is the implication of the result of the study to nursing education?
Significance of the Study
The result of the study is expected to be beneficial to the following sectors
The finding of this study will ultimately benefit the parents because it will help them
to understand the condition of their children
The finding of the study will help the family. Define and understand the importance
of nutrition. This will provide enough knowledge and information about the
importance of proper and balanced diet. How it will be practice at home to prevent
nutritional inadequacy in their children.
To the student, this will help them to understand and meet their nutritional
needs. This will make them aware of what they have been taken for their meals and
snacks and this will provide them advanced knowledge how to handle of a balance to
the community, this will help them recognize and organize plans and project to avoid
health deficiency such as plantation of vegetables, fruits and others which is
appropriate for the high quality nutrition
To the canteen owners, this will help them to encourage support for the
implementation of the DOH Sangkap Pinoy Program and to establish food products
with essential nutrients at level approved by the DOH to the nursing student they will
help them to determine and understand the specific conditions of the affected
mentally challenged children in relation to their behavior, growth and mental
development hence this could serve as basis to explore certain strategies and
organizations to implement programs to enhance and lessen nutritional deficiency
among children as well as to lessen mentally challenged children in the community.
Scope and Limitations of the study
This study is mainly about the maternal feeding practices in relation to
nutritional status of the mentally challenged children. Health practices of mother,
their profile and possible factors that may affect the nutritional status of mentally
challenged children when give focused.
The researchers did not cover about the awareness and knowledge of parents about
proper nutrition and vaccination of children, which is also a part of a children’s
profile, to know if the child is fully immunized or was not tackled here.
School-aged children 6-12 and their characteristics had been emphasized to provide
more understanding about their development for the researcher to provide more
appropriate recommendation since the target group has known disabilities, the
researcher decide to choose the mothers of mentally challenged children of some
schools specifically the Batangas South, East, and Sampaga elementary school to
retrieve more accurate into.
Definition of terms:
For better and clearer understanding of the following terms are defined according
to how it was used in this study:
Balanced diet- refers to the food eaten by the respondents.
Feeding behavior- refer to how individual provide food.
Malnutrition- refers to poor health status as a result of inadequate supply of nutrients
needed by too much or too little intake of food by the body.
Mentally challenged- refers to an individual with disabilities and is currently under the
Nutritional status- refers to ones state of health which is determined by the age, height,
weight and sex of children.
Special school- refers to an institution that accommodates individuals with certain
Vitamin A deficiency- a condition characterized by depleted liver stress and low blood
levels by vitamin A resulting from deficient dietary intake of vitamins A and secondarily
from poor absorption that may lead to serious eyes lesions.
Iron deficiency anemia- a condition in which the hemoglobin concentration of the blood
is below accepted values. The more important causes of IDA are low dietary intake of
iron, particularly from animal sources, poor absorption, chronic blood loss and increased
Height- is the measurement of vertical distance, but has two meanings in common use. It
can either indicate how "tall" something is, or how "high up" it is.
Nutrition- a process of absorbing nutrients from food and processing them in the body in
order to keep healthy or to grow
Health- is the general condition of a person in all aspects. It is also a level of functional
and/or metabolic efficiency of an organism, often implicitly human.
REVIEW OF RELATED LITERATURE
The chapter presents the research literatures reviewed by the researchers that as guide in
conducting the study.
The cycle of infants’ nutrition contributing to their success as future mothers and
of mothers’ nutrition determining that of infants is fundamentally important to the
long−term solution to malnutrition. For example, it is now better understood that the
period of growth up to around two to three years of age provides a window of opportunity
for ensuring adequate future growth, development, and nutritional status. Before that, the
relation between low birth weight, survival and child growth is also well established.
And, going further back, growth in utero even from the time of conception is now known
to be crucially affected by nutrition, and to have effects throughout the individual’s life.
As children mature they pass through stages of growth and development. It is very
important that they must receive proper nutrition. Parents are the first people concerned
towards developmental process and health maintenance. Approximately 2.5 to 3% of the
total populations are mentally retarded. In most cases, it is a lifelong condition. There is
no connection between mental retardation and gender or race. The children who cannot
catch up to other children (usually by the age of five) may be diagnosed as “mentally
retarded”. The term, “mental retardation,” means that a person has certain limitations in
their ability to thinkand learn. These limitations will cause this person to be less able to
communicate with others, to take care of him or herself, and to develop social skills.
Children with mental retardation may take longer to learn to speak, walk, and take care of
their personal needs such as dressing or eating. They are likely to have trouble learning in
school and there may be some things that they are unable to learn. Unlike developmental
delays where a child might catch up to other children, mental retardation is a permanent
condition. People with mental retardation can be helped to learn and to care for
themselves through special education and training, but their mental retardation cannot be
cured. Mental illnesses (such as depression) and specific learning disabilities (such as
dyslexia) are not the same thing as mental retardation.
The term mental retardation is commonly used to refer to people with an
intelligence quotient (IQ) below70. An IQ of 80-130 is considered the normal range, and
100 is considered average. According to the definition in the American Psychiatric
Association's Diagnostic and Statistical Manual (DSM-IV), a mentally retarded person is
significantly limited in at least two of the following areas: self-care, communication,
home living, social/interpersonal skills, self-direction, use of community resources,
functional academic skills, work, leisure, health, and safety. Mental retardation affects
roughly 1% of the American population. According to the U.S. Department of Education,
about 11% of school-aged children were enrolled in special education programs for
students with mental retardation. Mental retardation may be caused by problems that
occur during pregnancy and birth, including maternal nutritional deficiencies, toxemia,
infections such as rubella, maternal phenylketonuria (even if the fetus doesn't have the
condition), use of drugs or alcohol, maternal injury during pregnancy, extreme
prematurity, low birth weight, perinatal injury, or lack of oxygen at birth. Retardation can
also be the result of medical conditions and injuries that occur after birth, including
metabolic disorders, severe childhood malnutrition, prolonged high fever, near drowning,
lead poisoning, severe mental disorders such as autism, and infections such as meningitis
that affect the brain.
Environmental factors influencing mental retardation include deprivation of
physical or emotional nurturance and stimulation. Altogether, there are hundreds of
possible causes of, or factors contributing to, mental retardation.
Mental retardation is a condition diagnosed before age 18 that includes below-
average general intellectual function, and a lack of the skills necessary for daily living.
The primary goal of treatment is to develop the person's potential to the fullest.
Special education and training may begin as early as infancy. This includes social skills
to help the person function as normally as possible.
It is important for a specialist to evaluate the person for other affective disorders
and treat those disorders. Behavioral approaches are important for people with mental
Prenatal screening for genetic defects and genetic counseling for families at risk for
known inherited disorders can decrease the risk of inherited mental retardation.
Government nutrition programs are available to poor children in the first and most
critical years of life. These programs can reduce retardation associated with malnutrition.
Early intervention in situations involving abuse and poverty will also help.
Environmental programs to reduce exposure to lead, mercury, and other toxins
will reduce toxin-associated retardation. However, the benefits may take years to become
apparent. Increased public awareness of the risks of alcohol and drugs during pregnancy
can help reduce the incidence of retardation.
Mental retardation is a condition of arrested or incomplete development of the
mind, which is especially characterized by impairment of skills manifested during the
developmental period, which contribute to the overall level of intelligence, i.e. cognitive,
language, motor, and social abilities. Retardation can occur with or without any other
mental or physical disorder. However, mentally retarded individuals can experience the
full range of mental disorders, and the prevalence of other mental disorders is at least
three to four times greater in this population than in the general population. In addition,
mentally retarded individuals are at greater risk of exploitation and physical/sexual abuse.
Adaptive behavior is always impaired, but in protected social environments where
support is available this impairment may not be at all obvious in subjects with mild
mental retardation. Intelligence is not a unitary characteristic but is assessed on the basis
of a large number of different, more or less specific skills. Although the general tendency
is for all these skills to develop to a similar level in each individual, there can be large
discrepancies, especially in persons who are mentally retarded. Such people may show
severe impairment in on particular area (e.g. language), or may have a particular area of
higher skill (e.g. in simple visuo-spatial tasks) against a background of severe mental
retardation. This presents problems when determining the diagnostic category in which a
retarded person should be classified. The assessment of intellectual level should be based
on whatever information is available, including clinical findings, adaptive behavior
(judged in relation to the individual's cultural background), and psychometric test
According to Johnson SL, in his study “influence of parents eating behavior and
child feeding practices on children’s weight status”
Based on his findings it seems evident that the way parents eat affects the
environment in which they feed their children and this may be gender biased.
Louela Villalis Cordova indicators of nutritional status of school aged child
Implication for school nursing service.
At ages 3-5 years old the behavior might only be evident in a controlled setting
and may not be reflected in their weight status due to limited autonomy over eating this
young age at older when children have greater independence in food selections and intake
these earlier learned behaviors may begin to be expressed and subsequently affect the
child’s weight status or the nutritional status.
It is similar to the present study because it shows that parents eating and feeding
practices affect the children’s weight status. It also status that parents eating and feeding
practices is with determinant of what will be the eating a nd feeding practices of their
According to Deborah Steward “Selection of growth Parameters to define failure
to thrive” state that failure to thrive in infants occurs when infants might gain deviates
from an established pattern of growth and is directly attributed to under nutrition.
In addition to this, Belton (2002) study entitled “Childhood Nutritional
Deficiency”, stated that one deficiency occurs; it is probably too late to achieve optimal
development. Ideally, iron and other deficiency lately in the diet will compensate for any
lack in early childhood. Iron deficiency may be serious public health problem that can
lead to irreversible development delay, impaired behavior, lower attention span and
It is significant to the present study because it cited different factors where under
nutrition may occur though it is different because it is more applicable to infants which is
their target group.
According to some researcher male children suffer from disabilities more
frequently than female children. Among all disabled children under age 15, 38% were
girls and 62% were boys. Children age 6 were twice as likely to have a developed mental
disability, as they were to have a difficulty with improvement. Among children aged
6-14, 4 million or 11% had some type of disability in 2001 while 13% of boys had some
type of disability 18% of girls did.
Significance of the related literature
This topic of mental challenged children is rare privilege to some research to
conduct study since it imparts confidentially and differenced as an opportunities the quest
to make a constructive contribution in the art of giving and providing health education are
greatest achievement to conduct this study. It aimed to look into a deeper possible aspect
that the practices between eating and feeding behavior of parents and adults may
significantly influence the children’s nutritional status.
Of all the studies read and summary, this it does not focused on the nutritional
status of children with normal capabilities. In general, we conducted this research not
only the nutritional status nut of eating and feeding practice of children with mentally
challenged children specifically to those children with mental and physical disabilities.
Synthesis of the related literature
The research cited in support of this study proves that there has been a range of
explanations offered to understand why children eat what they eat.
Lack of knowledge had been implicated as causing poor diets, but is not explained
enough as health education campaign have had limited success is hanging eating habits
Based on the various researches we may conclude that nutrition influence mental ability
scores, physical development, social development and even the child’s participation in
school activities and has attention span. Parents must be educated on the importance of
nutritional for the total development of their children.
There is no significant relationship between milk feeding practice and nutritional
status of mentally challenged children.
1. Feeding practices of mother greatly influenced the nutritional outcome of
mentally challenged children.
2. the nutritional status of schooled age is combined effect of the situation at home
3. T.V. commercial and adults have predominant influence over the eating behaviors
of children’s food choices.
RESEARCH METHOD AND PROCEDURES
This chapter presents the methods and procedures used by the researchers. This
includes the research design, subjects of the study setting of the study, data- gathering
instrument, data gathering procedures and statistical treatment of data.
Research Method Design
To obtain necessary information that will seek answer to the problems the
researcher used to observe, describe and document aspects of a situation as it
naturally occur. This type of research answer question and satisfies curiosity about a
certain phenomenon. It also describes and elaborates the nature and causes of an
existing condition its meaning and significantly and then making adequate and
accurate interpretations of the data with or without the aid of statistics.
Using descriptive method the study wanted to know the nutritional status
feeding and eating practices of mentally challenged children.
Statistical Treatment of Data
The data from the questionnaire and interview will be studied and interpreted using
In order to complete the requirement of this particularly study, the researcher
will use %, height, and weight tools for children ranking method and weighted mean.
- describe the relation between the frequency of respondents to the total (n)
no. of respondents
Formula: P= percentage (%)
N= total no. of respondents
The respondent and sampling design
The respondent of this study are the mothers of mentally challenged children
with the age of 6-12 special schools of batangas city. The researcher’s respondents
are composed of 100 individuals who had the chance of participating in the study
provided by the researchers. The researchers are also used the homogenous kind of
sampling this kind of sampling permits a more focused inquiry in order to understand
a particular group of people.
3. Setting of the study
The setting of the study is located in batangas city, a commercialized city
where many schools and buildings were establish and is also known for its high
standard of education. There are also schools attended by special children and these
schools where the researchers aim to seek answer about nutritional status feeding and
eating practiced of mentally challenged children.
A set of questionnaire was designed to determine the respondents feeding
practice in relation to be nutritional status of their mentally challenged children.
Questions were instructed close-ended, which made used of a checklist to
determine the maternal feeding practices in relation to nutritional status of mentally
The questionnaire for the respondents is consist of P1, which is about the
demographic profile of parents, P2 is about the nutritional status of mentally
challenged children based on their age, weight, height and sex; P3 about feeding
practices of mothers applied to their children. Interview is also conducted for further
expansion of knowledge of this study.
Distribution and retrieval of questionnaire
Since the respondents of the study were the mothers of the mentally
challenged children and were not readily accessible personally the researcher asked
permission of the head of the different special schools in the distribution of the
The researcher explained to the principals and teacher of selected schools the purpose
of the study and its benefits for them to cooperate and will be the one to encourage
the mother of mentally challenged children to answer question honestly and correctly.
The retrieval of questionnaires was done after a week.
Please check the following statement application to the given question.
1 A. Age
( ) 25 below
( ) 26-30
( ) 31-35
( ) 36-40
( ) 41-45
( ) 46 above
( ) Civil status
( ) Single
( ) Married
( ) Widow
( ) Elementary graduate
( ) Elementary undergraduate
( ) High school graduate
( ) High school undergraduate
( ) College graduate
( ) College undergraduate
( ) Vocational
D. occupation/ month
( ) Less than 5,000
( ) 6,000-10,000
( ) 10,000 above
E. number of child
( ) 2-5
( ) 6-10
( ) 11 above
3. Children profile
Age weight height
___6 ____ ____
___7 ____ ____
III. Please rate the question by checking the corresponding numbers that describe the
experience of the parents of the respondents when:
1-never 2-seldom 3- sometime 4- often 5- always
QUESTIONS: 1 2 3 4 5
I do not allow my child to eat street foods
My child eats the food I personally prepared
I let my child eat on hi/her own
My child is taking vitamins
I provide fresh fruits and juices for my child
I feed my child on time 3x a say
I advised my child to wash hands after and before
I encourage my child to drink milk regularly
I do not let my Childs eat junk foods
My child eats vegetables regaularly.
Brown, Judith Nutrition Now 4th edition by Thomson Learning Asia Wadswort 2005
Potter, Patricia et al. fundamentals of nursing 6th edition Singapore Mosby Inc. 2005
Lucas, Betty. Food, Nutrition and Diet therapy. Published in the Philippines by Elsevier
Science Inc. Singapore 2004
Hockenberry, Marilyn et. Al Wong’s essentials of pediatric nursery 7th edition reprinted
edition, Elsevier Inc. Singapore 2005
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