what-when-how
In Depth Tutorials and Information
A balanced, varied diet rich in fruits and vegetables
is likely to provide adequate amounts of vitamins A, C
and K.
Treatment of OI with therapeutic doses of vitamin C,
sodium fluoride, magnesium and calcitonin has been
found to be ineffective and is no longer prescribed.
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length/stature, the National Center for Health Statistics
(NCHS) growth charts and typical rate of recom-
mended weight gain are not appropriate to assess ade-
quate growth, as these charts will overestimate weight/
height and body mass index in a person with unusually
short stature. In our practice we look for weight/height
or BMI that is proportional (between the 10th and 85th
percentile for weight/height or BMI). Another strategy
is to observe whether the child is tracking along his/
her own percentiles, but our observations for children
with more severe OI are that the proportion of weight
to height varies between infancy, toddlerhood and
adolescence.
FLUID
Adequate intake of fluid is essential for all humans.
Recommendations for how much fluid to drink vary.
The AI for water is 3.7 liters per day for men and 2.7
liters per day for women.
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Needs are increased during
pregnancy and lactation, with increased physical activ-
ity and with exposure to hot weather. Water, other bev-
erages and foods contribute to fluid intake.
Among its many other functions, water helps soften
stools, which may alleviate constipation. Persons with
OI who experience constipation are recommended to
ensure adequate intake of fluid.
Beverages other than water may contribute an unex-
pected number of kcalories to daily intake without pro-
viding substantial nutrients. Especially for individuals
whose kcalorie needs are lower because of small body
size and/or limited mobility, the focus should be on
low-fat or skim milk, lower-fat milk substitutes such as
lite soy milk, and water. Fruit juice should be limited to
8 oz per day for adults and 4-8 oz per day for children.
Whole fruit should be selected more frequently, as it
provides some fluid as well as fiber and phytonutrients
that are lacking in juice. Care should be taken with cof-
fee beverages, energy drinks, sports drinks, soda and
sweetened tea, as they can provide as many kcalories as
a full meal, without the nutritional benefits.
Infants and Toddlers
Because of low muscle tone and weak or lax oro-
facial joints, some infants with OI have difficultly latch-
ing onto and suckling at breast or from a bottle. Infants
with truncal skeletal anomalies such as scoliosis may
have difficulty with the suck-swallow-breathe pattern
necessary for safe and efficient nursing. Infants with
these difficulties may fatigue easily, leading to inad-
equate intake of breast milk or formula. Discomfort or
pain from fractures and casting may lead to decreased
appetite.
Infants with hypotonia, truncal skeletal anomalies or
short length may be prone to GER. These infants may
have frequent spitting up or vomiting, pain and arching
with feeding, and poor tolerance of an adequate vol-
ume of intake to meet their nutrition and fluid needs.
Some infants with OI appear to have intolerance to
milk-based formulas, and perhaps to soy formulas. It is
unclear whether this is related to GER, poor tolerance to
volume or other factors. These infants may require spe-
cialty formulas, including medical formulas made from
hydrolyzed proteins.
Strategies that may help infants with difficulty feed-
ing are:
SPECIAL NEEDS OF INFANTS,
CHILDREN AND ADOLESCENTS
WITH OI
●
Specialty nipples that decrease the effort of sucking
●
Positioning that promotes safe and efficient feeding
and swallowing, and minimizes GER
●
Frequent small feedings to maximize intake while
avoiding or decreasing emesis
●
Consultation with a lactation consultant to optimize
breast and bottle feeding
●
Consultation with a speech therapist or occupational
therapist familiar with oral-motor and feeding
therapy
●
If the child is unable to meet his/her nutrition needs
orally, placement of a feeding tube may be indicated.
Especially with more severe forms of OI, the growth
and nutrition of infants, children and adolescents with
OI may be strongly impacted. Some of the nutrition-
related concerns include poor growth and failure to
thrive (e.g., weight/height or BMI below the 10th per-
centile or decrease across one or more major growth
centiles), difficulty feeding, food sensitivities, intoler-
ances and allergies, gastroesophageal reflux (GER) and
constipation, delayed eruption of teeth and delayed fine
or gross motor skills that impact feeding.
Additionally, assessing appropriate growth may be
complicated for individuals with more severe forms
of OI. At this time, there are no growth charts spe-
cifically for children with OI. For children with small
As children with OI progress through the first year
of life, some may have difficulty when complementary
solid foods are introduced. The same concerns that
