what-when-how
In Depth Tutorials and Information
impact infant feeding may come into play with spoon
feeding. Jaw weakness, tongue weakness, delays in oral
motor coordination, as well as dentinogenesis imper-
fecta and/or late eruption of teeth may slow the child's
acceptance of and ability to process texture. Some chil-
dren may prefer to drink rather than eat solids because
they find drinking less effortful. A behavioral compo-
nent may come into play as caregivers and child strug-
gle with feeding difficulties.
Children with oral-motor difficulties may benefit
from:
in fiber than whole fruit. The American Academy of
Pediatrics suggests that lower-fat milk may be provided
once the child is 2 years or older.
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Low-fat milk con-
tains the same nutrients as whole milk, but the fat con-
tent is lower.
Helpful guidance about appropriate portion sizes
and meal composition for children is available online
plans that meet the nutrition needs for children of dif-
ferent ages.
If the child's energy needs are exceptionally low, care
must be taken to meet the child's protein and micronu-
trient needs. Lean protein foods such as lean meat, fish
and three servings/day of low-fat dairy foods should
be emphasized. A complete pediatric multivitamin/
mineral supplement may be beneficial.
Above all, families and clinicians are encouraged to
help children with OI develop optimal nutrition habits
to prepare them to make prudent dietary choices when
they reach adolescence and adulthood. Families can
help by modeling healthy eating, providing healthy
food choices, limiting the presence of unhealthier foods
in the home and involving children in food preparation
and serving.
●
A slower progression to higher textures while
providing a higher volume of purées and lower
textures to meet nutritional needs
●
Support with higher kcaloric density formula when
kcaloric intake of solids lags
●
Oral-motor therapy with a speech-language
pathologist or occupational therapist to improve
feeding skills
●
Behavioral recommendations to help with
introducing a greater variety of foods and improving
acceptance of feeding
Children with GER may experience pain or discom-
fort. Even after the GER is treated, the child may have
food refusal because of a history of pain with feeding.
This may manifest as extreme pickiness about variety
and/or inadequate volume of food intake. Treatment
of the underlying medical issue is essential. Behavioral
recommendations from a feeding therapist may assist
caregivers in increasing the child's acceptance of variety
and volume.
Constipation is an issue for some infants and chil-
dren with OI, especially individuals with pelvic asym-
metry.
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Constipation can create a feeling of fullness
and discomfort that leads to poor intake and food
refusal. Increasing the intake of fluid and fiber, as well
as increasing physical activity, may help alleviate con-
stipation. Medical management may be needed for
severe constipation.
As children with OI reach their toddler and older
childhood years, their nutrition needs parallel those of
all children. They need adequate kcalories for optimal
growth and brain development, and to support physi-
cal activity. They need a varied diet that provides ade-
quate protein, vitamins and minerals. Children with OI
who have shorter stature likely need fewer kcalories to
achieve adequate growth without becoming overweight
or obese.
If overweight or obesity is a concern, care should
be taken to control portion sizes and minimize high-
kcalorie, low-nutrient foods, both in and between
meals. Kcaloric drinks such as soda and sports drinks
should be given infrequently. Fruit juice should be lim-
ited to 4-8 oz/day, as it is higher in kcalories and lower
Pre-Puberty and Adolescence
The DRIs for many nutrients, including protein and
calcium, increase during pre-puberty and adolescence
to support physical and sexual maturation, includ-
ing optimal linear growth, peak bone mass develop-
ment, the increase in lean body mass for males, and the
increase in adequate adipose tissue for the maturing
female to support menarche, childbirth and lactation.
However, excess intake of total kcalories and nutri-
ents such as total fat and saturated fat increases the risk
for obesity and chronic diseases such as cardiovascular
disease and type 2 diabetes. Overweight and obesity
also impair mobility.
At the same time, adolescents are becoming more
independent in their choices of foods and beverages,
and they may eat more meals away from home. As with
younger children, families can continue to model and
encourage healthy eating patterns. If nutrition becomes
a concern, a consultation with an RD may be helpful.
PR
EGNANCY AND LACTATI
ON
There are no studies examining nutrition for preg-
nant or lactating women with OI. The goals are the
same as for any pregnant or lactating woman: to sup-
port the health and nutrient needs of mother and baby.
Women who plan to become pregnant are advised
to achieve a healthy pre-pregnancy bodyweight.
