1. Allergy
2. Autism
3. Caloric Needs
4. Choking
5. Cost
6. Diabetes
7. Down Syndrome
8. Early Intervention
9. Individualized Education Plan
10. Menu Modification
11. Nutrition Assessment
12. Regulations/Legislation
13. School Foodservice/School Lunch/School Breakfast
14. Team
15. Training Needs

Carroll, P., Caplinger, K. J. , & France, G. L. (1992). Guidelines for counseling parents of young children with food sensitivities. Journal of the American Dietetic Association, 92(5), 602-603.

This article gives a brief overview of what a food sensitivity is and its common treatment strategies. Suggestions are given to assist dietitians when counseling parents of children with food allergies. The authors suggest that those working with the parents and child consider the severity of the allergy, age of the child, other special dietary needs, and ethnic food preferences. A list of resources for food sensitivities is given.
(KEY WORDS: Nutrition Assessment, Allergy)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Gandy, L. T., Yadrick, M. K., Boudreaux, L. J., & Smith, E. R. (1991). Serving children with special health care needs: Nutrition services and employee training needs in the school lunch program. Journal of the American Dietetic Association, 91(12), 1585-1586.

Comprehensive nutrition services are important for all children including children with special health care needs. This professional brief provides the results of a needs assessment survey. The survey was conducted to determine the types of modifications provided for children with special nutrition needs as well as the knowledge and training needs of foodservice workers in Mississippi school districts. One hundred fifteen districts out of 146 responded to the survey. The most common reason for menu modifications reported was for food allergy (57%) followed by restrictions of calories, fat, cholesterol, or sodium (27%). Survey results also indicated the need for additional training in making modifications to menu.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Training Needs, Allergy)

Sinden, A. A. & Sutphen, J. L. (1991). Dietary treatment of lactose intolerance in infants and children. Journal of the American Dietetic Association, 91(12), 1567-1571.

During the past several years there have been many reports of alternative dietary therapies for primary and secondary lactose intolerance. We have learned that it is useful to feed through most episodes of mild diarrhea that previously would have been treated with clear liquid diets. Infant formulas, including both soy-protein and hydrolyzed formulas with specially designed carbohydrate, protein, and fat components, are available to treat the infant with diarrheal syndromes and secondary lactase deficiency. Also, the diet can be supplemented with lactase. Specialized lactose-reduced products as well as cultured and fermented dairy products may be used in varying degrees for lactose-intolerant children. The ingestion of milk with food and fiber components in the diet has also been shown to improve symptoms of lactose intolerance. This review summarizes the essentials of diagnosis of and dietary therapy for lactose intolerance. Our findings indicate that a number of specialized formulas and products are available for successful dietary management of lactose intolerance in infants and children.
(KEY WORDS: Allergy, Menu Modification)

Yadrick, K. & Sneed, J. (1994). Nutrition services for children with developmental disabilities and chronic illnesses in education programs. Journal of the American Dietetic Association, 94(10), 1122-1128.

A large percentage of school nutrition managers reported that they served no children with special food and nutrition needs. Special food and nutrition needs most frequently encountered by all groups included food allergy, food intolerance, diabetes, and conditions with which feeding problems are associated. The skills of dietitians were used by 23% of school nutrition managers, 21% of district school nutrition directors/supervisors, and 15% of special education program directors. Continuing education needs were greatest for the areas of assessing liability, calculating macronutrient content of menus, modifying menus, and understanding the physical and emotional needs of children with special needs.
(KEY WORDS: Individualized Education Plan, School Foodservice/School Lunch/School Breakfast, Allergy, Diabetes)

Breault, J. L. (1995). Development and evaluation of a training manual on feeding children with special needs, birth through age five. Kansas State University, Manhattan.

The purpose of this study was to develop a manual as a companion piece to a video focused on training child care providers on feeding children with special needs. The manual was developed considering the needs of adult learners. The total package, Special Foods for Special Kids, (video and manual) was then evaluated using a preliminary expert panel, modified Delphi panel, and focus groups. Evaluation was completed on content, readability, and format of the manual. The addition of a glossary of terms, a section on autism, and a section on choking were incorporated in the revision of the final manual.
(KEY WORDS: Autism, Choking)

Cannella, P. C., Bowser, E. K., Guyer, L. K., Borum, P. R. (1993). Feeding practices and nutrition recommendations for infants with cystic fibrosis. Journal of the American Dietetic Association, 93(3), 297-300.

Cystic fibrosis (CF) is an autosomal recessive disease characterized clinically by recurrent respiratory tract infections and malabsorption caused by pancreatic insufficiency. Typically diagnosed during infancy or childhood, CF impairs weight gain and growth, increases susceptibility to infection, and decreases longevity Until recently, no guidelines for infant feedings were available. A consensus report prepared through the Cystic Fibrosis Foundation summarizes guidelines for the optimal nutrition management of patients with CF. This study identified current feeding practices and nutrition recommendations of dietitians who treat infants with CF and compared them with the recommendations of the consensus report. A survey was developed and sent to dietitians (n=130) who work in accredited CF centers. Eighty-six dietitians (66%) responded after two mailings, and 75 usable surveys were analyzed. The survey investigated practitioners' recommendations for infant formulas, energy intake, nutritional supplements, and pancreatic enzyme supplementation. Protein hydrolyzed infant formulas were recommended by most respondents (69%). Energy intake greater than 130% of the Recommended Dietary Allowances (RDA's) was recommended for well-nourished infants with CF and greater than 140% of the RDA's for malnourished infants with CF at 1 year of age. Formula additives, including fat and carbohydrate modules, were used by all respondents and were frequently added to infant foods to increase caloric density. Enteric coated pancreatic enzymes were used by the majority (76%) of dietitians. These findings indicate that most dietitians follow the nutrition guidelines established by the Cystic Fibrosis Foundation consensus report for goals for energy and protein intake, use of nutritional supplements, and replacement of pancreatic enzymes in infants with CF.
(KEY WORDS: Early Intervention, Caloric Needs)

Chumlea, S. C., Guo, S. S., & Steinbaugh, M. L. (1994). Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. Journal of the American Dietetic Association, 94(12), 1385-1388, 1391..

Knee height predicted stature for white and black men, while the predictor variables for white and black women were knee height and age. For predicting stature in children 6 to 18 years of age, the predictor variable was knee height for all children.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Hoffman, C. J., Aultman, D., & Pipes, P. (1992). A nutrition survey of and recommendations for individuals with Prader-Willi Syndrome who live in group homes. Journal of the American Dietetic Association, 92(7), 823-830, 833.

The purpose of this study was to describe anthropometric data and identify diet-related problems of individuals with Prader-Willi Syndrome (PWS) who reside in group homes. A group home is a licensed foster care facility that provides 24-hour care for the developmentally disabled. Questionnaires were sent to dietitians (or the person responsible for nutrition care) of 25 group homes: responses from 18 homes were analyzed. The mean age of residents with PWS was 25 +/- 8.4 years and the mean height was 152.4 +/- 9.7 cm. The mean weight for 19- to 22-year-old men was 75.5 +/- 26.8 kg and that for women of the same age was 74.5 +/- 20 kg. The residents consumed a mean of 1,000 to 1,500 kcal/day. Most of the group homes (n=16) locked their kitchens at night, and in 12 of the homes stealing and hoarding of food occurred. Pica behavior (eating of nonfoods) was reported in 7 homes. One third of all residents had success in weight loss and were on a maintenance diet, but a major problem was determination of a desirable weight goal. Our key recommendations for dietitians are: weigh residents weekly; use the body mass index with prescribed zones for determination of weight goals; monitor change in circumference measurements; follow the guidelines of 7 to 8 kcal/cm of height for weight loss and 10 to 14 kcal/cm of height for weight maintenance; administer 1000 kcal/day or more and encourage daily aerobic exercise; respect food preferences while adhering to dietary prescriptions; adhere to strict food control procedures; and use nutrition education methods and an interdisciplinary approach for behavior modification.
(KEY WORDS: Caloric Needs, Menu Modification)

Johnson, R. K., Goran, M. I., Ferrara, M. S., & Poehlman, E. T. (1995). Athetosis increases resting metabolic rate in adults with cerebral palsy. Journal of the American Dietetic Association, 96(2), 145-148.

The increased energy requirements of adults with cerebral palsy can be partially explained by athetotic movements. In this sample, the presence of athetosis increased Resting Metabolic Rate by an average of 524 kcal/day.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Murphy, M. D., Ireton-Jones, C. S., Hilman, B. C., Gorman, M. A., & Liepa, G. U. (1995). Resting energy expenditures measured by indirect calorimetry are higher in preadolescent children with cystic fibrosis than expenditures calculated from prediction equations. Journal of the American Dietetic Association, 95(1), 30-33.

The Harris-Benedict equations and the Cystic Fibrosis Consensus Committee equations underestimated the energy expenditures of the study population by 13% and 8%, respectively. These findings support the usefulness of the measurement of energy expenditures in determining the energy needs of preadolescent patients with cystic fibrosis. In clinical practice, the resting energy expenditures would be multiplied by activity coefficients to determine the total daily energy expenditures of this population.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Thommessen, M., Riis, G., Kase, B. F., Larsen, S., & Heiberg, A. (1991). Energy and nutrient intakes of disabled children: Do feeding problems make a difference? Journal of the American Dietetic Association, 91(12), 1522-1525.

We examined the effect of feeding problems and alternative feeding practices on the energy and nutrient intakes of disabled children. Subjects were 221 disabled children aged 1 to 16 years from seven diagnostic groups: a 4-day food record was obtained for 166 children. The children's energy and nutrient intakes were examined in relation to the presence or absence of four feeding problems (gross motor/self-feeding impairment, oral-motor dysfunction, lack of appetite, food aversions) and two alternate feeding practices (prolonged assisted feeding and use of pureed foods). Cross-sectional analyses showed that children with feeding problems or alternative feeding practices had lower energy and nutrient intakes than did children without these factors. The presence of oral-motor dysfunction or prolonged assisted feeding significantly reduced relative energy intake. In general, differences in energy and nutrient intakes between children with and without other feeding problems or practices were small, and few statistically significant differences were found. The findings indicate that some feeding problems may reduce food intake in disabled children, although this effect is lessened by the conscientious efforts of parents. Parents and families of disabled children should receive dietary counseling to prevent deteriorative effects on the physical growth and health of children with long-standing feeding problems.
(KEY WORDS: Early Intervention, Caloric Needs)

Unonu, J. N., & Johnson, A. A. (1992). Feeding patterns, food energy, nutrient intakes, and anthropometric measurements of selected black preschool children with Down syndrome. Journal of the American Dietetic Association, 92(7), 856-858.

Down syndrome is characterized by mental and growth retardation associated with genetic anomalies; it occurs in about 1 of every 1,000 live births in the United States. The growth deficiency begins prenatally and continues until the children are between 3 and 5 years of age. Feeding difficulties and inappropriate nutrition are common problems among children with Down syndrome. The feeding skills of these children often develop at a slow rate, thereby making it difficult for some to achieve adequate dietary intakes. Inappropriate, excessive, or low intakes of food energy and nutrients; poor eating habits; and delayed feeding skills are major feeding problems. This study was conducted at a facility designed to improve the feeding practices and the health of children with Down syndrome. The existence of this program afforded an opportunity to carry out an exploratory study to examine the feeding and growth patterns and to determine the relationships between anthropometric measurements and dietary intakes among black preschool children with Down syndrome.
(KEY WORDS: Caloric Needs, Down Syndrome)

Breault, J. L. (1995). Development and evaluation of a training manual on feeding children with special needs, birth through age five. Kansas State University, Manhattan.

The purpose of this study was to develop a manual as a companion piece to a video focused on training child care providers on feeding children with special needs. The manual was developed considering the needs of adult learners. The total package, Special Foods for Special Kids, (video and manual) was then evaluated using a preliminary expert panel, modified Delphi panel, and focus groups. Evaluation was completed on content, readability, and format of the manual. The addition of a glossary of terms, a section on autism, and a section on choking were incorporated in the revision of the final manual.
(KEY WORDS: Autism, Choking)

Conklin, M. T. & Nettles, M. F. (1996). Costs associated with providing school meals for children with special food and nutrition needs. School Food Service Research Review, 20(2), 56-62.

The purpose of this research was to determine the labor and food costs associated with providing school meals for children with special food and nutrition needs. The researchers collected data in eight school districts from three states in the Southeast and Southwest USDA regions. Employees from 15 schools recorded data for five days on the labor time used to prepare special meals. The researchers then calculated the average time for special meal preparation and average food cost for special meals compared with regular meals for the data collection period. Results showed that the median time to prepare special meals ranged from four to six minutes for pureed meals and five to eight minutes for other types of special meals, such as for food allergies or diabetes. Researchers found very little - if any - difference in the food cost between regular and special meals except for a higher food cost associated with serving canned nutritional supplements. The researchers recommend clarifying the school district's policy on purchasing nutritional supplements because this expenditure will dramatically affect the cost of meals served to children with special needs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1994). Managing nutrition services for children with special needs. NFSMI Insight(1), 6.

Children who have a variety of special food and nutrition needs exist in every school district. Studies have shown that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies, diabetes, and a variety of disorders that require modifications to the texture of food. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization that his or her diet is restricted by a disability. Providing special meals need not be a costly undertaking for school nutrition services. This issue of NFSMI Insight presents recommendations for managing nutrition services for children with special food and nutrition needs. These recommendations focus on administrative processes that can reduce labor and food costs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Menu Modification, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Hayes, D. R., Sheehan, J. P., Ulchaker, M. M., & Rebar, J. M. (1994). Management dilemmas in the individual with cystic fibrosis and diabetes. Journal of the American Dietetic Association, 94(1), 78-80.

As their life expectancy has improved, patients with cystic fibrosis (CF) have experienced an increasing incidence of diabetes. Hyperglycemia may adversely influence weight, pulmonary function, and development of microvascular complications. Strict control of blood glucose with an aim of normoglycemia is described in this article. The typical cystic fibrosis diet is variable in quantity and features a preponderance of simple carbohydrates; this is contrary to the usual diabetes meal plan. We describe the use of a flexible meal-planning system to establish individualized carbohydrate targets with specific insulin boluses titrated to each meal to control postprandial blood glucose excursions. Records of 22 patients followed for more than 1 year are reviewed. Mean glycosolated hemoglobin was reduced from 11.3+/-3.1% (at baseline) to 8.1+/- 1.8% (at 1 year). Mean percent of ideal body weight also increased from 95.4 +/- 15.2 to 100 +/- 17.1. We conclude that strict metabolic control is an attainable goal in patients with cystic fibrosis and is associated with positive weight gain.
(KEY WORDS: Diabetes)

Yadrick, K. & Sneed, J. (1994). Nutrition services for children with developmental disabilities and chronic illnesses in education programs. Journal of the American Dietetic Association, 94(10), 1122-1128.

A large percentage of school nutrition managers reported that they served no children with special food and nutrition needs. Special food and nutrition needs most frequently encountered by all groups included food allergy, food intolerance, diabetes, and conditions with which feeding problems are associated. The skills of dietitians were used by 23% of school nutrition managers, 21% of district school nutrition directors/supervisors, and 15% of special education program directors. Continuing education needs were greatest for the areas of assessing liability, calculating macronutrient content of menus, modifying menus, and understanding the physical and emotional needs of children with special needs.
(KEY WORDS: Individualized Education Plan, School Foodservice/School Lunch/School Breakfast, Allergy, Diabetes)

Baer, M. T., Tanaka, T. L. & and Blyer, E. M. (1991). Nutrition strategies for children with special needs: Identifying kids at risk. Los Angeles. UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles.

This manual provides guidelines for nutrition screening for children from birth to three years. It includes dietary guidelines for young children and a feeding skills section that reviews the developmental sequence in the acquisition of skills needed to consume foods of various textures. A nutrition screening section provides several screening tools including guides for measuring height and weight and growth charts for evaluating measurements. The guide contains checklists and/or fact sheets on various nutrition problems that are frequently experienced by young children, particularly those with special needs. Several of these sections contain handouts for parents that are written in English, Spanish, and/or Chinese. Sections on cerebral palsy, drug-exposed infants and Down syndrome and their effects on nutritional status and feeding are also included. It was adapted from the C.H.E.W.S. Nutrition Project, New Mexico Health and Environment Department. To order, contact UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles, Attn: Resource Center Coordinator, P.O. Box 54700, Los Angeles, CA 90054. Telephone 213-669-2300.
(KEY WORDS: Early Intervention, Nutrition Assessment, Down Syndrome)

Hopman, E., Csizmadia, C. G., Bastiani, W. F., Engels, Q. M., Graaf, E. A., Cessie, S. L., & Mearin, M. L. (1998). Eating habits of young children with Down syndrome in the Netherlands: Adequate nutrient intakes but delayed introduction of solid food. Journal of the American Dietetic Association, 98(7), 790-794.

Heights and weights of the children with Down syndrome were in the normal range. Down syndrome does not affect the prevalence of breast-feeding of children or the adequacy of their energy and nutrient intakes, but it does significantly delay the age at which solid food is introduced, which can be deleterious to oral-motor development.
(KEY WORDS: Down Syndrome)

Unonu, J. N., & Johnson, A. A. (1992). Feeding patterns, food energy, nutrient intakes, and anthropometric measurements of selected black preschool children with Down syndrome. Journal of the American Dietetic Association, 92(7), 856-858.

Down syndrome is characterized by mental and growth retardation associated with genetic anomalies; it occurs in about 1 of every 1,000 live births in the United States. The growth deficiency begins prenatally and continues until the children are between 3 and 5 years of age. Feeding difficulties and inappropriate nutrition are common problems among children with Down syndrome. The feeding skills of these children often develop at a slow rate, thereby making it difficult for some to achieve adequate dietary intakes. Inappropriate, excessive, or low intakes of food energy and nutrients; poor eating habits; and delayed feeding skills are major feeding problems. This study was conducted at a facility designed to improve the feeding practices and the health of children with Down syndrome. The existence of this program afforded an opportunity to carry out an exploratory study to examine the feeding and growth patterns and to determine the relationships between anthropometric measurements and dietary intakes among black preschool children with Down syndrome.
(KEY WORDS: Caloric Needs, Down Syndrome)

Amundson, J. A., Sherbondy, A., Van Dyke, D. C., & Alexander, R. (1994). Early identification and treatment necessary to prevent malnutrition in children and adolescents with severe disabilities. Journal of the American Dietetic Association, 94(8), 880-883.

Children with severe developmental disabilities frequently have nutrition and growth problems that range from moderate to severe. Because of notable continuing medical concerns and lowered growth expectations, parents and physicians may fail to recognize gradual deterioration in nutritional status before severe medical complications occur. The two cases reported in this article illustrate the need for early identification and treatment to prevent the development of notable morbidity secondary to malnutrition. Children and adolescents who have growth parameters consistently below age norms require assessment and monitoring by a registered dietitian to detect feeding problems and intake changes and to provide early intervention to help prevent negative consequences (eg. dehydration, protein-energy malnutrition, decubitus ulcers, increased rate and duration of infections, and altered bowel motility). An initial assessment should consist of measurement of length or height, weight, triceps, and subscapular skinfolds; dietary and feeding history and a review of medical history; and biochemical testing as indicated by the medical and dietary histories. Monitoring frequency, which is determined by age, severity of condition, and response to treatment, may vary from weekly to bimonthly.
(KEY WORDS: Early Intervention, Nutrition Assessment)

Baer, M. T., Tanaka, T. L. & and Blyer, E. M. (1991). Nutrition strategies for children with special needs: Identifying kids at risk. Los Angeles. UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles.

This manual provides guidelines for nutrition screening for children from birth to three years. It includes dietary guidelines for young children and a feeding skills section that reviews the developmental sequence in the acquisition of skills needed to consume foods of various textures. A nutrition screening section provides several screening tools including guides for measuring height and weight and growth charts for evaluating measurements. The guide contains checklists and/or fact sheets on various nutrition problems that are frequently experienced by young children, particularly those with special needs. Several of these sections contain handouts for parents that are written in English, Spanish, and/or Chinese. Sections on cerebral palsy, drug-exposed infants and Down syndrome and their effects on nutritional status and feeding are also included. It was adapted from the C.H.E.W.S. Nutrition Project, New Mexico Health and Environment Department. To order, contact UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles, Attn: Resource Center Coordinator, P.O. Box 54700, Los Angeles, CA 90054. Telephone 213-669-2300.
(KEY WORDS: Early Intervention, Nutrition Assessment, Down Syndrome)

Cannella, P. C., Bowser, E. K., Guyer, L. K., Borum, P. R. (1993). Feeding practices and nutrition recommendations for infants with cystic fibrosis. Journal of the American Dietetic Association, 93(3), 297-300.

Cystic fibrosis (CF) is an autosomal recessive disease characterized clinically by recurrent respiratory tract infections and malabsorption caused by pancreatic insufficiency. Typically diagnosed during infancy or childhood, CF impairs weight gain and growth, increases susceptibility to infection, and decreases longevity Until recently, no guidelines for infant feedings were available. A consensus report prepared through the Cystic Fibrosis Foundation summarizes guidelines for the optimal nutrition management of patients with CF. This study identified current feeding practices and nutrition recommendations of dietitians who treat infants with CF and compared them with the recommendations of the consensus report. A survey was developed and sent to dietitians (n=130) who work in accredited CF centers. Eighty-six dietitians (66%) responded after two mailings, and 75 usable surveys were analyzed. The survey investigated practitioners' recommendations for infant formulas, energy intake, nutritional supplements, and pancreatic enzyme supplementation. Protein hydrolyzed infant formulas were recommended by most respondents (69%). Energy intake greater than 130% of the Recommended Dietary Allowances (RDA's) was recommended for well-nourished infants with CF and greater than 140% of the RDA's for malnourished infants with CF at 1 year of age. Formula additives, including fat and carbohydrate modules, were used by all respondents and were frequently added to infant foods to increase caloric density. Enteric coated pancreatic enzymes were used by the majority (76%) of dietitians. These findings indicate that most dietitians follow the nutrition guidelines established by the Cystic Fibrosis Foundation consensus report for goals for energy and protein intake, use of nutritional supplements, and replacement of pancreatic enzymes in infants with CF.
(KEY WORDS: Early Intervention, Caloric Needs)

Thommessen, M., Riis, G., Kase, B. F., Larsen, S., & Heiberg, A. (1991). Energy and nutrient intakes of disabled children: Do feeding problems make a difference? Journal of the American Dietetic Association, 91(12), 1522-1525.

We examined the effect of feeding problems and alternative feeding practices on the energy and nutrient intakes of disabled children. Subjects were 221 disabled children aged 1 to 16 years from seven diagnostic groups: a 4-day food record was obtained for 166 children. The children's energy and nutrient intakes were examined in relation to the presence or absence of four feeding problems (gross motor/self-feeding impairment, oral-motor dysfunction, lack of appetite, food aversions) and two alternate feeding practices (prolonged assisted feeding and use of pureed foods). Cross-sectional analyses showed that children with feeding problems or alternative feeding practices had lower energy and nutrient intakes than did children without these factors. The presence of oral-motor dysfunction or prolonged assisted feeding significantly reduced relative energy intake. In general, differences in energy and nutrient intakes between children with and without other feeding problems or practices were small, and few statistically significant differences were found. The findings indicate that some feeding problems may reduce food intake in disabled children, although this effect is lessened by the conscientious efforts of parents. Parents and families of disabled children should receive dietary counseling to prevent deteriorative effects on the physical growth and health of children with long-standing feeding problems.
(KEY WORDS: Early Intervention, Caloric Needs)

Florida Department of Education. Feeding for the future: Exceptional nutrition in the I.E.P. To obtain resource, contact Food & Nutrition Resource Center, Florida Department of Education, 908 S. Bronough Street, Room 206 Executive Building Tallahassee, FL 32399-0400 or call 850-487-3569

This 19-minute video and 64-page booklet provide information on feeding children with special needs. They emphasize the importance of a "Mealtime Team," (which includes food service personnel) when writing the Individualized Education Plan. Topics include steps to self-feeding, food safety, and sanitation, special advice for dietary problems, and parent/teacher "tip sheets." Each section contains references. This module is also available in Spanish.
(KEY WORDS: Individualized Education Plan)

Yadrick, K. & Sneed, J. (1994). Nutrition services for children with developmental disabilities and chronic illnesses in education programs. Journal of the American Dietetic Association, 94(10), 1122-1128.

A large percentage of school nutrition managers reported that they served no children with special food and nutrition needs. Special food and nutrition needs most frequently encountered by all groups included food allergy, food intolerance, diabetes, and conditions with which feeding problems are associated. The skills of dietitians were used by 23% of school nutrition managers, 21% of district school nutrition directors/supervisors, and 15% of special education program directors. Continuing education needs were greatest for the areas of assessing liability, calculating macronutrient content of menus, modifying menus, and understanding the physical and emotional needs of children with special needs.
(KEY WORDS: Individualized Education Plan, School Foodservice/School Lunch/School Breakfast, Allergy, Diabetes)

Carroll, J., & Koenigsberger, D. (1998). The ketogenic diet: A practical guide for caregivers. Journal of the American Dietetic Association, 1998.(3), 316-321.

The ketogenic diet is a high-fat, low-carbohydrate diet that results in ketosis. It has been in use for nearly 70 years. Several modifications of the diet's original form, including the medium-chain triglyceride (MCT) diet, have been made in an attempt to overcome the obstacles of compliance and acceptance, which have been critical factors in determining its success. The practical guide for caregivers that is presented here uses elements of both the original ketogenic diet and the MCT diet, with added ideas. Our modified diet has been in use for more than 3 years at Columbia Presbyterian Medical Center Babies and Children's Hospital of New York. The majority of parents and children find our diet more acceptable and/or more user friendly than other types of ketogenic diets. Thus, compliance is better. The variety of foods offered is greater and provides a more normal diet than the other types of ketogenic diets. In addition, the calculations for the nutritionists are easier, and parents are able to adjust the diet without the fear that their child will lose ketones.
(KEY WORDS: Menu Modification)

Conklin, M. T., Nettles, M. F., & Martin, J. (1994). Managing nutrition services for children with special needs. NFSMI Insight(1), 6.

Children who have a variety of special food and nutrition needs exist in every school district. Studies have shown that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies, diabetes, and a variety of disorders that require modifications to the texture of food. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization that his or her diet is restricted by a disability. Providing special meals need not be a costly undertaking for school nutrition services. This issue of NFSMI Insight presents recommendations for managing nutrition services for children with special food and nutrition needs. These recommendations focus on administrative processes that can reduce labor and food costs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Menu Modification, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Hoffman, C. J., Aultman, D., & Pipes, P. (1992). A nutrition survey of and recommendations for individuals with Prader-Willi Syndrome who live in group homes. Journal of the American Dietetic Association, 92(7), 823-830, 833.

The purpose of this study was to describe anthropometric data and identify diet-related problems of individuals with Prader-Willi Syndrome (PWS) who reside in group homes. A group home is a licensed foster care facility that provides 24-hour care for the developmentally disabled. Questionnaires were sent to dietitians (or the person responsible for nutrition care) of 25 group homes: responses from 18 homes were analyzed. The mean age of residents with PWS was 25 +/- 8.4 years and the mean height was 152.4 +/- 9.7 cm. The mean weight for 19- to 22-year-old men was 75.5 +/- 26.8 kg and that for women of the same age was 74.5 +/- 20 kg. The residents consumed a mean of 1,000 to 1,500 kcal/day. Most of the group homes (n=16) locked their kitchens at night, and in 12 of the homes stealing and hoarding of food occurred. Pica behavior (eating of nonfoods) was reported in 7 homes. One third of all residents had success in weight loss and were on a maintenance diet, but a major problem was determination of a desirable weight goal. Our key recommendations for dietitians are: weigh residents weekly; use the body mass index with prescribed zones for determination of weight goals; monitor change in circumference measurements; follow the guidelines of 7 to 8 kcal/cm of height for weight loss and 10 to 14 kcal/cm of height for weight maintenance; administer 1000 kcal/day or more and encourage daily aerobic exercise; respect food preferences while adhering to dietary prescriptions; adhere to strict food control procedures; and use nutrition education methods and an interdisciplinary approach for behavior modification.
(KEY WORDS: Caloric Needs, Menu Modification)

Hogan, S. E., & Evers, S. E. (1997). A nutritional rehabilitation program for persons with severe physical and developmental disabilities. Journal of the American Dietetic Association, 98(2), 162-166.

Purpose was to design and implement a nutritional rehabilitation program for persons with severe developmental disabilities who resided in a long-term care facility or a group home. We used weight for height (WH) to classify residents of both facilities into three groups: group 1, WH less than 5th percentile, goal=gain weight; group 2, WH between the 5th and 85th percentile, goal=maintain present rate of weight gain; and group 3, WH greater than 85th percentile, goal=slow down rate of weight gain. The challenge in all groups was to bring about these changes without increasing the quantity of food fed to the residents and to increase their fluid intake. For each subject, the project dietitian developed individualized menus that specified quantities and consistencies of food. Foodservice delivery was changed to a centralized system in the long-term-care facility to allow for closer control of the subjects' intake. A dietitian monitored the program with biweekly visits to the wards and frequent consultation with staff. Only a limited increase in fluid intake was noted; however, after 6 months of the program, the other goals were met. Our results suggest that nutritional rehabilitation of residents with developmental disabilities is enhanced by the involvement of a dietitian. Thus, compliance is better. The variety of foods offered is greater and provides a more normal diet than the other types of ketogenic diets. In addition, the calculations for the nutritionists are easier, and parents are able to adjust the diet without the fear that their child will lose ketones.
(KEY WORDS: Menu Modification)

Sinden, A. A. & Sutphen, J. L. (1991). Dietary treatment of lactose intolerance in infants and children. Journal of the American Dietetic Association, 91(12), 1567-1571.

During the past several years there have been many reports of alternative dietary therapies for primary and secondary lactose intolerance. We have learned that it is useful to feed through most episodes of mild diarrhea that previously would have been treated with clear liquid diets. Infant formulas, including both soy-protein and hydrolyzed formulas with specially designed carbohydrate, protein, and fat components, are available to treat the infant with diarrheal syndromes and secondary lactase deficiency. Also, the diet can be supplemented with lactase. Specialized lactose-reduced products as well as cultured and fermented dairy products may be used in varying degrees for lactose-intolerant children. The ingestion of milk with food and fiber components in the diet has also been shown to improve symptoms of lactose intolerance. This review summarizes the essentials of diagnosis of and dietary therapy for lactose intolerance. Our findings indicate that a number of specialized formulas and products are available for successful dietary management of lactose intolerance in infants and children.
(KEY WORDS: Allergy, Menu Modification)

Amundson, J. A., Sherbondy, A., Van Dyke, D. C., & Alexander, R. (1994). Early identification and treatment necessary to prevent malnutrition in children and adolescents with severe disabilities. Journal of the American Dietetic Association, 94(8), 880-883.

Children with severe developmental disabilities frequently have nutrition and growth problems that range from moderate to severe. Because of notable continuing medical concerns and lowered growth expectations, parents and physicians may fail to recognize gradual deterioration in nutritional status before severe medical complications occur. The two cases reported in this article illustrate the need for early identification and treatment to prevent the development of notable morbidity secondary to malnutrition. Children and adolescents who have growth parameters consistently below age norms require assessment and monitoring by a registered dietitian to detect feeding problems and intake changes and to provide early intervention to help prevent negative consequences (eg. dehydration, protein-energy malnutrition, decubitus ulcers, increased rate and duration of infections, and altered bowel motility). An initial assessment should consist of measurement of length or height, weight, triceps, and subscapular skinfolds; dietary and feeding history and a review of medical history; and biochemical testing as indicated by the medical and dietary histories. Monitoring frequency, which is determined by age, severity of condition, and response to treatment, may vary from weekly to bimonthly.
(KEY WORDS: Early Intervention, Nutrition Assessment)

Baer, M. T., Tanaka, T. L. & and Blyer, E. M. (1991). Nutrition strategies for children with special needs: Identifying kids at risk. Los Angeles. UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles.

This manual provides guidelines for nutrition screening for children from birth to three years. It includes dietary guidelines for young children and a feeding skills section that reviews the developmental sequence in the acquisition of skills needed to consume foods of various textures. A nutrition screening section provides several screening tools including guides for measuring height and weight and growth charts for evaluating measurements. The guide contains checklists and/or fact sheets on various nutrition problems that are frequently experienced by young children, particularly those with special needs. Several of these sections contain handouts for parents that are written in English, Spanish, and/or Chinese. Sections on cerebral palsy, drug-exposed infants and Down syndrome and their effects on nutritional status and feeding are also included. It was adapted from the C.H.E.W.S. Nutrition Project, New Mexico Health and Environment Department. To order, contact UAP Center for Child Development and Developmental Disorders, Children's Hospital of Los Angeles, Attn: Resource Center Coordinator, P.O. Box 54700, Los Angeles, CA 90054. Telephone 213-669-2300.
(KEY WORDS: Early Intervention, Nutrition Assessment, Down Syndrome)

Carroll, P., Caplinger, K. J. , & France, G. L. (1992). Guidelines for counseling parents of young children with food sensitivities. Journal of the American Dietetic Association, 92(5), 602-603.

This article gives a brief overview of what a food sensitivity is and its common treatment strategies. Suggestions are given to assist dietitians when counseling parents of children with food allergies. The authors suggest that those working with the parents and child consider the severity of the allergy, age of the child, other special dietary needs, and ethnic food preferences. A list of resources for food sensitivities is given.
(KEY WORDS: Nutrition Assessment, Allergy)

Chumlea, S. C., Guo, S. S., & Steinbaugh, M. L. (1994). Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. Journal of the American Dietetic Association, 94(12), 1385-1388, 1391..

Knee height predicted stature for white and black men, while the predictor variables for white and black women were knee height and age. For predicting stature in children 6 to 18 years of age, the predictor variable was knee height for all children.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Johnson, R. K., Goran, M. I., Ferrara, M. S., & Poehlman, E. T. (1995). Athetosis increases resting metabolic rate in adults with cerebral palsy. Journal of the American Dietetic Association, 96(2), 145-148.

The increased energy requirements of adults with cerebral palsy can be partially explained by athetotic movements. In this sample, the presence of athetosis increased Resting Metabolic Rate by an average of 524 kcal/day.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Murphy, M. D., Ireton-Jones, C. S., Hilman, B. C., Gorman, M. A., & Liepa, G. U. (1995). Resting energy expenditures measured by indirect calorimetry are higher in preadolescent children with cystic fibrosis than expenditures calculated from prediction equations. Journal of the American Dietetic Association, 95(1), 30-33.

The Harris-Benedict equations and the Cystic Fibrosis Consensus Committee equations underestimated the energy expenditures of the study population by 13% and 8%, respectively. These findings support the usefulness of the measurement of energy expenditures in determining the energy needs of preadolescent patients with cystic fibrosis. In clinical practice, the resting energy expenditures would be multiplied by activity coefficients to determine the total daily energy expenditures of this population.
(KEY WORDS: Caloric Needs, Nutrition Assessment)

Cloud, H. H. (1994). Role of school food service in providing nutrition for children with special needs. Topics in Clinical Nutrition, 9(4), 47-53.

School systems are challenged with modifying the school lunch and breakfast programs to meet the special dietary needs of children with disabling or handicapping conditions. This challenge became apparent when regulations were written following the Rehabilitation Act of 1973, Section 504. With the Education of All Handicapped Children Act of 1975, many more children with disabling conditions entered the public school system. Schools' nutrition programs have increased awareness of the complex nutrition needs of these children and how the food service program must be modified to meet them.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast)

Conklin, M. T. & Nettles, M. F. (1996). Costs associated with providing school meals for children with special food and nutrition needs. School Food Service Research Review, 20(2), 56-62.

The purpose of this research was to determine the labor and food costs associated with providing school meals for children with special food and nutrition needs. The researchers collected data in eight school districts from three states in the Southeast and Southwest USDA regions. Employees from 15 schools recorded data for five days on the labor time used to prepare special meals. The researchers then calculated the average time for special meal preparation and average food cost for special meals compared with regular meals for the data collection period. Results showed that the median time to prepare special meals ranged from four to six minutes for pureed meals and five to eight minutes for other types of special meals, such as for food allergies or diabetes. Researchers found very little - if any - difference in the food cost between regular and special meals except for a higher food cost associated with serving canned nutritional supplements. The researchers recommend clarifying the school district's policy on purchasing nutritional supplements because this expenditure will dramatically affect the cost of meals served to children with special needs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1994). Managing nutrition services for children with special needs. NFSMI Insight(1), 6.

Children who have a variety of special food and nutrition needs exist in every school district. Studies have shown that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies, diabetes, and a variety of disorders that require modifications to the texture of food. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization that his or her diet is restricted by a disability. Providing special meals need not be a costly undertaking for school nutrition services. This issue of NFSMI Insight presents recommendations for managing nutrition services for children with special food and nutrition needs. These recommendations focus on administrative processes that can reduce labor and food costs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Menu Modification, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Gandy, L. T., Yadrick, M. K., Boudreaux, L. J., & Smith, E. R. (1991). Serving children with special health care needs: Nutrition services and employee training needs in the school lunch program. Journal of the American Dietetic Association, 91(12), 1585-1586.

Comprehensive nutrition services are important for all children including children with special health care needs. This professional brief provides the results of a needs assessment survey. The survey was conducted to determine the types of modifications provided for children with special nutrition needs as well as the knowledge and training needs of foodservice workers in Mississippi school districts. One hundred fifteen districts out of 146 responded to the survey. The most common reason for menu modifications reported was for food allergy (57%) followed by restrictions of calories, fat, cholesterol, or sodium (27%). Survey results also indicated the need for additional training in making modifications to menu.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Training Needs, Allergy)

Position of the American Dietetic Association: Nutrition in comprehensive program planning for persons with developmental disabilities. (1997). Journal of the American Dietetic Association, 97(2), 189-193.

It is the position of the American Dietetic Association that program planning for persons with developmental disabilities should include comprehensive nutrition services as part of health care, vocational, and educational programs.
(KEY WORDS: Regulations/Legislation)

Position of the American Dietetic Association: Nutrition services for children with special health needs. (1995). Journal of the American Dietetic Association, 95(7), 809-812.

It is the position of the American Dietetic Association that nutrition services are an essential component of comprehensive care for children with special health needs. These nutrition services should be provided within a system of coordinated interdisciplinary services in a manner that is preventive, family centered, community based, and culturally competent.
(KEY WORDS: Regulations/Legislation, Team)

Cloud, H. H. (1994). Role of school food service in providing nutrition for children with special needs. Topics in Clinical Nutrition, 9(4), 47-53.

School systems are challenged with modifying the school lunch and breakfast programs to meet the special dietary needs of children with disabling or handicapping conditions. This challenge became apparent when regulations were written following the Rehabilitation Act of 1973, Section 504. With the Education of All Handicapped Children Act of 1975, many more children with disabling conditions entered the public school system. Schools' nutrition programs have increased awareness of the complex nutrition needs of these children and how the food service program must be modified to meet them.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast)

Conklin, M. T. & Nettles, M. F. (1996). Costs associated with providing school meals for children with special food and nutrition needs. School Food Service Research Review, 20(2), 56-62.

The purpose of this research was to determine the labor and food costs associated with providing school meals for children with special food and nutrition needs. The researchers collected data in eight school districts from three states in the Southeast and Southwest USDA regions. Employees from 15 schools recorded data for five days on the labor time used to prepare special meals. The researchers then calculated the average time for special meal preparation and average food cost for special meals compared with regular meals for the data collection period. Results showed that the median time to prepare special meals ranged from four to six minutes for pureed meals and five to eight minutes for other types of special meals, such as for food allergies or diabetes. Researchers found very little - if any - difference in the food cost between regular and special meals except for a higher food cost associated with serving canned nutritional supplements. The researchers recommend clarifying the school district's policy on purchasing nutritional supplements because this expenditure will dramatically affect the cost of meals served to children with special needs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Cost)

Conklin, M. T., Nettles, M. F., & Martin, J. (1994). Managing nutrition services for children with special needs. NFSMI Insight(1), 6.

Children who have a variety of special food and nutrition needs exist in every school district. Studies have shown that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies, diabetes, and a variety of disorders that require modifications to the texture of food. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization that his or her diet is restricted by a disability. Providing special meals need not be a costly undertaking for school nutrition services. This issue of NFSMI Insight presents recommendations for managing nutrition services for children with special food and nutrition needs. These recommendations focus on administrative processes that can reduce labor and food costs.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Menu Modification, Cost)

Cross-McClintic, K. A., Oakland, M. J., Brotherson, M. J., Secrist-Mertz, C., & Linder, J. A. (1994). School-based nutrition services positively affect children with special health care needs and their families. Journal of the American Dietetic Association, 94(11), 1307-1309.

The purpose of this study was to evaluate the effectiveness of a nutrition intervention program that included a dietitian in the school system to work collaboratively with children and their families. Family reactions to the program were also noted.
(KEY WORDS: School Foodservice/School Lunch/School Breakfast, Team)

Gandy, L. T., Yadrick, M. K., Boudreaux, L. J., & Smith, E. R. (1991). Serving children with special health care needs: Nutrition services and employee training needs in the school lunch program. Journal of the American Dietetic Association, 91(12), 1585-1586.

Comprehensive nutrition services are important for all children including children with special health care needs. This professional brief provides the results of a needs assessment survey. The survey was conducted to determine the types of modifications provided for children with special nutrition needs as well as the knowledge and training needs of foodservice workers in Mississippi school districts. One hundred fifteen districts out of 146 responded to the survey. The most common reason for menu modifications reported was for food allergy (57%) followed by restrictions of calories, fat, cholesterol, or sodium (27%). Survey results also indicated the need for additional training in making modifications to menu.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Training Needs, Allergy)

McLaren, P. (1998). Ready and able: What does it take to work with students and employees with special needs? School Foodservice and Nutrition, 52(7), 36-42.

This article offers practical suggestions for working with students or employees with disabilities. Included are personal accounts of several school food service directors' personal experiences. Suggestions from the AXIS Center for Public Awareness of People with Disabilities and the President's Committee on Employment of People with Disabilities for integrating people with disabilities into the workforce are also given.
(KEY WORDS: School Foodservice/School Lunch/ School Breakfast)

Yadrick, K. & Sneed, J. (1994). Nutrition services for children with developmental disabilities and chronic illnesses in education programs. Journal of the American Dietetic Association, 94(10), 1122-1128.

A large percentage of school nutrition managers reported that they served no children with special food and nutrition needs. Special food and nutrition needs most frequently encountered by all groups included food allergy, food intolerance, diabetes, and conditions with which feeding problems are associated. The skills of dietitians were used by 23% of school nutrition managers, 21% of district school nutrition directors/supervisors, and 15% of special education program directors. Continuing education needs were greatest for the areas of assessing liability, calculating macronutrient content of menus, modifying menus, and understanding the physical and emotional needs of children with special needs.
(KEY WORDS: Individualized Education Plan, School Foodservice/School Lunch/School Breakfast, Allergy, Diabetes)

Conklin, M. T., Nettles, M. F., & Martin, J. (1998). Modified meals: Strategies for managing nutrition services for children with special needs. School Foodservice and Nutrition, 52(7), 44-52.

Children who have a variety of special food and nutrition needs exist in every school district; in fact, studies show that most school nutrition managers have at least one child in their school with special needs. The medical conditions reported most frequently include food allergies and diabetes - which require menu adjustments - as well as a variety of disorders that require modifications to the texture of food served. Federal regulations require school nutrition professionals to modify meals for a child with a medical authorization demonstrating that his or her diet is restricted by a disability. Although feeding children with special needs often requires obtaining special foods, nutritional supplements, and adaptive feeding devices, providing these special meals need not be a costly or confusing undertaking for a school nutrition program. This article presents a number of recommendations for managing nutrition services for children with special food and nutrition needs, focusing on the administrative processes involved.
(KEY WORDS: Regulations/Legislation, Team, Allergy, Menu Modification, Diabetes, Cost)

Cross-McClintic, K. A., Oakland, M. J., Brotherson, M. J., Secrist-Mertz, C., & Linder, J. A. (1994). School-based nutrition services positively affect children with special health care needs and their families. Journal of the American Dietetic Association, 94(11), 1307-1309.

The purpose of this study was to evaluate the effectiveness of a nutrition intervention program that included a dietitian in the school system to work collaboratively with children and their families. Family reactions to the program were also noted.
(KEY WORDS: School Foodservice/School Lunch/School Breakfast, Team)

Fitzgerald, P. (1998). Resources to the rescue. School Foodservice and Nutrition, 52(7), 55-58.

Perhaps you work in a small district and are just now encountering your first student with special dietary or food needs. In either case, you will find that providing nutrition services to students with special needs can be very challenging, complicated, and even scary. You will need all the resources at your disposal to develop an effective program. Your state agency should be your first point of contact. Many state agencies have developed training and development resources to help individual school foodservice operators manage a special needs nutrition program. Following are some tips, strategies, sample forms and resources developed from materials compiled by the New Mexico Department of Education, Student Nutrition Programs Unit and the Minnesota Department of Children, Families and Learning. You can use or adapt these materials to develop or enhance your own special needs nutrition program.
(KEY WORDS: Team)

Position of the American Dietetic Association: Nutrition services for children with special health needs. (1995). Journal of the American Dietetic Association, 95(7), 809-812.

It is the position of the American Dietetic Association that nutrition services are an essential component of comprehensive care for children with special health needs. These nutrition services should be provided within a system of coordinated interdisciplinary services in a manner that is preventive, family centered, community based, and culturally competent.
(KEY WORDS: Regulations/Legislation, Team)

Gandy, L. T., Yadrick, M. K., Boudreaux, L. J., & Smith, E. R. (1991). Serving children with special health care needs: Nutrition services and employee training needs in the school lunch program. Journal of the American Dietetic Association, 91(12), 1585-1586.

Comprehensive nutrition services are important for all children including children with special health care needs. This professional brief provides the results of a needs assessment survey. The survey was conducted to determine the types of modifications provided for children with special nutrition needs as well as the knowledge and training needs of foodservice workers in Mississippi school districts. One hundred fifteen districts out of 146 responded to the survey. The most common reason for menu modifications reported was for food allergy (57%) followed by restrictions of calories, fat, cholesterol, or sodium (27%). Survey results also indicated the need for additional training in making modifications to menu.
(KEY WORDS: Regulations/Legislation, School Foodservice/School Lunch/School Breakfast, Training Needs, Allergy)

This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service through a grant agreement with The University of Mississippi. The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The University of Mississippi complies with all applicable laws regarding affirmative action and equal opportunity in all its activities and programs and does not discriminate against anyone protected by law because of age, color, disability, national origin, race, religion, sex, or status as a veteran or disabled veteran.