For further understanding of the study

For further understanding of the study, the researchers used different reading materials related to the nutritional status of children with special needs. These materials such as books, magazines, and other online articles and researches are essentials in broadening the knowledge of the researchers. These will also help and guide the researchers in achieving their target objectives by getting additional ideas and information on other related studies and makes improvements if possible.
The term special needs can refer to a vast array of diagnoses and/or disabilities. Children with special needs may have been born with a syndrome, terminal illness, profound cognitive impairment, or serious psychiatric problems. Others may have special needs that involve struggling with learning disabilities, food allergies, developmental delays, or panic attacks. These children need an extra support and additional services. Person with special needs may need lifetime guidance while dealing with everyday issues.
As the common notion says health is wealth malnutrition has been a problem for years all over the globe, also governments invest in resolving the issue and putting people to address the situation but the nutritional status of the children with special needs has always been overlooked. As stated by the United Nations Children’s Fund (UNICEF), the estimated number of children with disabilities under 18 years old was approximately 150 million. Children with Autism Spectrum Disorders (ASD), Cerebral Palsy (CP), Down syndrome (DS), Learning Disabilities and other types of disabilities are included. Nutritional status is an important indicator of the overall health status and wellbeing of children with disability. It portrays the physical growth of children and whether they are at risk of being underweight, overweight or obese. The impact of poor nutritional status and poor growth among children with disability may eventually lead to poor motor function, bone health, social participation and healthcare utilization.
All through the various life cycles, the effect of malnutrition to an individual’s sensory, intellectual, and physical aspect can be catastrophic, as stated in the study performed by Arkas and Challenger, et. al (2014). It is found in the study that countries with seemingly high prevalence of malnutrition show higher rates of disability and developmental delays. As stated in the Conventional on the Rights of the Child (CRC) all children including children who is disabled, have the right to have an adequate nutrition. They also highlighted the duty of States Parties to prevent discriminatory denial of health services of food and fluids on the basis of disability. Nutrition disorders and compromised nutritional status are common among children with special health care needs. According to UNICEF food security has always been an issue in families with a disabled member because of poverty and unequal distribution of households. Women and children are at greater risk, as access to nutritious food for women with children who have disabilities is typically ignored. Gonzales, Bauset, et. al (2015) have found out that children with autism spectrum disorder is encountering problems in food selectivity that leads to nutrient defeciencies implying risk on their overall health. It is quite similar to the research conducted by Aggarwal,et al. (2015), which associated poor eating habits to poor nutrition that leads to muscle wasting on patients. The research stated that the children with cerebral palsy who have very low weights are at risk for death. Based on the research made by Elizabeth Anaya, et. al (March 2016), they made a study that aims to know the association between gross motor function of children aged 2 to 12 with cerebral palsy and their nutritional status.
It is shown in their study that there are two prevalent condition among paediatric patients with Cerebral Palsy which are malnutrition and stunting, and both are directly associated with higher levels of gross motor dysfunction. It is stated in their study that children with cerebral palsy is associated with poor growth, and that causes the increasing levels of gross motor dysfunction. There are nutritional and non?nutritional factors that causes malnutrition and growth restriction including impaired oral–motor function, gastroesophageal reflux, aspiration and pneumonia, negative neurotropic effects, and endocrine abnormalities. The researchers also included socioeconomic factors as part factors that needs to be considered in prognosis for children with cerebral palsy.
According to Nalan Hakime Nogay (2013), he made a study about nutritional status of mentally disabled children and adolescents.The sample population (77) were evaluated. 14.3% of the children were found to be thin for their age. 28.6% of the participants were too short for their age. Based on the results, girls had a higher percentage for shortness than boys. They also found out that the folic acid and calcium intake of girls in the 10-13 age group were under suggested value. In the same age group, the boys only has low intake of calcium. While in the 14-18 age group, the vit C and calcium intakes of girls are under recommended value and the boys in the same age group has low intake of calcium.
Poor maternal nutrition is associated in these disabilities which has subsequently supported by the research of Chao Li,et al (2016). It has been found that the early deficit caused by malnutrition during women’s pregnancy is not compensated anymore in the later life. According to The Lancet Global Heath maternal nutrition leads to child’s impairment for example, folic acid deficient mother might result to a newborn with a neural tube disorder, maternal iodine deficiency may lead to hearing problems and psychomotor problems in infants. According world health organization 30 million babies are born with low birth weight annually, 23.8 % of these newborns are born with disabilities. Based on the study conducted by Groce, et al(2013) undernutrition cause constant damage, for example vitamin A deficiency cause permanent blindness and target the immune system tearing down body’s resistance to infection. It is also stated in the study that macronutrient and micro nutrtient defeciencies may result malaria and meningitis which is the leading cause of neuro-disability worldwide. One of the leading neuro disability is ASD or autism spectrum syndrome, based on the research conducted by Woolfenden, et. Al (2013) prevalence rate of mortality ASD children arise from 1.9 to 5.6 which pose vast public health implications. These kind of situation is often overlooked, having no substantial effort to reduce or improve the children’s needs in terms of nutrition support imposing greater risk for disabled children. As shown on the result of the study conducted by Barnhill, et al(2015) children neither met or exceed their recommended intake of carbohydrates and protein, and slightly lower fat intake than recommended. Additional study performed by Sharp, et al(2013) report inadequate dietary intake for a number of nutrients, including B vitamins, vitamin D, vitamin C, iron, and calcium There are many factors that can cause risks for autism such as genetic, environment, and nutrition. Vitamin D deficiency in pregnant mothers and in early childhood of the child is a possible genetic and environmental risk factor for autism spectrum disorder (ASD) as stated in the research conducted by Bener et. al(2014). This was reviewed by the BabyCenter Medical Advisory Board. Vitamin D Food sources for pregnant woman to avoid abnormal bone growth and rickets in newborns. There are fortified brands with vitamin D because some foods do not contain vitamin D naturally, be aware and always check the labels when buying food products. Here are some examples of food with best source of vitamin D, pink salmon, mackerel, sardines, orange juice fortified by vitamin D, low-fat milk, fortified with vitamin D, cereal, fortified with vitamin D, egg yolk.
fortified with vitamin D, egg yolk.
Vitamin D plays a special role in brain development; the study of Bener et. Al (2014) shows that children with autism have a lower mean value of vitamin D with median 18 than healthy children with median 21. Of total 254 of autism children, 14.2% had severe Vitamin D deficiency, 43.7% had moderate insufficient levels, 28.3% had mild insufficient levels, and only 13.8% of autism had sufficient levels. Of total 254 of healthy children 8.3% had severe Vitamin D deficiency, 37% had moderate insufficient level, 37.4% had mild insufficient levels, and only 17.3% had sufficient levels. Also, other vitamins and minerals such as calcium, phosphorus and others are more likely to be higher in healthy children than in children with autism. To reduce the risk factor of autism, the safe and effective way might be supplementing the infants with vitamin D.
And also, according to NCBI articles severe vitamin D deficiency can cause rickets and other several disorders such as hypertension, diabetes, osteoarthritis, cancer and other autoimmune diseases in later life.
According to Guo M (2018) children with autism have lower vitamin A and Vitamin D comparing with the control group. Also, higher proportion of picky eaters, have eating problems and resistance to new food are mostly children with ASD compared to control group. Vitamin D level on children with ASD is lower than control group and they are more likely to have vitamin A and vitamin D deficiency. This may cause health problems such as malnutrition and other diseases. According to the study conducted by Elsevie (2013).Excessive weight and obesity ranked among life style diseases, despite the case of gaining weight it is through diet and physical activity to become effective and also depends on the patients. It is too difficult to prevent gaining weight in this intellectually disabled people since they have a higher risk for developing obesity. People living with disabilities may be at greater risk than their peers without disabilities for weight gain due to low levels of activity supported by the study of PubMed Central(2012). The study found that total of 17.5% on individuals with mild and 50% of with moderate were found overweight or obese, and it occurred most in women. According to The American Journal of Clinical Nutrition, taking high dose of vitamin D supplement can help the malnourished children to gain weight and to develop language and motor skills. Children who are affected with severe acute malnutrition have a low body weight for their height and have severe muscle wasting; in addition, they may also have swollen feet, face and limbs. As stated in the study of Saleem et. al (2018) children with this condition are commonly having a low level of vitamin D. vitamin D helps the muscle and bone to maintaining a healthy immune system.
Based on the study conducted by Bhan et,al (2001), micronutrient deficiencies can affect the growth and development of the children. Besides breast feeding and complementary feeding, there is a need to increase the intake of a certain micronutrient. Consuming food is a long term approach to improve nutrition but supplementation for a certain micronutrient must also be considered for high risk groups or general population.
Children nowadays are changing their food habits and now they are eating less healthy food such as sweetened beverages, food with high in fats specially the unsaturated fats. Children do not consume enough fruits or vegetables and not getting enough fiber. Calcium and iron is also low. Most of the families can’t provide the food they needed such as milk, cheese, fruits and vegetables which is a big factor and affects the nutritional health of the child. One main reason of obesity in children is eating lot of foods with high in sugar such as soft drinks, and with no physical activities. It is important to address nutrient and activity deficiency as early as these may lead to severe health problems such as obesity, type 2 diabetes, stroke, cancer and others. The 2 most common nutrient deficiencies that seen among children are iron and vitamin D deficiency as said in the study of Haimi (2014)