Infant Toddler Development Training
Module 6, Lesson 2

Chronic Lung Conditions

Chronic lung conditions are often seen in premature infants and in children with cystic fibrosis. Infants and toddlers with chronic lung conditions have problems with feeding. They may exhibit a poor suck, have fluid intolerance, and experience gastro-esophageal reflux. If they are on diuretics to reduce fluid in their lungs, they also are at risk for the loss of minerals and salts. Their breathing is labored and this increases their need of energy. They are also at an increased risk of aspiration, particularly if they have shortness of breath. They tend to retain carbon dioxide, and for this reason, carbohydrates should not be increased.

These infants and toddlers tend to exhibit poor growth and need frequent checks by their primary medical provider and often a respiratory specialist. These specialists will monitor their growth and nutritional intake while also monitoring their oxygen needs, the hemoglobin levels, and the levels of other minerals such as calcium and phosphorus. The physician will also be monitoring protein status and the electrolyte balance. Treatment of the gastroesophageal reflux might require medical intervention.

An infant or toddler with a chronic lung condition may fatigue easily. The main role of the ITDS, if involved on the team, is to encourage the caregivers to provide calm, unhurried feedings and monitor to ensure that the infant is allowed to rest if overtaxed. Over stimulation can actually cause the infant to regress in development and can increase health risks. There may be poor coordination between breathing, sucking and swallowing and this can result in aspiration. Feeding can become a very negative experience particularly during the transition from liquids to solids

Chronic Cardiac Conditions

Chronic cardiac conditions also result in feeding intolerance due to poor suck. There are increased energy needs due to increased respiratory effort. Anorexia or poor appetite and malabsorption of nutrients is common. Chronic cardiac conditions are associated with some genetic disorders including Down syndrome.

Cerebral Palsy

Cerebral Palsy is a disorder of movement and posture. The incidence of reduced cognition is also higher in children who have cerebral palsy, however, the two are not necessarily correlated. Nutritional issues may include feeding dysfunction with a poor suck and swallow and decreased motility of the intestinal tract. As with many of the other conditions, the risk of aspiration is greater, as is the risk of gastro-esophageal reflux. There is an associated delay in feeding skills and there are often food refusals that lead to inadequate intake of food.

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