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Feeding Children with Special Health Care Needs

April 2025

CDPHE accessibility statement

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Children with Special Dietary and Feeding Needs

Food Allergies

Neurodiversity and Related Health Conditions

Adaptive Equipment

Special Diets

There are some situations where a child might need to avoid certain foods, receive medication in their foods or require an adjustment in the manner they are fed. In this module, we will review food intolerances and strategies for managing food allergies. We will also review children with signs and symptoms of Neurodiversity, including Autism Spectrum Disorder or ASD, knowing that many of the adaptations that support their needs can also be helpful for other children with or without a formal diagnosis. We will also touch on adaptive equipment that may be useful to consider and medical diets to help you prepare for an experience with a child who needs greater dietary modifications. As with every child in your care, we encourage you to see the child first, celebrate their unique qualities and create opportunities for their individual growth and development.

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Food Allergies and Intolerances

A food allergy occurs when the body identifies a protein in certain foods as harmful and overreacts
A food intolerance is when a person has difficulty digesting certain foods

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Preferences, Intolerance, Allergy

	Food Preference	Food Intolerance	Food Allergy
Reaction	None to Low	Mild to Moderate	Mild to Severe
Symptoms	Bad Taste Annoyance Dissatisfaction	Immediate or delayed Feeling sick or ill Migraine, bloating, lethargy, or diarrhea	Irritated skin Difficulty breathing Potentially fatal

Let’s look a little closer at the differences between preferences, intolerances and allergies. While each of these conditions is important to plan for and manage in your child care setting, food allergies are the reactions that can be life threatening. Because of that, we’ll spend most of this module covering how to manage food allergies.

�Supporting children in learning to try and accept new foods is the best way to manage food preferences and ultimately food choices. While it’s important to trust that children know what foods they like and what foods they don’t like, it’s also possible to help them become more relaxed and adventurous eaters. Utilizing the child’s health team, your Early Childhood Mental Health Consultant, a behavioral support specialist, occupational therapist, a school Psychologist or social worker may also provide any needed support for a child who may have behavioral concerns related to food.

�Food intolerances occur when a person is not able to digest a certain food or component of a food. For example, lactose intolerance is when a person is unable to digest lactose, the naturally occurring sugar in dairy products. It can lead to unpleasant symptoms such as stomach bloating and diarrhea. Food intolerances are not life threatening in the short term but still require careful management to keep the child healthy.

�Food allergies, as stated previously, are an immune system response and can range from mild to life-threatening. Let’s go over the basics of how to care for children with food allergies.

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Preparing for and Preventing �Food Allergies

Preventing exposure is key to maintaining safety
Work with the child’s parent and health care provider to obtain special diet statements to modify menus and ensure meals and snacks are safe

Providing allergy-free food and special diets will support the child

One of the most important steps in caring for a child with severe allergy is to prevent exposure to the food they are allergic to. A child’s parent can request a special diet statement from their health care provider (links above in the slide) that helps modify the child’s meals and snacks. This statement communicates to your child care program what foods the child should not eat and which foods may be substituted. For example, a child with a peanut allergy may not be able to eat peanut butter but may substitute with SunButter (made from sunflower seeds) or other substitute. Please note: some children may be allergic to both peanut butter AND SunButter – so it is important to follow the specifics of the special diet statement.

Prevention is key – and keeping the child away from the food they are allergic to is critical.��

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Nine Major Food Allergens

Milk

Shellfish

Fish

Peanuts

Soybeans

Tree nuts

Wheat

Eggs

Sesame Seeds

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Symptoms of a �Food Allergy

Swelling of the mouth or throat

Coughing or difficulty breathing

Vomiting or diarrhea

Hives or welts

Seek medical attention immediately if a child experiences any of these symptoms

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Allergy Management

A severe reaction may lead to anaphylaxis and require an epinephrine auto-injector (EpiPen) to be kept on hand
All children with food allergies should have a current emergency care plan from their health care provider with unexpired medication on site
Based on the child’s emergency care plan:

Parents provide the needed medications to ensure they are on site and ready in an emergency
Teachers and staff will receive training, delegation and oversight from their child care health consultant to administer medications and provide care for the child

Another important step in caring for a child with food allergies is to prepare for an emergency. The child’s family will provide documentation from the child’s health care provider, which is called a severe allergy emergency care plan. This plan will help you understand what food the child should not eat, the severity of the child’s allergy, as well as, the recommended actions for an emergency. Children’s allergic responses can vary widely and the emergency care plan can help clarify what needs to be done to keep the child safe.

�In severe cases, a child may go into anaphylaxis. This is when the allergic reaction involves multiple organ systems and is potentially life threatening. You or you team members may need to administer an epinephrine auto injector or EpiPen or other rescue medication. Having these medications on site is critical and the emergency care plan with have the details of when and how to use this medication.

�

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Neurodiversity and Related Health Conditions

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Neurodiversity and �Autism Spectrum Disorder

May have food preferences, sensitivities, and choose foods based on prior exposure
Many will only choose certain textures or colors of food:

At risk of becoming undernourished if whole food groups are avoided
Constipation often results due to dietary choices

May have trouble focusing on the meal and not finish the food provided
Some medications may cause a decrease in appetite

Children with Autism Spectrum Disorder, ASD, may have very mild to severe preferences to food texture, appearance, or taste, just as they might be sensitive in other areas of the classroom. They may also have side effects to medication that may cause changes or decreases in their appetite. Because they may be unable to tolerate some foods or even whole food groups, children are at risk for developing nutritional deficiencies that can impair their health. As a child care provider, your role in supporting the special dietary needs of children with ASD, or any neurodivergence, is important. Start by learning as much as you can about each individual child’s current capabilities and expectations the family has for the child while in your care. Every child with neurodiversity is unique and will need an individual approach. Work with their family, health provider, therapist, and your child care health consultant to ensure each child’s feeding plan meets their nutritional needs as well as their sensitivities.��

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How to Help

Work with the child’s parents and health care team
Create a plan that will make the child comfortable at mealtimes
Be flexible, the plan may change
Have patience

Most importantly, create lots of opportunities for two-way communication with the child’s family, and when you have permission, with the child’s health care team. They will give you lots of clues about the situations and strategies that are most beneficial for the child, as well as key stressors or triggers. The child’s health care team will also be able to offer strategies and support for your setting that might be new or different from what the child has experienced previously. Your partnership and patience will help children with ASD continue to engage and make progress at mealtime.

�Just as you would be flexible and supportive with a child as they are learning to explore at the texture table, being flexible and supportive at mealtimes promotes children’s emotional regulation, including children with ASD. What strategies can you adopt that will help you remain calm so you can in turn support the children? Use the child’s strengths as a starting place and limit the things that may add to their stress or overwhelm. Again, have patience and recognize where you can be even more flexible.

�

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Feeding and Meals

Create a consistent mealtime and routine
Keep the meal service simple, organized and avoid distractions
Sit at a table to help them eat
Offer a wide range of healthy choices
Do not serve foods that may trigger a reaction and cause a quick end to the meal
Keep food separated using a divided plate

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Special and Medical Diets

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Special and Medical Diets

Children could have medical conditions that require a specialized diet such as:

Diabetes
Celiac Disease
Heart Disease
Cystic Fibrosis
Sickle Cell Anemia
Inborn errors of metabolism

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Gastrostomy or G-Tubes

Small tube that enters the stomach through a small opening in the abdomen
Used to deliver nutrition, fluids, and medications
Improves nutrition, calorie, and fluid intake

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Caring for a Child with a G-Tubes

Children with a G-tube require support, accommodations and special diets
Partner with the parents and health care team for support and accommodations
A health care plan is needed with specific guidance and procedures – signed by parents and health care provider
Your program’s Child Care Health Consultant will train and work with child care staff to ensure safety
A special diet statement will help with feeding details

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Other Feeding and Diet Considerations

Where children sit during mealtime is important to eating success:

Sit together, with staff, to allow “normalcy”, role modeling and inclusion
Family style dining allows children with food preferences to have the food nearby but they don’t have to eat it, and allows them to set their own pace and how much they eat

Oral aversion – it is important to work with the child’s therapy team in creating a positive feeding experience

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Adaptive Equipment

Some children may need adaptive equipment to assist in eating

Adaptive feeding equipment or tools are used to help children with feeding problems and to increase independence as well as to help children feel “normal”

These children often work with an occupational therapist who will assist you with the type of equipment that is needed

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Adaptive equipment can include:

Utensils with large or foam handles
Suction bowls and plates
High rim plates
Straws
Cups with handles

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Resources and References�

https://www.foodallergy.org/resources/what-food-allergy
https://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538
https://www.cde.state.co.us/shs/standardhealthplanforallergy/anaphylaxisenabled
https://www.childrenscolorado.org/doctors-and-departments/departments/surgery/services-we-offer/g-tube-placement/
Special Diet Statements and Milk Substitution Forms: https://cdphe.colorado.gov/COFoodProgram/Materials-and-Forms
Caring for Our Children National Standards. Chapter 4: Nutrition and Food Service. 4.2. General Requirements/Feeding Plans and Dietary Modifications: https://nrckids.org/CFOC/Database/4.2.0
Children’s Hospital Colorado School Nurse Resources: https://www.childrenscolorado.org/community/community-health/school-health/school-nurse-resources/
Supporting children with special health conditions: https://drive.google.com/drive/folders/1pHi77OmEy1WCGP4iy8U8rPoKOjdOm7Bp?usp=sharing
https://www.foodallergy.org/living-food-allergies/information-you/children-food-allergies
USDA Food and Nutrition Service. Accommodating Children with Special Dietary Needs in School Nutrition Programs: www.fns.usda.gov/cn/accommodating-disabilities-school-meal-programs-guidance-qas

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Thank you

Made possible with funding from the Centers for Disease Control and Prevention