The Role of a Dietitian in the Disability Setting

What is a Dietitian?

A dietitian is a qualified and regulated health professional who assesses, diagnoses and treats dietary and nutritional problems at an individual and wider public-health level.

They work with both healthy and ill people, using the most up-to-date scientific research on food, health and disease to give practical guidance on appropriate food and lifestyle choices.

Diet and Nutrition in the Disability Setting:

It is well recognised that people with disabilities are at risk of nutritional challenges.

There are many reasons but commons causes include sensory sensitivity, difficulty swallowing and gastro-intestinal issues.

Challenges within specific conditions are listed below:

Autism: sensory sensitivity, cognitive rigidity/dislike of change and desire for sameness, food neophobia, anxiety and disgust surrounding contamination/mixing/touching of different foods.

Cerebral Palsy: swallowing difficulties, poor oral motor skills/difficulty chewing, self-feeding, excessive drooling, issues with sensory processing, gastro-intestinal tract sensitivity/dysfunction, poor mobility, challenges with motor function and seating posture.

Down Syndrome: small stature, low tone, structural anomalies of the face & mouth such as large tongue. Adults with down syndrome have an increased prevalence of diabetes mellitus, coeliac disease, dementia and swallowing difficulties.

Common nutritional challenges often seen in people with disabilities include:

• Difficulty meeting nutritional requirements for calories, protein, fluid, vitamins and minerals
• Growth faltering / low body weight
• Exceeding nutritional requirements resulting in overweight / obesity
• Constipation
• Dehydration
• Restricted intake
• Nutrient deficiencies
• Excessive intake of 1 or more nutrients
• Choking / aspiration – food/fluid entering the lungs – chest infections
• Dental caries

How can a Dietitian help?

Dietitians are responsible for the nutritional management of individuals who are referred to their care. The Dietitian can help a child or adult with a Disability in the following ways:

• The dietitian will assess the individual’s nutritional needs taking into account diagnosis, medical history, bloods and medications. Dietitians can tailor advice depending on the individual’s calorie, protein, fluid and micronutrient needs.
• The use of oral nutritional supplements (ONS) and or Enteral tube feeding (ETF) should be supported by a dietitian.
• The dietitian may also be able to help with symptoms such as bowel habits, stomach problems or sensitivities with certain foods.
• The dietitian will also be responsible for monitoring and reviewing the nutritional plan based on changes for the individual
• As part of the dietetic consultation the dietitian will also take measurements including weights, height/length to assess the individuals growth

Other considerations

Tube Feeding:

Tube feeding is when nutrition is delivered to the stomach or other parts of the gastrointestinal tract via a tube.

This practice is used when an individual is unable to meet their nutritional requirements orally or has an unsafe swallow. It can also be used for the delivery of fluid and medications. Therefore it is common within the Disability setting.

Oral Nutritional Supplements:

Oral nutritional supplements are specially-made food products. They are prescribed when an individual is unable to meet their full nutritional requirements orally.

Therefore there are also commonly used within the Disability setting.

Close communication with the multidisciplinary team is essential for effective management of nutritional challenges within this setting. As nutritional challenges are multi-faceted and have knock- on effects on their therapies, the team should ideally include Medical, Speech & Language Therapy, Physiotherapy, Occupational Therapy, Psychology etc.

How to access a Dietitian:

Considering the associated nutritional challenges it is very important that there is access to dietetic services for this group.

Dietetic services for people with disabilities can vary across the country. Potential routes to access services if they are available include:

• Children’s Disability Network Team (CDNT)
• Voluntary agency where the person attends
• Local community nutrition and dietetic service (Primary Care with the HSE)
• Acute hospital service where the person attends

The way children’s disability services are delivered have changed in Ireland and the country is now divided into Children’s Disability Network Teams or CDNT’s. For more information on this please visit: https://www2.hse.ie/services/disability/childrens-services/services/overview/

The dietitian is a member of this team. You can find contact details for your local team through the below website to check if they have a dietitian available to them: https://www2.hse.ie/services/disability/childrens-services/services/find-a-service/

Primary care dietetic services may be the appropriate option (apart from the CDNT) if needs are identified as non-complex as per PDS national policy on access to services and referral guidance.

In some cases people do seek service via Dietitians working in a private capacity. Membership of the INDI provides an assurance the Dietitian is suitably qualified. You can find a list of Private Dietitians in the Find a Dietitian section on the homepage www.indi.ie.

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