Combating Malnutrition Among Children with Disabilities in Twelve Countries:

Development of Culturally Appropriate Texture-Modified Recipes

About the SPOON Foundation:

OHSU Dietetic Interns: Katie Attema, Sarah Glasser, Jennifer Hamilton, Miranda Meyer, Jessica Somohano, & Amanda Wittenberg
SPOON Foundation Project Mentors: Maureen Dykinga, MS, CCC-SLP & Zeina Makhoul, PhD, RD
Multi-Phase Project
Phase 1: Literature search on nutrition needs
and cultural foods per country. Creation of
recipes and templates including nutritional
breakdown.

The SPOON Foundation works closely with

leaders in the fields of pediatrics, nutrition,
disability, feeding, orphan care, public health,
and child development to combat malnutrition
by providing tools and resources to educate
caregivers of orphan and foster children.

Phase 2: Preparation of each recipe, test

groups including people from each country,
feedback on recipes. Literature search on
readily available thickeners.

The SPOON Foundation partners with foster

care homes, orphanages, and community
settings around the world to provide
assessment and intervention tools that
address how to feed children safely and
adequately.

Phase 3: Adjustments made to recipes in

response to feedback, standardization of
recipes, in depth nutritional analysis.

These include:
Assessing and improving the safety of
caregiver feeding practices of children with
disabilities.

Our Objectives (Phase 1):

Identifying children at-risk for nutrition

deficiencies and prescribing individualized
interventions.

2. Build a collection of fifteen snack recipes

for each country that is nutritionally
balanced and tailored by the following
textures:
Smoothie
Pudding/yogurt/custard
Soft bite-sized

1. Identify prevalent nutritional deficiencies

within each of the twelve individual
countries.

Evaluating diet and recommending

supplementation.

Children with disabilities living in

orphanages and foster care homes are
often isolated and overlooked by child
health programs.
Children with neurological disabilities and
poor oral-motor skills are at increased risk
for aspiration, choking, upper respiratory
infections, pneumonia, and even death.
Improper feeding practices around the world
have been linked to poor growth and
developmental outcomes in children.
Oral-motor problems may limit the types of
foods a child may eat or drink, which may
compromise a childs nutrition and hydration
status in countries already experiencing
nutritional deficits.

Caregivers of orphan children with

disabilities often lack the knowledge, skills,
and resources to prepare consistent and
reliable texture-modified foods and thickened
beverages, while maximizing the nutrition
content of food.

Projected Impact and Next Steps:

Bhutan Mongolia Russia Tajikistan

Micronutrient Deficiencies

Countries and Major Deficiencies

Vitamin B12

China

Zambia

Ethiopia

Thiamine

Vitamin A

Vitamin A

U.S.A

Vietnam Bulgaria

Dietary
Vitamin A
imbalances/
not
Vitamin C
deficiencies

Vitamin A

Vitamin A

Vitamin A

Vitamin D

Vitamin D

Iodine

Vitamin
B12

Vitamin D

Iodine

Iron

Calcium

Folate

Vitamin E

Riboflavin

Anemia

Folate

Zinc

Calcium

Selenium

Iron

Iron

Zinc

Selenium

Magnesium

Manganese

Zinc

Phosphorus

Iodine

India

Kazakhstan

Vitamin A

Vitamin A

Vitamin C

Iodine

Potassium

Stunting

Anemia

Iodine

As a group, we agreed it was challenging

not being familiar with the cultural food
practices of each country.

Stunting
Wasting

Wasting
Over
nutrition
High
Protein
sugar/high
Energy
fat
Malnutrition

Overweight
Night
blindness

Anemia

Food insecurity
Protein
Energy
Malnutrition

Our team created nutrient dense, culturally

appropriate recipes for each country,
including estimated calories, protein,
calcium, iron, vitamin A, and vitamin C per
serving.
The projected impact of our contribution to
the SPOON Foundations educational
materials is to increase the nutritional status
of children with dysphagia in each of the
countries.
Next steps include creating breakfast, lunch
and dinner recipes, recipe testing feedback
from caregivers in respective countries and
creation of meal recipes (Phase 2 & 3).

Underweight

Nutrition Related
Problems

Project Significance:

Protein
Energy
Malnutrition