Review article
Gastrointestinal and nutritional problems in neurologically impaired children

https://doi.org/10.1016/j.ejpn.2016.05.019Get rights and content

Abstract

The current increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Gastrointestinal and nutritional problems in neurologically impaired children have been recently recognized as an integral part of their disease, often leading to growth failure and worsened quality of life for both children and caregivers. Nutritional support is essential for the optimal care of these children. Undernourished handicapped children might not respond properly to intercurrent diseases and suffer unnecessarily. On the other hand, restoring a normal nutritional status results in a better quality of life in many. The easiest and least invasive method to increase energy intake is to improve oral intake. However, oral intake can be maintained as long as there is no risk of aspiration, the child is growing well and the time required to feed the child remains within acceptable limits. When oral intake is unsafe, insufficient or too time consuming, enteral nutrition should be initiated.

Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux (GER), with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children, carrying further challenging long-term management issues.

Introduction

The current increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Although the primary problems for patients with developmental disabilities are physical and mental incapacities, several clinical reports have indicated that brain damage may result in significant gastrointestinal dysfunction.1, 2, 3, 4 The enteric nervous system contains more neurones than the spinal cord and thus it is not surprising that insults to the central nervous system may affect the complex integrated capacities underlying feeding and nutrition.5 As a consequence, many children with cerebral palsy are at high risk of poor nutritional status, particularly those with severe gross motor impairment and oropharyngeal dysfunction.6, 7, 8 The increased awareness of such conditions, together with a better understanding of their etiology and interplay, is essential to achieve an optimal global management of this group of children.

Section snippets

Feeding and nutritional aspects

A significant proportion of children with neurodevelopmental disabilities are undernourished.9, 10, 11, 12 This state of malnutrition was once considered to be part of the disease and accepted as an unavoidable and irremediable consequence of neurological impairment. Poor nutritional state was often marked by linear growth failure, decreased lean body mass, and diminished fat stores.13, 14 Over the past two to three decades, multidisciplinary feeding programs providing comprehensive evaluation

Gastrointestinal problems

Gastrointestinal issues are a major chronic problem in 80–90% of children with cerebral palsy and in children with neurodevelopmental disabilities.42 Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux (GER), with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding

Authors contribution

PQ wrote the first draft of the manuscript and approved the final version of the paper. NT critically revised the manuscript and approved the final version of the paper. AS critically revised the manuscript and approved the final version of the paper. OB designed the research, critically revised the manuscript and approved the final version and the submission.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors have no conflicts of interest to declare.

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