Review articleGastrointestinal and nutritional problems in neurologically impaired children
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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2021, Research in Developmental DisabilitiesCitation Excerpt :Our study found a high prevalence of GER in children with CP. This provides support to previous studies (Kim et al., 2017; Penagini et al., 2015; Quitadamo et al., 2016) in showing the magnitude of GER problems among children with severe CP. The high prevalence of feeding problems in our study could be explained by the severity of CP in our population since all children were classified GMFCS IV and V.
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