Feeding children with neurodisability: challenges and practicalities

Abstract

Nutritional management for children with neurodisability can be challenging and there are an increasing number of children at risk of malnutrition. Management involves healthcare professionals in community and hospital working together with the family with the aim of optimising nutrition and quality of life. Feeding difficulties can be the result of physical causes like lack of oromotor coordination, discomfort associated with reflux oesophagitis or gastrointestinal dysmotility. Non-physical causes include parental/professional views towards feeding, altered perception of pain and discomfort, extreme sensitivity to certain textures and rigidity of feeding schedule associated with artificial feeding. Estimating nutritional needs can be difficult and is affected by comorbidities including epilepsy and abnormal movements, severity of disability and mobility. Defining malnutrition is difficult as children with neurodisability reflect a wide spectrum with disparate growth patterns and body composition and auxology is less reliable and less reproducible. Management involves selecting the type and method of feeding best suited for the patient. As artificial feeding can place a significant burden of care any decision-making should be, as much as possible, in concurrence with the family. Symptom management sometimes requires pharmacological interventions, but polypharmacy is best avoided. The article aims to discuss the pathways of identifying children at risk of malnutrition and available management options with a strong emphasis on working as a clinical team with the child and family.

Anthropometric profile and body composition of children and adolescents with cerebral palsy on enteral diet

“…Furthermore, the nutritional composition of the enteral diet used must be considered, as it is known that energy requirements decrease as the severity of cerebral palsy increases [36]. When a child is being fed enterally, nutritional needs should be calculated individually, based on physical activity level and CP severity, to avoid overweight and/or increased body fat [37]. Thus, the continued use of a hyperlipidic, hypoproteic industrialized diet may have influenced the negative results presented in this study, such as low fat free mass and excess fat mass.…”

Case report: Dravet syndrome, feeding difficulties and gastrostomy

“…Caregiver-reported “loss of appetite” is one of the most common feeding difficulties described in people with DS, yet the factors that lead to reduced food intake and food refusal (observed as “loss of appetite”), are likely to be complex and multifaceted. In children with neurodisability, oropharyngeal dysfunction, dental abnormalities, gastrointestinal disorders (such as gastro-esophageal reflux and constipation), pain and behavioral factors [including those related to comorbid ASD ( 26 )], all contribute to difficulties with feeding ( 27 – 29 ). Many of these issues are reported in people with DS, and may contribute to reduced food intake/food refusal, and other feeding difficulties.…”

Are children with disabilities more likely to be malnourished than children without disabilities? Evidence from the Multiple Indicator Cluster Surveys in 30 countries

“…For example, there is evidence that functional limitations, feeding difficulties and inadequate energy intake are key risk factors that lead children with cerebral palsy to be malnourished. 10 While nutritional disorders are common among some impairment types (such as cerebral palsy), [10][11][12][13] these inequities are inexplicable by impairment alone. Moreover, several of the social factors that lead to worse nutritional outcomes are also more prevalent in children with disabilities.…”