Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study

Abstract

The aim of this study was to estimate the prevalence and severity of feeding and nutritional problems in children with neurological impairment within a defined geographical area. In a cross-sectional study, a validated questionnaire was sent to 377 parents of children (aged 4 to 13 years) on the Oxford Register of Early Childhood Impairments with oromotor dysfunction. The return rate was 72%. Of these, 93% had cerebral palsy; 47% were unable to walk; 78% had speech difficulty; and 28% continuous drooling of saliva. Gastrointestinal problems were commonly encountered: 59% were constipated; 22% had significant problems with vomiting, and 31% had suffered at least one chest infection in the previous 6 months. Feeding problems were prevalent: 89% needed help with feeding and 56% choked with food; 20% of parents described feeding as stressful and unenjoyable. Prolonged feeding times (3h/day) were reported by 28%. Only 8% of participants received caloric supplements and 8% were fed via gastrostomy tube. Even though 38% of respondents considered their child to be underweight, 64% of children had never had their feeding and nutrition assessed. The results highlight that feeding problems in children with neurological impairment are common and severe, causing parental concern. Many of these children would benefit from nutritional assessment and management as part of their overall care.

Perinatal Risk Factors for Feeding and Eating Disorders in Children Aged 0 to 3 Years

“…As for prematurity, SGA showed a dose-response relationship with FED in our study. Both are associated with neurologic problems, 1,16 and many premature or SGA infants receive tube feeding during their stay in the neonatal department. Although our study design does not allow conclusions about the reasons for the increased FED in preterm and SGA children, we consider that the potential causal factors include neurologic problems, effects of tube feeding, and early mother-infant relationship.…”

“…1,2 Feeding and eating problems affect 25% to 40% of infants and young children with normal development and 80% of those with chronic or serious medical conditions or developmental disorders. 3 In the International Classification of Diseases, 10th Revision (ICD-10), 4 the diagnosis of feeding and eating disorders (FED) in infancy and early childhood is made in accordance with clinical guidelines and diagnostic criteria that include the failure to eat adequately, failure to gain weight or loss of weight over a period of at least 1 month, with no organic disease or mental disorder to account for the failure to eat.…”

Home Care of Children and Youth With Complex Health Care Needs and Technology Dependencies

“…At every visit, it is important to assess each child' s growth by using readily available standardized growth curves. 23 It is important to consider the route of feeding as well as its safety and efficacy. For example, does the child who eats orally cough, choke, or demonstrate respiratory distress during or after meals?…”

Psychosocial aspects of feeding children with neurodisability

“…5 Caregivers, usually mothers, report prolonged mealtimes, which can be experienced as stressful. 6 In some cases, caregivers spend in excess of three hours per day feeding with individual mealtimes lasting more than half an hour. 6 Not surprisingly, mothers may feel that their everyday lives are dominated by feeding, particularly where a child refuses to feed from anyone else, which can be experienced as isolating, as mothers feel unable to leave their child, go out to work or socialize.…”

“…6 In some cases, caregivers spend in excess of three hours per day feeding with individual mealtimes lasting more than half an hour. 6 Not surprisingly, mothers may feel that their everyday lives are dominated by feeding, particularly where a child refuses to feed from anyone else, which can be experienced as isolating, as mothers feel unable to leave their child, go out to work or socialize. The demands of care can be high in this population of children as they are frequently ill and require numerous visits to health professionals and periods of hospitalization.…”