Top-ten tips for managing nutritional issues and gastrointestinal symptoms in children with neurological impairment

Abstract

The prevalence of children with neurological impairment (NI) presenting feeding difficulties and gastrointestinal symptoms is rising. The most recent guidelines recommend early nutritional assessment and intervention in order to prevent undernutrition and growth failure, along with the proper diagnosis and treatment of some frequent gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) and constipation, which can further worsen the feeding process and nutritional status. Nonetheless, the nutritional issues and growth deficits of children with NI are often considered to be of low priority or under recognised by healthcare providers. The present article proposes ten top tips that highlight the major points along the nutritional management pathway of NI children. The implementation of these tips in all healthcare settings could potentially improve patient outcomes and reduce morbidity and mortality.

Endoscopic ultrasound-guided gastrojejunostomy with lumen-apposing metal stent in a boy with neurological impairment requiring jejunal feeding

“…Moreover, nearly all NPDC have 1 or more comorbidity that negatively affects feeding and worsens GI symptoms such as retching and bloating, requiring prompt gastric decompression. [3][4][5] When jejunal feeding is recommended, 3,6 long-term access is represented by jejunal tube introduction through gastrostomy (percutaneous endoscopic gastrojejunostomy [PEGJ]), surgical gastrojejunostomy (SJ), or direct percutaneous endoscopic jejunostomy (DPEJ). [1][2][3][4][5][6][7][8] Because PEGJ allows both gastric decompression via PEG and simultaneous jejunal nutrition via PEGJ, it is the preferred method, especially in NPDC who are unfit for surgery.…”

“…[3][4][5] When jejunal feeding is recommended, 3,6 long-term access is represented by jejunal tube introduction through gastrostomy (percutaneous endoscopic gastrojejunostomy [PEGJ]), surgical gastrojejunostomy (SJ), or direct percutaneous endoscopic jejunostomy (DPEJ). [1][2][3][4][5][6][7][8] Because PEGJ allows both gastric decompression via PEG and simultaneous jejunal nutrition via PEGJ, it is the preferred method, especially in NPDC who are unfit for surgery. However, PEGJ is associated with technical adverse events that compromise its long-term durability, such as tube clogging or retrograde dislodgement, necessitating repeated hospitalization: the average duration of PEGJ in NPDC is 39 days.…”

LUNCH—Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial

“…In the last couple of decades, the nutritional needs of children with neurological impairment have become a major matter of interest so that, in 2017, the European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published a consensus statement (ESPGHAN guidelines) on the diagnosis and management of gastrointestinal and nutritional complications in children with neurological disability [ 9 ]. Both diagnosis of GERD and accurate monitoring of growth and nutritional status are among the “top ten-tips” in managing nutritional issues and gastrointestinal function in neurologically impaired children [ 10 ].…”

Prevalence of dysphagia symptoms in Cretan children and adolescents with neurological disorders

“…More specific neurological disorders include genetic and metabolic disorders, degenerative neurological disorders, prematurity, autism spectrum disorders, and acquired brain injury. 5 …”