Gastrointestinal and Nutritional Problems in Neurologically Handicapped Children

Abstract

The increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Gastrointestinal (GI) 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. In fact, 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 for 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.

Chronic GI disorders are very common in children with neurological impairment, being reported a prevalence of up to 92 %. Dysphagia, rumination, gastroesophageal reflux, delayed gastric emptying, abdominal pain, and constipation have all been described in this group of children, potentially contributing to feeding difficulties and carrying challenging long-term management issues.