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. 1994 Sep 15;151(6):753–759.

Undernutrition in children with a neurodevelopmental disability. Nutrition Committee, Canadian Paediatric Society.

PMCID: PMC1337130  PMID: 7522121

Abstract

OBJECTIVE: To offer guidelines for optimal nutritional care in children with a neurodevelopmental disability and an associated impairment in their ability to eat and drink. OPTIONS: Assessment of nutritional status by skinfold thickness measurement, high-energy nutrition supplementation given orally and feeding by nasogastric tubes, gastrostomy tubes or gastrojejunal tubes. OUTCOMES: Children receiving adequate nourishment are generally calmer and appear more normal than those who are undernourished. Patients with less severe disabilities have an increased functional status with improved nutrition. In patients with gastroesophageal reflux and aspiration of food, the use of gastrojejunal tubes prevents pneumonia and reduces the need for surgery to correct the reflux. Economic benefits of various options were not considered. EVIDENCE: Members of the Nutrition Committee of the Canadian Paediatric Society, most of whom are involved in caring for children with a neurodevelopmental disability, reviewed the literature. Members interpreted the literature and developed the guidelines on the basis of their experience and research activities. VALUES: Improved psychologic, nutritional and functional status were all given a high value. BENEFITS, HARMS AND COSTS: Supplemental tube feeding allows caregivers to devote less time to feeding and more time to stimulating and educating children with this type of disability. The need for surgery to correct reflux, along with the associated risks and costs, has been greatly reduced with the development of percutaneous placement of the gastrostomy and gastrojejunal tubes. RECOMMENDATIONS: It is unacceptable not to treat undernutrition associated with a neurodevelopmental disability. Management of nutrition in patients who require tube feeding is greatly simplified by the use of percutaneous enterostomy. Energy needs in children with this type of disability are lower than in other children, ranging from 2900 to 4600 kJ per day. Because they require less energy, such children should be given a formula designed for children less than 6 years of age that has a high ratio of nutrients to energy. Every effort should be made to improve the oral-motor skills of children with a mild disability. VALIDATION: The guidelines were reviewed and approved by the board of the Canadian Paediatric Society. There are no equivalent guidelines from the Committee on Nutrition of the American Academy of Pediatrics.

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Selected References

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  1. Albanese C. T., Towbin R. B., Ulman I., Lewis J., Smith S. D. Percutaneous gastrojejunostomy versus Nissen fundoplication for enteral feeding of the neurologically impaired child with gastroesophageal reflux. J Pediatr. 1993 Sep;123(3):371–375. doi: 10.1016/s0022-3476(05)81734-2. [DOI] [PubMed] [Google Scholar]
  2. Bandini L. G., Schoeller D. A., Fukagawa N. K., Wykes L. J., Dietz W. H. Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatr Res. 1991 Jan;29(1):70–77. doi: 10.1203/00006450-199101000-00014. [DOI] [PubMed] [Google Scholar]
  3. Bax M. Eating is important. Dev Med Child Neurol. 1989 Jun;31(3):285–286. doi: 10.1111/j.1469-8749.1989.tb03996.x. [DOI] [PubMed] [Google Scholar]
  4. Berg K., Isaksson B. Body composition and nutrition of school children with cerebral palsy. Acta Paediatr Scand Suppl. 1970;204(Suppl):41+–41+. [PubMed] [Google Scholar]
  5. Boland M. P., Stoski D. S., MacDonald N. E., Soucy P., Patrick J. Chronic jejunostomy feeding with a non-elemental formula in undernourished patients with cystic fibrosis. Lancet. 1986 Feb 1;1(8475):232–234. doi: 10.1016/s0140-6736(86)90772-5. [DOI] [PubMed] [Google Scholar]
  6. Coben R. M., Weintraub A., DiMarino A. J., Jr, Cohen S. Gastroesophageal reflux during gastrostomy feeding. Gastroenterology. 1994 Jan;106(1):13–18. doi: 10.1016/s0016-5085(94)93969-1. [DOI] [PubMed] [Google Scholar]
  7. Dedinsky G. K., Vane D. W., Black T., Turner M. K., West K. W., Grosfeld J. L. Complications and reoperation after Nissen fundoplication in childhood. Am J Surg. 1987 Feb;153(2):177–183. doi: 10.1016/0002-9610(87)90810-5. [DOI] [PubMed] [Google Scholar]
  8. Dobbing J. Boyd Orr memorial lecture. Early nutrition and later achievement. Proc Nutr Soc. 1990 Jul;49(2):103–118. doi: 10.1079/pns19900017. [DOI] [PubMed] [Google Scholar]
  9. Feldman M., Burton M. E. Histamine2-receptor antagonists. Standard therapy for acid-peptic diseases. 1. N Engl J Med. 1990 Dec 13;323(24):1672–1680. doi: 10.1056/NEJM199012133232405. [DOI] [PubMed] [Google Scholar]
  10. Fried M. D., Khoshoo V., Secker D. J., Gilday D. L., Ash J. M., Pencharz P. B. Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr. 1992 Apr;120(4 Pt 1):569–572. doi: 10.1016/s0022-3476(10)80003-4. [DOI] [PubMed] [Google Scholar]
  11. Frisancho A. R. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981 Nov;34(11):2540–2545. doi: 10.1093/ajcn/34.11.2540. [DOI] [PubMed] [Google Scholar]
  12. Fung K. P., Seagram G., Pasieka J., Trevenen C., Machida H., Scott B. Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. Clin Invest Med. 1990 Oct;13(5):237–246. [PubMed] [Google Scholar]
  13. Gisel E. G. Chewing cycles in 2- to 8-year-old normal children: a developmental profile. Am J Occup Ther. 1988 Jan;42(1):40–46. doi: 10.5014/ajot.42.1.40. [DOI] [PubMed] [Google Scholar]
  14. Gisel E. G., Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet. 1988 Feb 6;1(8580):283–286. doi: 10.1016/s0140-6736(88)90360-1. [DOI] [PubMed] [Google Scholar]
  15. Hull M. A., Rawlings J., Murray F. E., Field J., McIntyre A. S., Mahida Y. R., Hawkey C. J., Allison S. P. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet. 1993 Apr 3;341(8849):869–872. doi: 10.1016/0140-6736(93)93072-9. [DOI] [PubMed] [Google Scholar]
  16. Johnson C. B., Deitz J. C. Time use of mothers with preschool children: a pilot study. Am J Occup Ther. 1985 Sep;39(9):578–583. doi: 10.5014/ajot.39.9.578. [DOI] [PubMed] [Google Scholar]
  17. Jones P. M. Feeding disorders in children with multiple handicaps. Dev Med Child Neurol. 1989 Jun;31(3):404–406. doi: 10.1111/j.1469-8749.1989.tb04013.x. [DOI] [PubMed] [Google Scholar]
  18. KARLE I. P., BLEILER R. E., OHLSON M. A. Nutritional status of cerebral-palsied children. J Am Diet Assoc. 1961 Jan;38:22–26. [PubMed] [Google Scholar]
  19. Khoshoo V., Fried M., Pencharz P. Incidence of gastroesophageal reflux with casein and whey-based formulas. J Pediatr Gastroenterol Nutr. 1993 Jul;17(1):116–117. doi: 10.1097/00005176-199307000-00024. [DOI] [PubMed] [Google Scholar]
  20. Krick J., Murphy P. E., Markham J. F., Shapiro B. K. A proposed formula for calculating energy needs of children with cerebral palsy. Dev Med Child Neurol. 1992 Jun;34(6):481–487. doi: 10.1111/j.1469-8749.1992.tb11468.x. [DOI] [PubMed] [Google Scholar]
  21. Krick J., Van Duyn M. A. The relationship between oral-motor involvement and growth: a pilot study in a pediatric population with cerebral palsy. J Am Diet Assoc. 1984 May;84(5):555–559. [PubMed] [Google Scholar]
  22. Lewis D., Khoshoo V., Pencharz P. B., Golladay E. S. Impact of nutritional rehabilitation on gastroesophageal reflux in neurologically impaired children. J Pediatr Surg. 1994 Feb;29(2):167–170. doi: 10.1016/0022-3468(94)90312-3. [DOI] [PubMed] [Google Scholar]
  23. Mago H., Chen C. L., Wesson D. E., Filler R. M. Incisionless gastrostomy for nutritional support. J Pediatr Gastroenterol Nutr. 1986 Jan;5(1):66–69. doi: 10.1097/00005176-198601000-00012. [DOI] [PubMed] [Google Scholar]
  24. Mollitt D. L., Golladay E. S., Seibert J. J. Symptomatic gastroesophageal reflux following gastrostomy in neurologically impaired patients. Pediatrics. 1985 Jun;75(6):1124–1126. [PubMed] [Google Scholar]
  25. Nelson K. B., Ellenberg J. H. Epidemiology of cerebral palsy. Adv Neurol. 1978;19:421–435. [PubMed] [Google Scholar]
  26. Nielson D. W., Heldt G. P., Tooley W. H. Stridor and gastroesophageal reflux in infants. Pediatrics. 1990 Jun;85(6):1034–1039. [PubMed] [Google Scholar]
  27. Patrick J., Boland M., Stoski D., Murray G. E. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol. 1986 Dec;28(6):734–739. doi: 10.1111/j.1469-8749.1986.tb03925.x. [DOI] [PubMed] [Google Scholar]
  28. Rempel G. R., Colwell S. O., Nelson R. P. Growth in children with cerebral palsy fed via gastrostomy. Pediatrics. 1988 Dec;82(6):857–862. [PubMed] [Google Scholar]
  29. Sochaniwskyj A. E., Koheil R. M., Bablich K., Milner M., Kenny D. J. Oral motor functioning, frequency of swallowing and drooling in normal children and in children with cerebral palsy. Arch Phys Med Rehabil. 1986 Dec;67(12):866–874. [PubMed] [Google Scholar]
  30. Spady D. W., Payne P. R., Picou D., Waterlow J. C. Energy balance during recovery from malnutrition. Am J Clin Nutr. 1976 Oct;29(10):1073–1088. doi: 10.1093/ajcn/29.10.1073. [DOI] [PubMed] [Google Scholar]
  31. Spender Q. W., Cronk C. E., Charney E. B., Stallings V. A. Assessment of linear growth of children with cerebral palsy: use of alternative measures to height or length. Dev Med Child Neurol. 1989 Apr;31(2):206–214. doi: 10.1111/j.1469-8749.1989.tb03980.x. [DOI] [PubMed] [Google Scholar]
  32. Stewart R. J., Sheppard H., Preece R., Waterlow J. C. The effect of rehabilitation at different stages of development of rats marginally malnourished for ten to twelve generations. Br J Nutr. 1980 May;43(3):403–412. doi: 10.1079/bjn19800108. [DOI] [PubMed] [Google Scholar]
  33. TOBIS J. S., SATUREN P., LARIOS G., POSNIAK A. O. Study of growth patterns in cerebral palsy. Arch Phys Med Rehabil. 1961 Jun;42:475–481. [PubMed] [Google Scholar]
  34. Tolia V., Calhoun J., Kuhns L., Kauffman R. E. Randomized, prospective double-blind trial of metoclopramide and placebo for gastroesophageal reflux in infants. J Pediatr. 1989 Jul;115(1):141–145. doi: 10.1016/s0022-3476(89)80351-8. [DOI] [PubMed] [Google Scholar]
  35. Wesley J. R., Coran A. G., Sarahan T. M., Klein M. D., White S. J. The need for evaluation of gastroesophageal reflux in brain-damaged children referred for feeding gastrostomy. J Pediatr Surg. 1981 Dec;16(6):866–871. doi: 10.1016/s0022-3468(81)80836-6. [DOI] [PubMed] [Google Scholar]

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