UNDERNUTRITION IN CHILDREN WITH A NEURODEVELOPMENTAL DISABILITY

Objective: To offer guidelines for optimal nutritional care in childre n with a neurodevelopmental disability and an associated impairment in their ability to eat and drink. Options: Assessment of nutritional st atus by skinfold thickness measurement, high-energy nutrition suppleme ntation given orally and feeding by nasogastric tubes, gastrostomy tub es or gastrojejunal tubes. Outcomes: Children receiving adequate nouri shment are generally calmer and appear more normal than those who are undernourished. Patients with less severe disabilities have an increas ed functional status with improved nutrition. In patients with gastroe sophageal reflux and aspiration of food, the use of gastrojejunal tube s prevents pneumonia and reduces the need for surgery to correct the r eflux. Economic benefits of various options were not considered. Evide nce: Members of the Nutrition Committee of the Canadian Paediatric Soc iety, most of whom are involved in caring for children with a neurodev elopmental disability, reviewed the literature. Members interpreted th e literature and developed the guidelines on the basis of their experi ence and research activities. Values: Improved psychologic, nutritiona l and functional status were all given a high value. Benefits, harms a nd costs: Supplemental tube feeding allows caregivers to devote less t ime to feeding and more time to stimulating and educating children wit h this type of disability. The need for surgery to correct reflux, alo ng with the associated risks and costs, has been greatly reduced with the development of percutaneous placement of the gastrostomy and gastr ojejunal tubes. Recommendations: It is unacceptable not to treat under nutrition associated with a neurodevelopmental disability. Management of nutrition in patients who require tube feeding is greatly simplifie d by the use of percutaneous enterostomy. Energy needs in children wit h this type of disability are lower than in other children, ranging fr om 2900 to 4600 kJ per day. Because they require less energy, such chi ldren should be given a formula designed for children less than 6 year s of age that has a high ratio of nutrients to energy. Every effort sh ould be made to improve the oral-motor skills of children with a mild disability. Validation: The guidelines were reviewed and approved by t he board of the Canadian Paediatric Society. There are no equivalent g uidelines from the Committee on Nutrition of the American Academy of P ediatrics.