Gastrointestinal problems in the handicapped child

Gastrointestinal issues are a major chronic problem in 80 to 90% of childre n with cerebral palsy and in children with neurodevelopmental disabilities who are at special risk of developing malnutrition because of uncoordinated swallowing, gastroesophageal reflux, and constipation. In addition to poor linear growth, there is a decrease in muscle strength and coordination, im paired cerebral function leading to decreased motivation and energy, Signif icant neurodevelopmental progress can be achieved with improved nutritional status. A multidisciplinary approach, with input from neurologists, gastro enterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these ch ildren. Different neurological diseases (eg, spinal dysraphism, syringomyel ia, tethered cord syndromes) can give rise to gastrointestinal dysfunction and symptoms that may need different gastrointestinal or surgical managemen t. The introduction of new drugs, including proton pump inhibitors and inno vative endoscopic and surgical techniques in the management of gastroesopha geal reflux disease and constipation also may have an impact on the treatme nt of neurologically handicapped children in the future. Curr Opin Pediatr 2001, 13:441-446 (C) 2001 Lippincott Williams & Wilkins, Inc.