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

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.