title: Gastrointestinal and nutritional problems in neurologically impaired children.
abstract: The current increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Gastrointestinal 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. 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 in 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. Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux (GER), with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children, carrying further challenging long-term management issues.
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy. Electronic address: paoloquitadamo@yahoo.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Quitadamo
authors.affiliation: Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thapar
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
authors.affiliation: Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Borrelli
mesh_terms: D002648:Child; D019988:Children with Disabilities; D004750:Enteral Nutrition; D019959:Feeding and Eating Disorders of Childhood / Q000150:complications / Q000628:therapy*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy*; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications*; D011788:Quality of Life
keywords: Constipation; Dysphagia; Enteral nutrition; Gastro-esophageal reflux; Malnutrition; Neurological impairment; Percutaneous endoscopic gastrostomy