Table 1 Top-ten tips for the nutritional management of children with neurological impairment
Item | Tip |
|---|---|
1. Burden of NI | • Awareness of rising prevalence of NI-associated feeding difficulties and gastrointestinal symptoms |
2. Assessment of nutritional status | • Standard anthropometrics and evaluation of body composition |
3. Definition of undernutrition | • Physical examination and nutritional status (see Tip 2) |
4. Nutritional needs | • Dietary reference intake for basal energy expenditure for typically-developing children, individualized according to motor function, muscle tone, and activity level • Daily supplements in specific clinical conditions (see Text) |
5. GERD | • Early assessment and treatment • PPIs as the first line treatment |
6. Constipation | • Careful history, abdominal, perineal, and eventually digital rectal examination • Osmotic agents (polyethylene glycol) |
7. Enteral nutrition | • Consider start before the development of undernutrition |
8. Enteral access and feeding regimen | • Gastrostomy as the preferred way for prolonged enteral tube feeding • Post-pyloric feeding in case of contraindication to gastric feeding (see Text) |
9. Enteral formula | • Choice of enteral formula based on patient’s age, nutritional needs and enteral access • Safety concerns about blenderized food |
10. Benefits of enteral tube feeding | • Long-term improvement of nutritional status, health-related quality of life • Low rates of serious complications |