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Nutritional problems in the child with neurodisability 

Nutritional problems in the child with neurodisability
Chapter:
Nutritional problems in the child with neurodisability
Author(s):

John Puntis

DOI:
10.1093/med/9780198759928.003.0021
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date: 25 May 2020

Feeding problems occur in around 50% of children with neurological disability. Needing help with feeds, choking, prolonged meal times, and poor weight gain are common. Gastro-oesophageal reflux and constipation may further complicate management, and obesity is a risk particularly in those with low energy requirements. Assessment should include a detailed feeding history and anthropometry. Oromotor skills and safety of swallow can be gauged by a speech and language therapist, and appropriate seating and eating tools by an occupational therapist. The dietician advises on nutritional requirements and how these can be met. Tube feeding is indicated for an unsafe swallow, recurrent aspiration pneumonia, and when an adequate energy intake cannot be achieved despite optimizing oral intake. On rare occasions, parenteral nutrition may be considered if gastrointestinal dysmotility progresses to the point that enteral feeding is no longer possible. This raises difficult ethical issues and early involvement of a palliative care team is highly recommended.

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