Book Review: Feeding and Nutrition in Children with Neurodevelopmental Disabilities

Abstract

Book Review: Feeding and Nutrition in Children with Neurodevelopmental Disabilities A practical guide from Mac Keith Press Edited by Peter B Sullivan Mac Keith Press , 2009 , £20.00 (Paperback) , 196 pages . ISBN 978-1-898683-60-5 This book follows on from, ‘Feeding the Disabled Child ’, published in the Clinics in Developmental Medicine series by Mac Keith Press over 10 years ago. Apart from providing a welcome medical update, this book concentrates on practical aspects as it is written by members of a multidisciplinary team. Dr Sullivan starts with an overall account of the many and severe problems faced by children with dysphagia and their carers and illustrates these with a series of helpful case scenarios. Dieticians then describe how to assess nutrition, emphasizing the use of skinfold thicknesses as well as other proxy measures of height for children who cannot stand. A later chapter by different dieticians discusses nutritional management, both oral and by tube, with details of the pros and cons of enteral formulae as against liquidised table food. We are reminded that a disabled child only needs around 75% at most of the normal calorie requirements for height and age. The two dietetic teams use different estimates of fluid requirements, but agree that the best guide is to ensure that adequate volumes of urine are produced. Oromotor problems are described in full by a speech and language therapist, stressing the importance of a detailed and accurate clinical assessment that includes all aspects such as behavior and communication during feeding. The consequences of a diagnosis of an unsafe swallow are very significant, although we do need more research on the variable pulmonary consequences of aspiration for complete accuracy. The chapter written by a nurse gives a detailed account of the wider issues affecting feeding the disabled child, including the importance of coordination of the multidisciplinary team, behavioural issues, practicalities of tube feeding, and a sensitive section on the difficulties some parents have over planning to feed their child artificially. The editor adds a chapter on the assessment and management of gastrointestinal disorders in disabled children and another doctor summarizes the different investigations now available, from videoflouroscopic swallowing study, pH and impedance monitoring for reflux, through to anal manometry. A good clinical examination does remain paramount, including the use of the finger, still the best way by far of diagnosing constipation. The book ends with an extremely helpful appendix, which contains growth charts specifically for disabled children, guidelines for management of tube feeding, ways of incorporating nutrient-rich foods, and much more. This book is essential reading for all members of the multidisciplinary team involved with feeding the disabled child. I would also heartily recommend it to parents, and suggest they themselves could contribute a chapter in the inevitable sequel in this successful series.