Nutrition in children with neurodisability

Abstract

Children with neurodisability are at risk of nutritional impairment due to a number of factors including feeding and swallowing difficulties, gastrointestinal disorders, disorders of movement and posture, immobility, medication, adverse food related sensory experience and behavioural feeding difficulties. Undernutrition has a negative impact on growth, general health indices, bone health, muscle strength, immunity and wound healing and brain and cognitive development. Regular multidisciplinary assessment including the routine measurement of body composition and micronutrient status are recommended to inform appropriate nutritional support and intervention. Intervention may include management of tone, posture and positioning for feeding, comorbid gastrointestinal disease, seizure management, alteration to medications or use of a sensory diet as well as changes to protein and energy intake, dietary fluid and fibre content, micronutrient supplementation, or establishment of an appropriate enteral feeding route in children unable to safely maintain nutritional needs orally. Children having nutritional support should have regular multidisciplinary follow up as clinically indicated, and when the clinical situation changes. This article aims to briefly review the most important aspects of nutrition in children with neurodisability and offer practical advice to health care practitioners involved in their care.