Stunted growth
MANAGING MALNUTRITION IN CHILDREN WITH GASTROINTESTINAL (GI) CONDITIONS
GI symptoms can be relatively common in infants and children and are often quickly treated with medicine or dietary changes. However, undiagnosed GI problems can lead to ongoing issues that could impact a child’s growth, development, and overall health.1
Among the most common GI conditions are irritable bowel syndrome (IBS), coeliac disease, and inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis.1 GI conditions can cause problems with food tolerance, which may mean the child becomes malnourished or at risk of malnutrition. In severe cases, this can lead to malabsorption, affecting their response to nutritional support and their ability to recover.2
Nutritional assessment is integral to clinical care as early intervention can support improved patient outcomes.3
Malnutrition and associated comorbidities in children with GI conditions can be common:
Growth failure is seen in up to
40% of children with IBD as a
result of poor nutrition4
Up to 40% of children with
coeliac disease have severe
wasting for age5
In a vicious cycle, malnutrition can lead to altered GI function, such as malabsorption and diarrhoea, whilst pre-existing GI disorders may also lead to malnutrition. Presence of malnutrition in children with GI conditions is critical as issues such as malabsorption can directly interfere with nutritional support, which can limit recovery from malnutrition.2
Long-term health conditions in children, such as GI disorders, can have a detrimental impact on growth, which can caused by many factors, including:6
Increased energy
expenditure
Nutritional loss
through
malabsorption
Difficulty
ingesting food
Decreased
appetite
Children with compromised GI function are at increased risk of malnutrition,7 with consequences including:2, 8-10
Stunted growth
Hindered cognitive
development
Increased risk of
morbidity and
mortality
Negative behavioural
changes
Increased risk of
infection
Poor sleep patterns
Reduced quality of life
Increased use of
healthcare resources
Ongoing GI symptoms in children can also impact the quality of life of their family, with parents reporting greater interpersonal sensitivity, depression and anxiety compared to parents of healthy children.11
Identifying the signs and symptoms of malnutrition early is vital to provide timely and appropriate nutritional intervention.12
Nutritional assessment/screening is a quick and simple way to identify disease-related malnutrition,13 providing a proactive approach to ensuring adequate nutrition that enables children to:14
A validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age.
A validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation.
MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children.
Nutritional support is an important part of the care of children with GI and may support:2,15-17
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NUTRITIONAL SUPPORT GUIDANCE FOR MANAGING CHILDREN WITH GI CONDITIONS
Nutritional therapy in children with compromised GI function should involve interventions which address the effects of diarrhoea and malnutrition to help improve the child’s development.2
In the case of children experiencing GI symptoms, a Peptide-based formula may be the most appropriate intervention. Peptide formulas provide protein in shorter parts (peptides) that are absorbed more rapidly by the body. Compared to whole protein feeds, peptide-based feeds have been associated with improved GI symptoms, improved tolerance and a reduced risk of diarrhoea in malnourished children with compromised GI function.2
The choices made for nutritional support should be determined using a multi-disciplinary approach and should be based on the severity of malnutrition and the sufficiency of food intake/expected food intake.15
PaediaSure® Plus
PaediaSure Plus is suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. PaediaSure Plus provides 1.5 kcal/ml and is available both as a 500 ml Ready to Hang tube feed and as a 200 ml oral nutritional supplement.
PaediaSure® Compact
PaediaSure Compact is a 125 ml oral nutritional supplement suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. It has been specifically developed for children who may benefit from a smaller volume, as an alternative to ready-to-drink supplements which are 200 ml in volume. Each bottle provides 301 kcal (2.4 kcal/ml) and 8.4 g of protein. The milkshake style oral nutritional supplement is ready-to-drink and available in three delicious flavours: banana, strawberry and vanilla.
PaediaSure® Peptide
PaediaSure Peptide is suitable for the dietary management of children weighing 8-30 kg with malabsorption or children who experience symptoms of poor feed tolerance.
PaediaSure Peptide is 1.0 kcal/ml, with 100% proteins broken down to peptides*, 50% fat as medium-chain triglycerides (MCT) and clinically lactose free. PaediaSure Peptide is available both as a 500 ml Ready to Hang tube feed and as a 200 ml bottle. It is available in vanilla flavour and is best served chilled.
*Peptides are partially broken down proteins, which makes them easier to digest and absorb in the gut than whole proteins.
This article has been developed by a multi-disciplinary group with a specialist interest in paediatric gastrointestinal issues. It has been designed to support members of the multidisciplinary team (MDT) identify, assess and manage GI symptoms in children.
This article by Lauren McVeigh, Regional Specialist Paediatric Dietitian (Gastroenterology), Bristol Royal Hospital for Children, discusses the use of peptide-based feeds in children with disease-related malnutrition and their impact on clinical outcomes in various paediatric patient groups.
References:
1. NHS Northern Lincolnshire and Goole NHS Foundation Trust, 2022.
2. Selimoglu MA, et al. Frontiers in Pediatrics. 2021;9:2296-2360
3. Agostoni C et al. Journal of Pediatric Gastroenterology and Nutrition 2005;41(1):8–11
4. Forbes A et al. Clin Nutr. 2017;36(2):321-347
5. Elramli SS. International Journal of Health Sciences 2023;6(1):1-15
6. Westwood A S. Afr Med J 2015;105(7):606
7. Chen L et al. JAND 2017;117(9):A30
8. Tette E et al. BMC Pediatr 2015;15:189.
9. Martins V et al. Int J Environ Res Public Health 2011;8(6):1817–1846
10. Stanga Z et al. Clin Nutr 2007;26(3):379-382
11. Hommel KA et al. J Clin Psychol Med Setting 2010;17(2):159–166
12. Romano C et al. JPGN 2017;65: 242-264
13. McCarthy H, et al. J Hum Nutr Diet. 2021;25(4):311-8
14. RCN, 2010: Nutrition in children and young people with cancer. Available online at https://media.gosh.nhs.uk/documents/nutrition_in_children_andg_people_with_cancer.pdf. Last accessed July 2023
15. Balestrieri P, et al. Nutrients 2020;12(2):372
16. Chio TD et al. Nutrients 2021;13:2109
17. Corsello A et al. Nutrients 2020;12:2693
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ENSURE PLUS
1 x 220 ml
Flavor: Apple
1,5 kcal / ml
Nutrition Information
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
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