Feeding difficulties
MANAGING MALNUTRITION IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT (NI)
Neurological Impairment (NI) relates to disorders of the central nervous system, affecting speech, motor skills, vision, memory, muscle actions, and learning abilities.1 NI includes conditions such as cerebral palsy, autism, ADHD (attention deficit hyperactivity disorder) and epilepsy.2
It is estimated that 3-4% of children in England have a neurological impairment or condition.2 Children with NI often experience feeding difficulties, such as oropharyngeal dysphagia, gastroesophageal reflux and altered energy metabolism, meaning they often either have or are at risk of disease-related malnutrition.3
For children living with NI, disease-related malnutrition can have a significant impact on their condition and their quality of life. Nutritional assessment is therefore an important part of clinical care as early intervention can support improved patient outcomes.3
Malnutrition risk in children is common across a variety of NI conditions:3-5
Undernourishment is found in
46-90% of children with cerebral
palsy
89% of autistic children display
difficulty with eating
Up to 40% of children with
refractory epilepsy are
malnourished
Children with NI are often at increased risk of disease-related malnutrition. There can be many reasons for this, depending on the condition and the severity of motor impairment, but causes can include:3
Feeding difficulties
Altered energy requirements
Dysphagia
Frequent gastrointestinal (GI)
symptoms, such as constipation
or reflux
Reduced energy and nutrient
intake
Cognitive impairment making it
difficult to communicate hunger
or thirst
BURDEN OF DISEASE-RELATED MALNUTRITION FOR CHILDREN WITH NIFeeding difficulties and GI symptoms are common in children with NI, adversely impacting nutritional status, comorbidities and overall health and wellbeing.1,3
Over and undernutrition in children with NI can lead to:1,3
Poor growth
Impaired wound
healing
Osteopenia
Increased spasticity
Reduced quality of life
Increased healthcare
use
Malnutrition in children with NI can also impact their participation in educational and social activities.3
Regular nutritional assessment is essential in children with NI to identify early signs and symptoms of malnutrition. Height, weight and body composition should be checked at least every 6 months, and micronutrient status should be assessed annually.1
A feeding history using a food diary is important to determine textures, viscosity, quantity and duration of feeding, as well as any problems with chewing and swallowing.3
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 NI and may support:3
The choice of nutritional support should be determined by the patient, their condition and their nutritional needs. Energy, fibre, feed volume, protein source (e.g. whole protein vs peptides) and micronutrient levels should all be considered.1
Oral ingestion should be encouraged where possible, but enteral tube feeding (either full or partial) should be considered if oral feeding is found to be unsafe or is not meeting their nutritional requirements using oral feeds.
As children with NI often have problems with dysphagia, it can be useful to concentrate calories in a small volume. Inclusion of medium chain triglycerides (MCTs) is beneficial for children with malabsorption, as they are more easy to digest.3,6
If the patient is experiencing GI symptoms, a peptide-based formula may be the most appropriate intervention. Peptide-based 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.7
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.
In this course, Vicky Davies will talk about the symptoms of gastrointestinal intolerance, discuss local strategies for improving nutritional support and feeding tolerance in the neuro intensive care setting, and review the processes that can be used to address feeding intolerance in other clinical settings.
This consensus article from Iva Hojsak and colleagues highlights the importance of dietary fibre, an essential nutrient that is crucial for children in health and disease. Differing functional properties according to fibre type, whether bulking or fermentable, are discussed and benefits for health explained. Practical information is provided for clinicians and practitioners to help children meet their fibre needs.
References:
1. Romano C et al. JPGN 2017;65: 242-264.
2. Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays. Chapter 9. Children with neurodevelopmental disabilities. Clare Blackburn, Janet Read, Nick Spencer, authors.
3. Penagini F et al. Nutrients 2015;7:9400-9415.
4. Beyond Autism, 2022: Autism and Eating. Available online: https://www.beyondautism.org.uk/about-autism/understanding-autism/autism-and-eating/. Last accessed March 2024.
5. Bertoli S et al. Nutrition Journal 2006;5:14.
6. Shah N and Limetkai BN. The Use of Medium-Chain Triglycerides in Gastrointestinal Disorders. Practical Gastroenterology 2017. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-February-17.pdf Last Accessed March 2024.
7. Selimoglu MA et al. Front. Pediatr 2021;9:610275.
SESSION TIMEOUT
You have now gained access to ProConnect for a limited time. We will now verify your details before your account becomes fully active.
You are now able to freely access all resources and education during this visit to the ProConnect website. An email will be sent to you within 2 working days to activate your account which will complete your registration process.
Added to Bag
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 |
footnotes
Product details not available.
You are about to exit for another Abbott country or region specific website.
Please be aware that the website you have requested is intended for the residents of a particular country or region, as noted on that site. As a result, the site may contain information on pharmaceuticals, medical devices and other products or uses of those products that are not approved in other countries or regions.
The website you have requested also may not be optimised for your specific screen size.
Do you wish to continue and exit this website?
UK-N/A-2200465 | July 2022
This website is for UK HCPs and UK Patients only. If you are outside of the UK please visit our global website Abbott.com
If you choose "I am a patient/carer”, you will be entering a website intended for patients and carers which has information on Abbott products. Products on this website are to be used under medical supervision. If you have questions about the product information discussed on this website, you should consult with your healthcare professional.
Stay Connected