Diagnosis and management of gastroentestinal problems in the neurolgically impaired child

Nutrition problems in neurologically impaired children are very common but are often not given enough attention. Retardation in length and weight, diminished muscle strength, impaired cardiac activity, lowered mental alertness and less resistance to infections often follow. The child gets easily tired and feeding problems often increase in a vicious circle. Gastrointestinal reflux, aspiration and constipation can worsen the problems. If untreated, aspiration can result in pneumonia, lung fibrosis and pulmonary insufficiency. Modern methods now exist to evaluate and treat undernutrition. In the first instance minor nutritional problems can be dealt with by a better consistency of food and liquid, enrichment of food and a bulk laxative, but if the problems are more severe early referral to an experienced team for assessment is recommended. Oral feeding must be safe and give enough nutrients otherwise gastrostomy feeding should be instituted early. Where reflux and aspiration are not controlled by medicine, antireflux surgery can relieve these symptoms. There is a critical window in the first year of life to treat malnutrition and enable the child to catch up. Improved nutrition can lead to improved growth, strength and mobility, better cognitive development, decreased irritability and spasticity, better immunity, prophylaxis and healing of pressure sores and improved peripheral circulation.