Feeding problems and malnutrition in children and adolescents with severe neurological impairments

Feeding problems are particularly common in children and adolescents with neurological handicaps and cerebral palsy. These difficulties impose agreat burden on caregivers, lead to alower quality of life and increased risk of secondary complications, especially related to malnutrition. Gastrointestinal (GI) comorbidities, such as oropharyngeal dysphagia, gastroesophageal reflux disease (GERD) and constipation make a substantial contribution to malnutrition.At each visit the feeding situation has to be documented and anthropometric data should be recorded. Simply measuring the height and body weight is not sufficient and segment length, triceps skinfold thickness and upper midarm circumference measurements should be also be performed because they are a better reflection of the nutritional status.In children with recognizable malnutrition or red flag signs, various interventions can be considered to improve the situation. The type of intervention is mainly dependent on the GI comorbidities. In many cases tube feeding via percutaneous endoscopic gastrostomy (PEG) improves the nutritional status and diminishes the burden of time-consuming and unsafe oral feeding. In cases with severe GERD this has to be combined with antireflux surgery or jejunal tube insertion. There are several possibilities to improve the type and composition of formula feeding.In addition to neurological follow-up, routine management of patients with such complex problems should also include nutritional and gastroenterological expertise and interdisciplinary care including physiotherapists, speech therapists and psychologists to ensure the optimal basis for further physical and neurological development and to avoid unnecessary hospital admissions.