Nutrition Management in Pediatric Gastrointestinal Motility Disorders

Abstract

Gastrointestinal (GI) motility disorders are associated with suboptimal nutrition in children, mainly because of malabsorption and symptoms limiting dietary intake. Apart from medical therapy, nutrition support has a crucial role in maintaining growth and improving clinical outcomes in children. Based on recent data and guidelines, this review provides an overview of nutrition assessment and specific interventions for common pediatric GI disorders including gastroesophageal reflux disease, esophageal motility disorders, gastroparesis, chronic intestinal pseudo‐obstruction, and constipation. Several approaches including diet modification, enteral nutrition (gastric vs post‐pyloric, temporary vs permanent access, bolus vs continuous), and parenteral nutrition need to be tailored based on patient's nutrition and clinical assessment.

Paediatric intestinal pseudo-obstruction: a scoping review

“…Various strategies to maintain nutrition in patients with PIPO include oral feeding, enteral nutrition (EN) and parenteral nutrition (PN) [ 2 ]. Up to two-thirds of patients will require PN during the disease course; however, in the long-term, one-third of patients will tolerate oral nutrition, another third will require EN and the remaining third will require partial or total PN [ 51 , 54 ]. Poorer outcomes for intestinal autonomy are associated with neonatal-onset PIPO and the presence of urinary tract involvement [ 55 ].…”

“…EN is initiated in children who are unable to meet their nutritional needs with oral feeds alone [ 5 ]. EN is preferable in those with the presence of MMC activity as it maintains stimulation of the GIT mucosal transporters, preserves GIT architecture and function and promotes mucosal growth [ 5 , 49 , 54 ]. EN is initially administered via a nasogastric tube as constant or cyclical feeds [ 52 ].…”

A Pragmatic Approach to Assessment of Chronic and Recurrent Pain in Children with Severe Neurologic Impairment

“…Indeed, this should be considered in any irritable, sweaty and restless child with a PEG two hours after the meal and confirmed by detection of hypoglycemia. In the perspective of a gastric motility disorder, a trial with a different feeding should be considered [ 25 ].…”

Pediatric Intestinal Pseudo-Obstruction: Progress and Challenges

“…Children with PIPO often have malnutrition from malabsorption and food avoidance because of GI symptoms. Small, frequent meals low in fat and fiber are recommended as well as avoiding lactose-containing beverages and carbonated drinks ( 43 ). Over time, one third of patients will require total or partial PN, one third EN and the remaining will tolerate oral feeding ( 2 ).…”