The relationship between oral-motor involvement and growth: A pilot study in a pediatric population with cerebral palsy

293

426

Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.

Section: Does Feeding Times Compete With Rehabilitation?mentioning

confidence: 99%

European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment

Romano

Wynckel²,

Hulst

et al. 2017

293

426

“…Oral motor dysfunction is a major factor in the pathogenesis of undernutrition and usually correlates with the severity of motor impairment (27,38‐41). Children may present with inadequate lip closure, drooling, and persistent tongue thrust, resulting in food loss through spillage (35,42).…”

Section: Undernutrition Growth Failure and Overweightmentioning

confidence: 99%

Nutrition Support for Neurologically Impaired Children

Marchand

Motil²

2006

137

Undernutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that affect the neurologically impaired child. Monitoring neurologically impaired children for nutritional comorbidities is an integral part of their care. Early involvement by a multidisciplinary team of physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is essential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status. Careful evaluation and monitoring of severely disabled children for nutritional problems are warranted because of the increased risk of nutrition-related morbidity and mortality.

“…Feeding impairment frequently complicates the clinical course of children with neurologic disorders (1‐3), including those with Rett syndrome (RS) (4‐8). Food refusal, difficulty in chewing or swallowing, choking on table foods, and/or regurgitation through the nose are reported in approximately 75% of girls with RS (4‐7).…”

mentioning

confidence: 99%

“…Feeding impairment places the child with neurologic disabilities at risk for nutritional disorders (2,6). Children with inadequate lip closure or the presence of the extrusion reflex, tongue incoordination, tonic bite reflex, gagging, or delayed deglutition take 12 to 15 minutes longer to chew and swallow pureed and solid food than their healthy counterparts (1).…”

mentioning

confidence: 99%

“…Parents often overestimate the duration of meal times, particularly in children with the most severe neurologic deficits (10). The significance of these observations is that feeding impairment is likely to results in poor dietary intake, malnutrition, and growth failure (2,7,11,12). Whether early oromotor intervention reverses the adverse nutritional outcome, particularly in RS, is unknown.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Oropharyngeal Dysfunction and Gastroesophageal Dysmotility Are Present in Girls and Women with Rett Syndrome

Motil,

Schultz,

Browning

et al. 1999

Background:Feeding impairment frequently complicates the course of children with neurologic disorders and places them at risk for malnutrition and growth failure. Although feeding abnormalities have been reported in female patients with Rett syndrome, the mechanisms that account for these findings have not been elucidated fully. This study was designed to characterize the clinical features of oropharyngeal and gastroesophageal dysfunction and their impact on the dietary intake and nutritional status of female subjects with Rett syndrome.Methods:The clinical features of oropharyngeal and gastroesophageal dysfunction in 13 female patients with Rett syndrome, (age range, 3.7 to 25.7 years) were characterized by an oral feeding assessment, swallowing function study, and upper gastrointestinal series. Growth, nutritional status, and body composition were determined by stadiometry and anthropometry. Dietary intakes were determined from 3‐day food records.Results:Oropharyngeal dysfunction and gastroesophageal dysmotility were present in 100% and 69%, respectively, of the study patients with Rett syndrome. The scope and severity of these abnormalities were apparent only by videofluoroscopy. Abnormalities of oropharyngeal function included poor tongue mobility, reduced oropharyngeal clearance, and laryngeal penetration of liquids and solid food during swallowing. Esophageal dysmotility included absent primary or secondary waves, delayed emptying, atony, the presence of tertiary waves, spasm, and gastroesophageal reflux. Gastric dysmotility included diminished peristalsis or atony. Lower dietary energy intakes were associated with persistence of residue in the valleculae and pyriform sinuses and less body fat.Conclusion:The prevalence of oropharyngeal dysfunction and gastroesophageal dysmotility warrants early diagnostic evaluation and intervention strategies to improve the nutritional status of girls and women with RS.