Focus
La nutrizione nella patologia neurologica
NUTRITION IN SEVERELY DISABLED CHILDREN
A. Tedeschi
Marzo 2001 - pagg. 158 -166
Abstract
As many as 90% of severely disabled children suffer from nutritional problems. Deglutition
problems and gastroesophageal reflux hamper nutrition and cause frequent lower respiratory
infections. Malnutrition follows in many cases. Appropriate management is based on
early assessment of oropharyngeal function, GER and nutritional status. Nutritional status
can be improved by appropriate feeding techniques and enteral nutrition (EN). EN is indicated
when severe feeding problems or severe GER are present. The article also discusses the
indications for gastrostomy or jejunostomy are discussed and provides recommendations for
minimizing the risk of aspiration, bacterial contamination and ostruction of the EN tube.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
developmental disorders. Springfield, IL:
Charles C Thomas, 1978.
2. Jones PM. Feeding disorders in childen with multiple handicaps. Dev Med Child Neurol 1989;31:404-6.
3. Edebol-Tysk K. Evaluation of care-load for individuals with spastic tetraplegia. Dev Med Child Neurol 1989;31:737-45.
4. Sondheeimer JM, Morris BA. Gastroesophageal reflux among severely retarded children. J Pediatr 1979;94:710-4.
5. Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM, Pencharz PB. Decrease of gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 1992; 120:569-72.
6. Morris SE. Development of oral-motor skills in the neurologically impaired child receiving non oral feeding. Dysphagia 1989; 3:135-54.
7. Dietz WH, Bandini L. Nutritional assessment of the handicapped child. Pediatr Rev 1989;11:109-15.
8. Cravioto J, DeLicardie ER, Birch HG. Nutrition, growth and neurointegrative development: an experimental and ecological study. Pediatrics 1966;38:319-72.
9. Dobbing J. Early nutrition and later achievement. Proc Nutr Soc 1990;49:103-18.
10. Rosso P, Winick M. Relation of nutrition to physical and mental development. Pediat Ann 1973;2:33-43.
11. Sanders KD, Cox K, Cannon R, et al. Growth response to enteral feeding by children with cerebral palsy. JPEN 1990;14:23-6.
12. Lewis D, Khoshoo V, Pencharz P, Golladay ES. Impact of nutritionall rehabilitation on gastroesophageal reflux in neurologically impaired children. J Pediatr Surg 1994;29: 167-70.
13. Gisel EG, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988;i:283-6.
14. Patrick J, Boland M, Stoski D, Murray GE. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 1986;28:724-39.
15. Patrick J, Pencharz PB. Undernutrition in Neurodevelopmental disability. A statement of the Nutrition Committee of the Canadian Paediatric Society. Canadian Medical Association Journal 1994;151:753-9.
16. Rudolph CD. Feeding disorders in infants and children. J Pediatr 1994;125:S116-24.
17. Dodds W, Logemann J, Stewart E. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR 1990; 154:965-74.
18. Newman LA, Cleveland RH, Blickman JG, Hillman RE, Jaramillo D. Videofluoroscopic analysis of the infant swallow. Invest Radiol 1984;19:82-6.
19. Muz J, Mathog R, Miller P, et al. Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy. Laringoscope 1987;97:1180-5.
20. Shawker TH, Sonies B, Hall TE, Baum BF. Ultrasound analysis of tongue, hyoid, and larynx activity during swallowing. Invest Radiol 1984;19:82-6.
21. Cerro P, Diotallevi P, Fanucci E, Metastasio F, Fanucci A. L’ecografia nello studio della fase orale della deglutizione. Radiol Med 1990;79:59-64.
22. Rogers BT, Arvedson J, Msall M, Demerath RR. Hypoxaemia during oral feeding of children with severe cerebral palsy. Dev Med Chil Neurol 1993;35:3-10.
23. Couriel JM, Bisset R, Miller R, Thomas A, Clarke M. Assessment of feeding problems in neurodevelopmental handicap: a team approach. Arch Dis Child 1993;69:609- 13.
24. Booth IW. Silent gastro-oesophageal reflux: how much do we miss? Arch Dis Child 1992;67:1325-7. reflux among severely retarded children. J Pediatr 1979;94:710-4.
5. Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM, Pencharz PB. Decrease of gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 1992; 120:569-72.
6. Morris SE. Development of oral-motor skills in the neurologically impaired child receiving non oral feeding. Dysphagia 1989; 3:135-54.
7. Dietz WH, Bandini L. Nutritional assessment of the handicapped child. Pediatr Rev 1989;11:109-15.
8. Cravioto J, DeLicardie ER, Birch HG. Nutrition, growth and neurointegrative development: an experimental and ecological study. Pediatrics 1966;38:319-72.
9. Dobbing J. Early nutrition and later achievement. Proc Nutr Soc 1990;49:103-18.
10. Rosso P, Winick M. Relation of nutrition to physical and mental development. Pediat Ann 1973;2:33-43.
11. Sanders KD, Cox K, Cannon R, et al. Growth response to enteral feeding by children with cerebral palsy. JPEN 1990;14:23-6.
12. Lewis D, Khoshoo V, Pencharz P, Golladay ES. Impact of nutritionall rehabilitation on gastroesophageal reflux in neurologically impaired children. J Pediatr Surg 1994;29: 167-70.
13. Gisel EG, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988;i:283-6.
14. Patrick J, Boland M, Stoski D, Murray GE. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 1986;28:724-39.
15. Patrick J, Pencharz PB. Undernutrition in Neurodevelopmental disability. A statement of the Nutrition Committee of the Canadian Paediatric Society. Canadian Medical Association Journal 1994;151:753-9.
16. Rudolph CD. Feeding disorders in infants and children. J Pediatr 1994;125:S116-24.
17. Dodds W, Logemann J, Stewart E. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR 1990; 154:965-74.
18. Newman LA, Cleveland RH, Blickman JG, Hillman RE, Jaramillo D. Videofluoroscopic analysis of the infant swallow. Invest Radiol 1984;19:82-6.
19. Muz J, Mathog R, Miller P, et al. Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy. Laringoscope 1987;97:1180-5.
20. Shawker TH, Sonies B, Hall TE, Baum BF. Ultrasound analysis of tongue, hyoid, and larynx activity during swallowing. Invest Radiol 1984;19:82-6.
21. Cerro P, Diotallevi P, Fanucci E, Metastasio F, Fanucci A. L’ecografia nello studio della fase orale della deglutizione. Radiol Med 1990;79:59-64.
22. Rogers BT, Arvedson J, Msall M, Demerath RR. Hypoxaemia during oral feeding of children with severe cerebral palsy. Dev Med Chil Neurol 1993;35:3-10.
23. Couriel JM, Bisset R, Miller R, Thomas A, Clarke M. Assessment of feeding problems in neurodevelopmental handicap: a team approach. Arch Dis Child 1993;69:609- 13.
24. Booth IW. Silent gastro-oesophageal reflux: how much do we miss? Arch Dis Child 1992;67:1325-7.
25. Sondheimer JM. Enteral feeding in infants and children with neurologic handicaps and developmental delay: questions needing answers. In: Balistreri WF, Farrell MK. Enteral Feeding: scientific basis and clinical applications. Report of the 94th Ross Conference on Pediatric Research. Columbus, Ohio: Ross Laboratories, 1988:125-35.
26. Ferry DG, Selby M, Pietro TJ. Clinical response to short-term nasogastric feeding in infants with gastroesophageal reflux and growth failure. J Pediatr Gastroenterol Nutr 1983;2:57-61.
27. Tedeschi A, Profiti V, Crupi I, Tortorella G, Guzzetta F, Lombardo G. Trattamento nutrizionale dei bambini con handicap neurocognitivo. Medico e Bambino, in stampa.
28. Spitz L, Roth K, Kiely EM, Brereton RJ, Drake DP, Milla PJ. Operation for gastro-oesophageal reflux associated with severe mental retardation. Arch Dis Child 1993;68:347- 51.
29. Bandini LG, Puelzl-Quinn H, Morelli JA, Fukagawa NK. Estimation of energy requirements in persons with severe central nervous system impairment. J Pediatr 1995;126: 828-32.
30. Fried MD, Pencharz PB. Energy and nutrient intakes of children with spastic quadriplegia. J Pediatr 1991;119:947-9.
31. Tolman KG, Jubiz W, Sanella JJ, et al. Osteomalacia associated with anticonvulsivant drug therapy in mentally retarded children. Pediatrics 1975;56:45-51.
32. Pencharz PB, Azcue MP. Resting energy expenditure in clinical practice. J Pediatr 1995;127:269-71.
33. World Health Organization. Energy and protein requirements: report of a joint FAO/WHO/UNU expert consultation. (WHO Technical Report Series No.724.). Geneva: World Health Organization, 1985.
34. Wilson SE. Pediatric Enteral Feeding. In: Grand RJ, Sutphen JL, Dietz WH (eds). Pediatric Nutrition: Theory and practice. Boston: Butterworths, 1987:771-86.
35. Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981;34:2540-5.
36. Logeman JA. Approaches to management of disordered swallowing. Baillière’s Clinical Gastroenterology 1991;5:269-80.
37. Sitzmann JV. Nutritional support of the dysphagic patient: Methods, risks, and complications of therapy. JPEN 199014:60-3.
38. American Gastroenterological Association Patient Care Committee. American Gastroenterological Association Medical Position Statement: Guidelines for the use of enteral nutrition. Gastroenterology 1995;108: 1280-301.
39. A.S.P.E.N. Board of Directors. Routes to deliver nutrition support in pediatric patients. JEPN 1993;17(S):29-31.
40. Park RHR, Allison MC, Lang J, et al. Randomized comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992;304:1406-9.
41. King SJ, Chait PG, Daneman A, Pereira J. Retrograde percutaneous gastrostomy: a prospective study in 57 children. Pediatr Radiol 1993;23:23-5.
42. Rempel GR, Colwell SO, Nelson RP. Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 1988;82:857-62.
43. Mollitt DL, Golladay ES, Sebert JJ. Symptomatic gastroesophageal reflux following gastrostomy in neurologically impaired patients Pediatrics 1985;75:1124-6.
44. Gauderer MWL. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg 1991;26:288-94.
45. Grunow JE, Al-Hafidh AS, TunellWP. Gastroesophageal reflux following percutaneous endoscopic gastrostomy in children. J Pediatr Surg 1989;24:42-5.
46. Grunow JE, Chait P, Savoie S, Mullan C, Pencharz PB. Gastrostomy feeding. Recent Advances in Paediatrics 1993;12:23-9.
47. Eicher PM. Feeding the child with disabilities. In: Batshaw ML, Perret MY (eds). Children with disabilities. Baltimora: Paul H Brookes Publishing C, 1992:197-211.
48. Khoshoo V, Zembo M, King A, Dhar M, Refen R, Pencharz P. Incidence of gastroesophageal reflux with Whey- and Casein-based formulas in infants and in children with severe neurological impairment. J Pediatr Gastroenterol Nutr 1996;22:48-55.
49. Bertollo D. Your child and home nasogastric tube feeding. The Hospital for Sick Children, Nutrition Support Nursing Team. Toronto: Medical Publications, 1987.
50. Bertollo-Harrison D. Your child and home gastrostomy feeding. The Hospital for Sick Children, Nutrition Support Nursing Team. Toronto: Medical Publications, 1992.
51. Moore MC, Greene HL. Tube feeding of infants and children. Pediatr Clin North Am 1985;32:381-400.
2. Jones PM. Feeding disorders in childen with multiple handicaps. Dev Med Child Neurol 1989;31:404-6.
3. Edebol-Tysk K. Evaluation of care-load for individuals with spastic tetraplegia. Dev Med Child Neurol 1989;31:737-45.
4. Sondheeimer JM, Morris BA. Gastroesophageal reflux among severely retarded children. J Pediatr 1979;94:710-4.
5. Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM, Pencharz PB. Decrease of gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 1992; 120:569-72.
6. Morris SE. Development of oral-motor skills in the neurologically impaired child receiving non oral feeding. Dysphagia 1989; 3:135-54.
7. Dietz WH, Bandini L. Nutritional assessment of the handicapped child. Pediatr Rev 1989;11:109-15.
8. Cravioto J, DeLicardie ER, Birch HG. Nutrition, growth and neurointegrative development: an experimental and ecological study. Pediatrics 1966;38:319-72.
9. Dobbing J. Early nutrition and later achievement. Proc Nutr Soc 1990;49:103-18.
10. Rosso P, Winick M. Relation of nutrition to physical and mental development. Pediat Ann 1973;2:33-43.
11. Sanders KD, Cox K, Cannon R, et al. Growth response to enteral feeding by children with cerebral palsy. JPEN 1990;14:23-6.
12. Lewis D, Khoshoo V, Pencharz P, Golladay ES. Impact of nutritionall rehabilitation on gastroesophageal reflux in neurologically impaired children. J Pediatr Surg 1994;29: 167-70.
13. Gisel EG, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988;i:283-6.
14. Patrick J, Boland M, Stoski D, Murray GE. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 1986;28:724-39.
15. Patrick J, Pencharz PB. Undernutrition in Neurodevelopmental disability. A statement of the Nutrition Committee of the Canadian Paediatric Society. Canadian Medical Association Journal 1994;151:753-9.
16. Rudolph CD. Feeding disorders in infants and children. J Pediatr 1994;125:S116-24.
17. Dodds W, Logemann J, Stewart E. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR 1990; 154:965-74.
18. Newman LA, Cleveland RH, Blickman JG, Hillman RE, Jaramillo D. Videofluoroscopic analysis of the infant swallow. Invest Radiol 1984;19:82-6.
19. Muz J, Mathog R, Miller P, et al. Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy. Laringoscope 1987;97:1180-5.
20. Shawker TH, Sonies B, Hall TE, Baum BF. Ultrasound analysis of tongue, hyoid, and larynx activity during swallowing. Invest Radiol 1984;19:82-6.
21. Cerro P, Diotallevi P, Fanucci E, Metastasio F, Fanucci A. L’ecografia nello studio della fase orale della deglutizione. Radiol Med 1990;79:59-64.
22. Rogers BT, Arvedson J, Msall M, Demerath RR. Hypoxaemia during oral feeding of children with severe cerebral palsy. Dev Med Chil Neurol 1993;35:3-10.
23. Couriel JM, Bisset R, Miller R, Thomas A, Clarke M. Assessment of feeding problems in neurodevelopmental handicap: a team approach. Arch Dis Child 1993;69:609- 13.
24. Booth IW. Silent gastro-oesophageal reflux: how much do we miss? Arch Dis Child 1992;67:1325-7. reflux among severely retarded children. J Pediatr 1979;94:710-4.
5. Fried MD, Khoshoo V, Secker DJ, Gilday DL, Ash JM, Pencharz PB. Decrease of gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 1992; 120:569-72.
6. Morris SE. Development of oral-motor skills in the neurologically impaired child receiving non oral feeding. Dysphagia 1989; 3:135-54.
7. Dietz WH, Bandini L. Nutritional assessment of the handicapped child. Pediatr Rev 1989;11:109-15.
8. Cravioto J, DeLicardie ER, Birch HG. Nutrition, growth and neurointegrative development: an experimental and ecological study. Pediatrics 1966;38:319-72.
9. Dobbing J. Early nutrition and later achievement. Proc Nutr Soc 1990;49:103-18.
10. Rosso P, Winick M. Relation of nutrition to physical and mental development. Pediat Ann 1973;2:33-43.
11. Sanders KD, Cox K, Cannon R, et al. Growth response to enteral feeding by children with cerebral palsy. JPEN 1990;14:23-6.
12. Lewis D, Khoshoo V, Pencharz P, Golladay ES. Impact of nutritionall rehabilitation on gastroesophageal reflux in neurologically impaired children. J Pediatr Surg 1994;29: 167-70.
13. Gisel EG, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988;i:283-6.
14. Patrick J, Boland M, Stoski D, Murray GE. Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 1986;28:724-39.
15. Patrick J, Pencharz PB. Undernutrition in Neurodevelopmental disability. A statement of the Nutrition Committee of the Canadian Paediatric Society. Canadian Medical Association Journal 1994;151:753-9.
16. Rudolph CD. Feeding disorders in infants and children. J Pediatr 1994;125:S116-24.
17. Dodds W, Logemann J, Stewart E. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR 1990; 154:965-74.
18. Newman LA, Cleveland RH, Blickman JG, Hillman RE, Jaramillo D. Videofluoroscopic analysis of the infant swallow. Invest Radiol 1984;19:82-6.
19. Muz J, Mathog R, Miller P, et al. Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy. Laringoscope 1987;97:1180-5.
20. Shawker TH, Sonies B, Hall TE, Baum BF. Ultrasound analysis of tongue, hyoid, and larynx activity during swallowing. Invest Radiol 1984;19:82-6.
21. Cerro P, Diotallevi P, Fanucci E, Metastasio F, Fanucci A. L’ecografia nello studio della fase orale della deglutizione. Radiol Med 1990;79:59-64.
22. Rogers BT, Arvedson J, Msall M, Demerath RR. Hypoxaemia during oral feeding of children with severe cerebral palsy. Dev Med Chil Neurol 1993;35:3-10.
23. Couriel JM, Bisset R, Miller R, Thomas A, Clarke M. Assessment of feeding problems in neurodevelopmental handicap: a team approach. Arch Dis Child 1993;69:609- 13.
24. Booth IW. Silent gastro-oesophageal reflux: how much do we miss? Arch Dis Child 1992;67:1325-7.
25. Sondheimer JM. Enteral feeding in infants and children with neurologic handicaps and developmental delay: questions needing answers. In: Balistreri WF, Farrell MK. Enteral Feeding: scientific basis and clinical applications. Report of the 94th Ross Conference on Pediatric Research. Columbus, Ohio: Ross Laboratories, 1988:125-35.
26. Ferry DG, Selby M, Pietro TJ. Clinical response to short-term nasogastric feeding in infants with gastroesophageal reflux and growth failure. J Pediatr Gastroenterol Nutr 1983;2:57-61.
27. Tedeschi A, Profiti V, Crupi I, Tortorella G, Guzzetta F, Lombardo G. Trattamento nutrizionale dei bambini con handicap neurocognitivo. Medico e Bambino, in stampa.
28. Spitz L, Roth K, Kiely EM, Brereton RJ, Drake DP, Milla PJ. Operation for gastro-oesophageal reflux associated with severe mental retardation. Arch Dis Child 1993;68:347- 51.
29. Bandini LG, Puelzl-Quinn H, Morelli JA, Fukagawa NK. Estimation of energy requirements in persons with severe central nervous system impairment. J Pediatr 1995;126: 828-32.
30. Fried MD, Pencharz PB. Energy and nutrient intakes of children with spastic quadriplegia. J Pediatr 1991;119:947-9.
31. Tolman KG, Jubiz W, Sanella JJ, et al. Osteomalacia associated with anticonvulsivant drug therapy in mentally retarded children. Pediatrics 1975;56:45-51.
32. Pencharz PB, Azcue MP. Resting energy expenditure in clinical practice. J Pediatr 1995;127:269-71.
33. World Health Organization. Energy and protein requirements: report of a joint FAO/WHO/UNU expert consultation. (WHO Technical Report Series No.724.). Geneva: World Health Organization, 1985.
34. Wilson SE. Pediatric Enteral Feeding. In: Grand RJ, Sutphen JL, Dietz WH (eds). Pediatric Nutrition: Theory and practice. Boston: Butterworths, 1987:771-86.
35. Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981;34:2540-5.
36. Logeman JA. Approaches to management of disordered swallowing. Baillière’s Clinical Gastroenterology 1991;5:269-80.
37. Sitzmann JV. Nutritional support of the dysphagic patient: Methods, risks, and complications of therapy. JPEN 199014:60-3.
38. American Gastroenterological Association Patient Care Committee. American Gastroenterological Association Medical Position Statement: Guidelines for the use of enteral nutrition. Gastroenterology 1995;108: 1280-301.
39. A.S.P.E.N. Board of Directors. Routes to deliver nutrition support in pediatric patients. JEPN 1993;17(S):29-31.
40. Park RHR, Allison MC, Lang J, et al. Randomized comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992;304:1406-9.
41. King SJ, Chait PG, Daneman A, Pereira J. Retrograde percutaneous gastrostomy: a prospective study in 57 children. Pediatr Radiol 1993;23:23-5.
42. Rempel GR, Colwell SO, Nelson RP. Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 1988;82:857-62.
43. Mollitt DL, Golladay ES, Sebert JJ. Symptomatic gastroesophageal reflux following gastrostomy in neurologically impaired patients Pediatrics 1985;75:1124-6.
44. Gauderer MWL. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg 1991;26:288-94.
45. Grunow JE, Al-Hafidh AS, TunellWP. Gastroesophageal reflux following percutaneous endoscopic gastrostomy in children. J Pediatr Surg 1989;24:42-5.
46. Grunow JE, Chait P, Savoie S, Mullan C, Pencharz PB. Gastrostomy feeding. Recent Advances in Paediatrics 1993;12:23-9.
47. Eicher PM. Feeding the child with disabilities. In: Batshaw ML, Perret MY (eds). Children with disabilities. Baltimora: Paul H Brookes Publishing C, 1992:197-211.
48. Khoshoo V, Zembo M, King A, Dhar M, Refen R, Pencharz P. Incidence of gastroesophageal reflux with Whey- and Casein-based formulas in infants and in children with severe neurological impairment. J Pediatr Gastroenterol Nutr 1996;22:48-55.
49. Bertollo D. Your child and home nasogastric tube feeding. The Hospital for Sick Children, Nutrition Support Nursing Team. Toronto: Medical Publications, 1987.
50. Bertollo-Harrison D. Your child and home gastrostomy feeding. The Hospital for Sick Children, Nutrition Support Nursing Team. Toronto: Medical Publications, 1992.
51. Moore MC, Greene HL. Tube feeding of infants and children. Pediatr Clin North Am 1985;32:381-400.