The following recommendations are based on existing, mainly descriptive, studies and on the expert opinion of the committee.
- Secondary undernutrition due to an eating problem in children with a neurodevelopmental disability should be treated or, ideally, prevented. Restoring the nutrition of these children and reducing the time spent feeding them each day should be regarded as an important part of their general care.
- The nutritional status of these children is best determined by techniques that measure body fat stores and for which there are normative data, such as triceps skinfold measurements.
- Treatment should start with high-energy supplementation, given orally. However, in children with a severe disability, therapy must involve tube feeding, either to supplement oral feeding or to replace it. The advent of percutaneous enterostomy has introduced a welcome alternative for any child who requires tube feeding for more than 6 to 8 weeks.
- Daily energy needs are lower in patients with a neurodevelopmental disability than in other patients because they are inactive and have reduced muscle mass; energy needs range from 2900 to 4600 kJ per day.
- Hence, formulas designed for infants or children less than 6 years of age should be used because of their higher ratios of nutrients to energy.
- In children with mild disabilities, oral-motor skills should be maintained and improved. One effective strategy is to feed the child through an enterostomy tube only when he or she is asleep, usually at night. The child is then likely to get thirsty and hungry during the day and want to eat, which gives the caregiver or therapist an opportunity to promote oral-motor skills.
- The management of undernutrition in children with a neurodevelopmental disability is best carried out by a multidisciplinary team.
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