This is the current release of the guideline.

1. Nutritional support is an integral part of the care of neurologically impaired children and is carried out by a multidisciplinary team of pediatric specialists, including physicians, nurses, dietitians, occupational and speech therapists, psychologists, and social workers.
2. Nutritional assessments may be performed at least annually in the older child and more frequently in the infant and toddler; height or length, weight, and body mass index (BMI) or weight-for-length may be sufficient to document adequate growth and nutrient intakes.
3. Mechanisms must be in place to insure the early identification of children at high risk for undernutrition, growth failure, chronic lung disease due to aspiration, and overweight, particularly younger children, children with severe neurological disability, and children with oral motor dysfunction.
4. Alternative anthropometric indices such as mid upper arm circumference, triceps skinfold thickness, and lower leg length can be used to evaluate nutritional status when accurate weight and height measurements are difficult to obtain.
5. Monitoring the rate of weight gain and BMI in response to nutritional therapy is an appropriate method to determine the adequacy of dietary intake because nutrient requirements may be lower than the Dietary Reference Intake (DRI) for age and because abnormalities of muscle tone, physical activity, and growth may be present.
6. Monitoring for micronutrient deficiencies such as iron and vitamin D may be considered annually; providing prophylactic supplements of micronutrients serves as a reasonable preventive strategy.
7. Foods with high nutrient and energy density are an appropriate first step in the nutritional repletion of children who can be fed orally; modification of food and beverage textures and consistencies may be required in children with advanced oral motor dysfunction. Periodic reassessment of oral feeding skills is important to determine the potential for oral feeding.
8. Enteral tube feedings can be initiated early in children who are unable to feed orally or who cannot achieve sufficient oral intake to maintain adequate nutritional or hydration status.
9. Nasogastric or nasojejunal tube feedings are reserved for short-term nutritional intervention; gastrostomy or gastrojejunostomy tube feedings may be considered when long-term nutritional rehabilitation is required.
10. Antireflux procedures such as esophageal fundoplication are reserved for appropriate clinical indications; anticipatory guidance that highlights symptoms such as retching and frequency of fundoplication failure is important.
11. Although the health and welfare of the child are paramount, parental concerns and family issues have a role in the decision to provide aggressive nutritional support.
12. Assessments can be performed to provide assurances that a family support system to care for the child exists and that the family has the ability to carry out the nutritional rehabilitation program.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Not applicable: The guideline was not adapted from another source.

2006 Jul

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - Professional Association

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Committee on Nutrition

Primary Authors: Valeri Marchand, MD, Montreal, Canada; Kathleen J. Motil, MD, PhD, Houston, TX

Committee Members: Jane Balint, MD, Columbus, OH; Dana Boctor, MD, Philadelphia, PA; Margaret P. Boland, MD, Ottawa, ON; Pamela I. Brown, MD, Ann Arbor, MI; Linda M. Casey, MD, M Sc, Edmonton, AB; George J. Fuchs III, MD, Little Rock, AR; Van S. Hubbard, MD, PhD, Bethesda, MD; Robert M. Issenman, MD, Hamilton, ON; Alfredo Larrosa-Haro, MD, Guadalajara, MX; Maria R. Mascarenhas, MD, Philadelphia, PA; Sonia Michail, MD, Dayton, OH; Patrika Montricul Tsai, MD, Boston, MA; Ann O. Scheimann, MD, Baltimore, MD; Francisco Sylvester, MD, Hartford, CT

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on November 29, 2006. The information was verified by the guideline developer on November 30, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) at (215) 233-0808.