Nutritional support in children with neurodevelopmental disabilities. Proceedings Bespghan Meeting, Ghent December 2011.

Feeding difficulties, mainly determined by oral motor problems, are common in patients with severe neurodevelopmental disabilities (NDD). These problems have a negative impact on health and developmental outcome as a consequence of insufficient intake. Research data show that insufficient intake, and not enhanced caloric needs, is the major cause of malnutrition. However, no direct relation between intake and nutritional state has been shown, illustrating the wide variety in caloric needs in this population. Individual caloric needs in patients with NDD show a wide variety, but are generally lower than in normal children. Treatment of these patients is complex as data on adequate daily allowances for this population are not available and standard anthropometric cut-off points to define malnutrition need adaptation. In order to prevent and treat malnutrition in patients with neurodevelopmental problems, careful multidisciplinary follow-up is indicated, aimed at early detection of feeding problems, nutritional deficiencies and growth failure. Oral food intake can be enhanced using adapted food texture and special feeding devices, giving positional support combined with specialized dietary advice on nutrient- and caloric-dense food. When oral feeding is unsafe or inefficient, partial or total enteral nutrition is started through a gastrostomy, with or without concomitant fundoplication. Evidence based criteria guiding this decision are lacking.