Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia.
Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland.
J Hum Nutr Diet. 2025 Feb;38(1):e13277. doi: 10.1111/jhn.13277. Epub 2024 Jan 9.
Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.
严重神经发育障碍 (SNI) 儿童的营养管理非常复杂，且该人群的特征正在发生变化。本综述的目的是为读者广泛描述高资源环境下儿童严重神经发育障碍的营养管理演变。在过去十年中，人们强调使用多种人体测量指标来监测 SNI 儿童的营养状况，并且已经尝试了几种标准化方法。现在已经有一些工具可以使用，例如喂养和营养筛选工具、主观整体营养评估、进食和饮水能力分类系统以及早期进食和饮水吞咽焦点 (FEEDS) 工具包。人们越来越了解肠道微生物群如何影响 SNI 儿童常见的胃肠道症状，并且在这些方面使用纤维也受到了关注。还定义了一个新的诊断，即“胃肠道张力障碍”。混合食物管饲的使用和接受度增加是 SNI 儿童营养管理的重大进展，据报道，这种方法在管理胃肠道症状方面具有益处。新的干预措施可支持 SNI 儿童进食和饮水技能的发展，显示出了希望。总之，由于医疗和营养护理方面的进步，SNI 患者的预期寿命延长，我们的治疗方法需要考虑到长期的健康和生活质量。这需要在支持生长、发育和幸福感的同时，平衡充足的营养摄入，避免营养过剩及其相关的长期不利影响。
