European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment
Journal of Pediatric Gastroenterology and Nutrition
Romano, C., van Wynckel, M., et al. (2017).
Journal of Pediatric Gastroenterology and Nutrition, 65(2), 242-264.
This is a guideline providing recommendations on the evaluation and treatment of gastrointestinal and nutritional complications (including dysphagia) in children with neurological impairment. The guideline working group defines neurological impairment as a group of disorders relating to the central nervous system affecting an individual's speech, motor skills, vision, memory, muscle actions, and learning abilities. The guideline working group also considered cerebral palsy as a major subgroup of neurological impairment.
European Society for Paediatric Gastroenterology, Hepatology and Nutrition
<div>It is suggested that nutritional evaluation and management of gastrointestinal problems in children with neurological impairment should be performed by a multidisciplinary team, ideally involving the speech-language pathologist along with other disciplines, such as, but not limited to, the physician, dietitian, and nurse (Moderate).</div>
<div>It is recommended that close attention be paid to possible dental problems, general posture, and orthopedic issues in patients with neurological impairment as these may contribute to feeding difficulties (Moderate).</div>
<div>It is suggested to consider oropharyngeal dysphagia in all patients with neurological impairments even in the absence of apparent clinical signs and symptoms (Moderate).</div>
<div>It is recommended to use videofluoroscopy when there is suspicion of abnormal pharyngeal phase of swallowing and/or concerns of aspiration. This could be combined with esophageal manometry, if available, to increase diagnostic yield (Low).</div>
<div>It is suggested to include feeding history starting from early infancy and direct visual assessment of feeding conducted by appropriately trained professionals, usually speech-language pathologists (Moderate).</div>
<div>It is recommended that children with neurological impairments be orally feed if it is nutritionally sufficient, safe, stress-free, and feeding time is not prolonged (Moderate).</div>
<div>It is suggested to consider speech and language interventions for oropharyngeal dysphagia in children with neurological impairment, and/or where there is need for modification of the consistency of feeds (Moderate).</div>
