Nutritional disorders

There is a wide spectrum of nutritional disorders, varying from protein-energy malnutrition to micronutrient nutritional deficiencies to morbid obesity.

Causes

Diets low in protein, energy, or specific nutrients.

• Strict fad or vegetarian diets.

• Diseases causing malabsorption, eg

·      coeliac disease, cystic fibrosis

·      Crohn’s disease, severe GORD

·      immunodeficiency, chronic infection.

• Eating disorders, eg anorexia nervosa

Enteral nutritional support is addressed at the underlying cause, and may involve a paediatric dietitian to assess nutritional status and requirements for volume, calories, and composition,

Oral supplementation

Includes high energy milks, mineral/vitamin supplementation.

Specialized foods

 Huge range of specialized milk and feeds exist for many different conditions, (modular elemental diets for IBD, hypoallergenic milk for milk protein allergy).

Enteral tube feeding

Can be orogastric, NG, nasojejunal, and gastrostomy.

• Liquid feeds are given as boluses or continuously, e.g. overnight.

Indications:

• swallowing problems (e.g. severe cerebral palsy, prematurity), cardiorespiratory compromise, GORD, anorexia, generalized debilitation, e.g. trauma.

Feeds:

• standard polymeric diets (e.g. ready to feed nutritionally complete whole protein products); elemental diets and semi-elemental diets requiring little or no digestion; or disease-specific formulations.

Gastrostomy reduces orofacial complications/discomfort, but complications include: Gastric leakage; localized skin infection or inflammation; GI perforation/trauma/haemorrhage.

Summary

Nutritional assessment is an essential component of the evaluation of children with gastrointestinal diseases because their clinical course frequently is complicated by undernutrition, growth failure, overweight, and micronutrient deficiencies. Although a complete nutritional assessment includes a review of the diet history, physical examination, growth and anthropometric measurements, and selected laboratory testing, accurate height and weight measurements and their transformation to relative indices of undernutrition or overnutrition serve as the mainstay of the nutritional assessment of the child with gastrointestinal disorders. The maintenance of a favorable nutritional status is essential to minimize disease-associated morbidity and maximize the child’s quality of life.