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Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia and nutritional comorbidites. Gastrointestinal problems including gastroesophageal reflux disease, constipation and dysphagia are also very frequent in this population and impact quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, ESPGHAN aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in neurologically impaired chidren.Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess: 1) the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; 2) to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; 3) to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; 4) to define indications for surgical interventions (e.g. Nissen Fundoplication, oesophago-gastric disconnection) and finally 5) to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate the outcomes. During two consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.

Original publication




Journal article


Journal of pediatric gastroenterology and nutrition

Publication Date



*Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi" - University of Messina, Italy †Dep Paediatric Gastroenterology, Hepatology and Nutrition Ghent University Hospital, Belgium ‡Department of Pediatric Gastroenterology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands §Pediatric Gastroenterology, University Children's Hospital, Faculty of Medicine, University of Cologne, Cologne, Germany ||Department of Paediatrics, University Hospital Motol, Prague, Czech Republic ¶Digestive Endoscopy and Surgery Bambino Gesù Children's Hospital. Rome #Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Slovenia **Children's Hospital Zagreb, Zagreb, Croatia ††University Children's Hospital Ljubljana, Slovenia ‡‡Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital "Agia Sofia", Athens, Greece §§Pediatric Center, Clinic des Grangettes, Geneva, Switzerland ||||Department of Pediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom ¶¶Pediatric Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel ##University of Oxford, Department of Paediatrics, Children's Hospital, Oxford, UK ***CHU Lille, University Lille, UMR 995 LIRIC, Department of Pediatric Gastroenterology, Hepatology and Nutrition, F-59000 Lille, France.