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Nutritional Management bei schwerstbehinderten Kindern

Nutritional Management in severely handicapped children

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Zusammenfassung

Schwerbehinderte Kinder zeigen aufgrund von Fütter- und Schluckstörungen sowie gastrointestinalen Dysfunktionen häufig eine Mangelernährung, eine Gedeih- und Wachstumsstörung, einen Mangel an einzelnen Mikronährstoffen, selten aber auch eine Adipositas. Beschwerden durch eine gastroösophageale Refluxerkrankung, pulmonale Symptome oder eine chronische Obstipation sind häufig. Im Rahmen der medizinischen Betreuung der Kinder sollten diese Probleme immer wieder evaluiert und adäquat behandelt werden. Wenn eine Optimierung der oralen Nahrungszufuhr nicht ausreicht, kann eine Sondenernährung erwogen werden. Ziele der Therapie sind die Verbesserung des Ernährungszustands, die Vermeidung von Mangelernährung oder Übergewicht, die Verminderung von Erbrechen, die Behandlung der Refluxerkrankung, die Prävention einer chronischen Lungenerkrankung durch rezidivierende Aspirationen, aber auch die Optimierung der pflegerischen Situation, um die Lebensqualität der Kinder und deren Eltern zu verbessern.

Abstract

Children with severe neurodevelopmental disabilities are often malnourished due to oral-motor impairment and intestinal dysmotility. Growth failure, micronutrient deficiencies, and infrequently overweight are nutritional comorbidities. Discomfort caused by gastroesophageal reflux disease, pulmonary symptoms or chronic constipation is common. Monitoring for and treating these comorbidities should be part of the general care of neurologically impaired children. If oral feeding interventions are insufficient to promote weight gain, growth and adequate hydration or to prevent aspirations, enteral tube feeding should be considered. Nutritional management should prevent malnutrition, overweight, vomiting, pain and complications due to gastroesophageal reflux disease, chronic lung disease due to aspiration and should optimize care for these patients and therefore increase the quality of life of these children and their parents.

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Ballauff, A. Nutritional Management bei schwerstbehinderten Kindern. Monatsschr Kinderheilkd 157, 136–146 (2009). https://doi.org/10.1007/s00112-008-1835-3

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