Undernutrition in children with a neurological handicap is mostly caused by a decreased appetite or intake. Increased requirements or increased losses are not reported. Eating problems or difficulties in chewing, swallowing disturbances, absent swallowing reflex, no co-ordination of oral and esophageal phases and choking of food into the nose are implicated. Also, rumination, hyper-sensitivity in the mouth area, food refusal or aversion contribute to eating disorders.
Nutrition is further influenced negatively by changes in taste, dry mouth, epigastric pain, nausea, sedation and hypersalivation. Specifically, anti-epileptics cause gingival hyperplasia and anorexia; antidepressants such as lithium increase thirst and appetite; mental stimulants such as Ritalin® decrease appetite; antacids might cause constipation; and aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) cause pyrosis and nausea and may lead to ulcerations in the gastrointestinal tract. In the Institutional Tokyo Study it was shown that around 10% of the blind needed assistance with eating, mostly because of some chewing problems, and around 20% had poor appetite. In the mentally retarded, around 25% needed assistance during eating, 2% had swallowing disorders, around 35% had chewing disorders and 20% had poor appetite. In the physically handicapped, around 65% needed assistance with eating, 20% had swallowing disorders, 40% had chewing disorders and 30% had poor appetite. Four per cent of the mentally retarded children had a voracious appetite, which was in keeping with their overweight tendency.15,16
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