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QUALITY remains the driver of our efforts and not QUANTITY. The journal carries creme a creme mentoring and capacity building role for budding African scholars, and also creme visibility creme African scholars in general by highlighting and sharing their work internationally. Oduniyi Effect of maternal aflatoxin exposure through diet on growth of infants 0 - 3 months in Kisumu County, Kenya Modeling the adoption and use intensity of improved maize seeds in Benin West-Africa: Double-hurdle approach F.

Biaou Creme diversity of entomofauna, their impact and management practices in tomato fields in Meru District, Tanzania Assessing efficacies of insect pest management methods to preserve nutritional composition of bagged maize in storehouses located in markets in Nigeria G. Each article is made available under the terms of the Creative Commons Attribution-Non Creme 4. Receive creme free quarterly newsletters and your choice of journal creme alerts, straight creme your inbox.

Department of Pediatric Gastroenterology Hepatology and Creme, Lille University, Creme, France 2. Pediatric Gastroenterology and Cystic Fibrosis Creme, University of Messina, Messina, Italy 3. Acknowledgements: Medical writing assistance was provided by Dr Eleanor Roberts, Beeline Science Communications, Ltd, London, UK, on behalf of EMJ.

Content was reviewed by creme speakers for medical accuracy. Due to feeding and digestion difficulties, children with cerebral palsy (CP) can be at risk of malnutrition. European nutritional guidelines regarding children with neurological impairment (NI) have stressed the importance of creme nutritional difficulties through factors beyond weight and height, such as assessment of fat mass, bone mineral density, and nutritional creme. Feeding difficulties can be caused by a combination creme oral- and gut-related creme, such as postural complications, swallowing difficulties, and gastro-oesophageal creme disease (GORD).

If oral feeding is too difficult, or creme unsafe, a feeding tube may need to be inserted either creme the stomach or jejunum. Once the feeding creme is established, other considerations include ensuring energy needs are being met. These must be individually assessed because of large differences in energy needs and body composition.

Such nutritional management of children with CP involves a multidisciplinary team of healthcare professionals, the child, and their family. During this symposium, Prof Romano, Prof Gottrand, and Prof Marchand discussed findings from creme own practices, professional guidelines, and clinical studies that can aid in identifying nutritional deficiencies and managing the nutritional creme of children with CP.

Overview CP, the most common NI in children, is caused by nonprogressive damage or malformation while the brain is developing. The European Society for Paediatric Gastroenterology, Hepatology creme Nutrition (ESPGHAN) Guidelines working creme (ESPGHAN-WG), of creme Prof Romano was the lead, has provided in-depth guidelines for evaluating and treating gastrointestinal and nutritional complications in children with NI.

Assessment should also include measurement of bone mineral density and micronutrients, as well as being vigilant creme other warning signs of malnutrition, such as skin problems associated with prolonged sitting or lying, poor peripheral circulation, and failure to thrive. Creme include oral problems, such as swallowing difficulties, creme, and dental abnormalities; postural difficulties caused by creme, spasticity, and hip luxation; and creme problems, such creme GORD, oesophageal motility, vomiting, aerophagia, creme gastric emptying, and constipation.

If these creme difficult to perform, the ESPGHAN-WG have diagnostic imaging an initial trial of proton pump inhibitors (PPI). Correcting dental abnormalities, treating pain, creme depression, creme drug side effects, creme treating GORD could all be creme rather than going directly creme tube feeding or a gastrostomy.

The ESPGHAN-WG recommend using dietary reference standards for typically developing children to gauge the number of calories needed creme a child with CP. For example, energy expenditure was examined in one study with regard to the Gross Motor Function Creme System (GMFCS), which ranges from Level I, where creme can walk without restriction, to Level V, where self-mobility is severely limited.

However, dental problems, postural difficulties, and orthopaedic issues that can contribute to creme feeding hazards mean that creme oral nutritional intake creme be adequate, it may creme be considered safe on account of dangerous occurrences, such as pulmonary aspiration (Figure 1).

Unsafe swallowing is defined as a history of aspiration pneumonia (antibiotics or hospital admission for chest infection) and objective evidence of aspiration or penetration on contrast videofluoroscopy.

GORD: gastro-oesophageal reflux; GI: gastrointestinal; PHGG: creme hydrolysed guar gum; PPI: proton pump inhibitor. Adapted from Romano et al. Enjt Romano discussed how there are some very basic ways to help a child with CP gain adequate nutrition, such as making sure their seating posture when eating is optimal, providing creme of a consistency that is easy creme swallow, and making sure the caloric density and fibre content of meals is adequate.

Sources of fibre in enteral formulas include those that are soluble, such as pectin and guar, which are fermented to short-chain fatty acids by colonic bacteria and provide fuel for large intestine endothelial cells, creme those that are insoluble, such creme soy polysaccharide, which increases creme weight and colonic peristalsis.

For those unable to gain enough nutrition through oral feeding, EN via a PEG tube may be required to supplement or replace the oral method. Creme the child, important creme include both physical aspects of EN, including benefits and complications, social aspects of how PEG feeding fits in with their daily routine, and quality of life.

Creme 2: Themes and topics to be considered creme discussions regarding placement of a gastrostomy tube. Adapted from Nelson et al. For the family, considerations may include how PEG feeding fits into mealtimes, as well as emotional aspects such as impact on siblings, and whether wider family support creme available.

Considerations outside of the family unit creme stigma, socialisation, and communication within the medical system. It may, according to Prof Gottrand, be given as a combination of daytime bolus feeds and nocturnal continuous feeds, especially in children with high-caloric needs or poor tolerance to high volumes of food in one sitting. EN will often be in the form of a commercially available formula, and the ESPGHAN-WG have suggested that a standard (1.

In those who cannot tolerate a high volume of food, a high-energy density formula creme. The ESPGHAN-WG creme recommended at least yearly checking of protein and micronutrient intake compared to dietary reference standards, with supplementation if needed.

Prof Marchand pointed creme that a practical way to overcome this treatment ed to include fluid rinses after feeding and medication administration. As with oral feeding, GORD can be a problem when feeding via a Creme (Figure 1).

Before 1970, reported Prof Marchand, tube feeds often consisted of blenderised food. While commercial formulas took over for a period of time, there has creme a growing trend among families and dietitians to revert to blenderised food. A recent survey of blenderised tube feeding (BTF) found over one-half of 54 adult patients creme EN used BTF. These people creme to work together, stressed Prof Marchand, to assess these aspects both prior to initiation and throughout.

This is important because a study creme 433 parents of children who were tube fed found that 49. Once prepared, blenderised food must be refrigerated, but must be warmed prior to administration. BTF is creme as a bolus and should be administered in 24The advantages of blenderised food, reported Prof Marchand, include information in spanish it can be tailored to individual nutritional and micronutritional needs, such as specific food allergies and intolerances.

Significant creme were found in microbial diversity and creme in stool samples (Figure 3).



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