الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 103 |  |  |
| | | from | 103 | | |
Abstract
Neurodevelopmental disorders (NDD) are a group of conditions with onset in the developmental period. These disorders include communication disorders, attention deficit hyperactive disorders (ADHD), intellectual developmental disorders (IDD), specific learning disorders, autism spectrum disorders (ASD) and motor disorders.
Some feeding behaviors are problematic in children with neurodevelopmental disorders and may lead to inadequate nutrition. These feeding behaviors include tantrums, bizarre food habits, multiple food dislikes, food-texture selectivity, delay or difficulty in chewing, sucking or swallowing, delay in self feeding, pica, excessive overeating, malnutrition through eating very little and rumination.
As a result of these feeding problems, malnutrition, either under- or over nutrition, is a common condition among children with neurodevelopmental disorders. In these children, malnutrition negatively affects quality of life and is associated with increased health care use and impaired participation in various activities. Thus, considering the multiple nutritional risk factors that face the children with neurodevelopmental disorders, this study aims at exploring the feeding problems of neurodevelopmental disorders children in Alexandria and their body mass index.
The study was carried out on 605 children with neurodevelopmental disorders aged 5-18 years from the private and governmental intellectual rehabilitation schools in Alexandria. Pre-designed structured questionnaire was used to collect socio-demographic data, assessment of feeding problems using screening Tool of feeding Problems (STEP): which contains twenty three items that assess mealtime behavior problems related to aspiration risk, food selectivity, feeding skills, food refusal, and nutrition-related behavior problems. The weight and height for each child was measured and then body mass index for age and height for age were calculated.
Data regarding socioeconomic status revealed that children aged 5-10 years represented 42% of the sample size while children aged 11-18 years represented 58%of the sample size. For sex, 55.7% of the children were males compared to 44.3% females. The same disability was found in 15.2% of siblings of children. About one third of cases (35.5%) there was consanguinity between parents.
Concerning the types of neurodevelopmental disorders, half of the studied sample (53.5%) suffered from intellectual developmental disorders(36.5% had mild intellectual developmental disordersand 17% suffered from moderate intellectual developmental disorders). About one quarter (24.5%) of the sample suffered from Down’s syndrome, 14% suffered from autism spectrum disorders, 4.5% and 3.5% suffered from cerebral palsy and microcephaly respectively. Concerning medical history of the children, only 6.3% suffered from chronic diseases. Prevalence of chronic diseases was higher among age group 5-10 years than age group 11-18 years (10.2% and 3.4% respectively) with significant difference between the two groups. Epilepsy was the most prevalent condition where 78.9% of these children suffered from epilepsy followed by bronchial asthma (76.3%). Only hypertension was found to be significantly higher in older age group.
Using STEP questionnaire, the mean total score of the sample was 9.14 ± 4.59, which is considered moderate feeding difficulty with no significant difference between younger (5-10 years) and older children (11-18 years).
Concerning the difference between genders in relation to the total score of STEP, males scored higher than females where mean±SD were 9.224.82 and 9.054.30 respectively with no statistical significant difference between the two groups.
Regarding the scores for each of the five subscales of the STEP: aspiration risk, selectivity, feeding skills, food refusal and nutrition related behavior problems, the most prevalent condition was nutrition related behavior problems with mean 2.84 ±1.52 and the least prevalent problem was aspiration risk with mean 0.30 ±0.62. As for the five subcategories of STEP questionnaire, there was a statistical significant difference between male and female groups regarding aspiration risk and problems in feeding skills.
Concerning aspiration risk, children with moderate intellectual developmental disordershad the highest scores where the mean ± SD was 0.59 ± 0.82. Regarding selectivity of food, children with autism had the highest scores where the mean ± SD was 3.55 ± 2.18. As for feeding skills, children with cerebral palsy had the highest scores where the mean ± SD was 5.04 ± 2.33.Regarding food refusal, children with moderate intellectual developmental disorders were the highest scorers where mean± SD was 1.77±1.46. Concerning nutrition related behaviorproblems, children with moderate intellectual developmental disorders were the highest scorers with mean ± SD of 3.33 ± 1.86.
Among the twenty-three items of STEP questionnaire, the most prevalent item was the tendency to steal or attempting to steal food outside of mealtimes that occurred in 62.8% of cases. The least prevalent item was requiring special positioning during feeding that occurred in 9.4% of cases.
Concerning physical activity of the studied sample, the present study states that only about one third (35.9%) of children with neurodevelopmental disorders played sports. Children with cerebral palsy were the least to engage in sports where only 7.4% played sports.
Regarding body mass index for age, about one fifth of the studied sample (21.8%) were overweight and about half of the studied sample were obese (50.7%). Down syndrome had the highest body mass index for age compared to the other disabilities where 94.6% of subjects with Down syndrome were overweight or obese. On the other hand, this study revealed that only 3.3% were underweight, with a higher prevalence of underweight in the older age group (11-18 years) (4.0%) than the younger age group (5-10 years) (2.4%).
Concerning height for age,the overall prevalence of stunting was 39.7%. The prevalence of stunting was significantly higher among older age group (11-18 years) (41.3%) compared with the younger one (5-10 years) (37.4%). Also stunting was higher in females (48.5%) than males (32.6%) with significant difference between the two groups. Concerning types of neurodevelopmental disorders, children with Down syndrome showed the highest prevalence of stunting (40%) followed by mild intellectual developmental disorders (27.1%) while children with microcephaly were the least to show stunting where only 3.3% were stunted. There was statistical significant difference between the six groups.
As regards relation between body mass index and feeding problems, multivariate analysis revealed that children suffering from food refusal are 0.8 times less likely to be overweight or obese than those who don’t have this problem while children suffering from nutrition related behavior problems are 1.4 times more likely to be overweight or obese than those who don’t suffer from this problem.
On the other hand, children showing selectivity of food are 0.5 times less likely to be underweight whereas children having problems with feeding skills are 1.3 times more likely to be underweight than those not suffering from this problem. Children suffering from food refusal are 1.7 times more likely to be underweight than those not suffering from this problem.
The present study revealed that children with neurodevelopmental disorders experience feeding problems such asaspiration risk, selectivity, feeding skills, food refusal and nutrition related behavior problems which affect their nutritional status where obesity and overweight occurred in about three quarters of the studied sample and stunting occurred in more than one third of the sample.
Recommendations:
These recommendations can be carried out through schools:
• Periodic screening of the children with neurodevelopmental disorders in schools using STEP questionnaire and anthropometric indices is recommended for early detection of feeding problems which needs collaboration between teachers, doctors and social workers.
• Nutrition education should be directed to caregivers as they provide their children with meals. Caregivers should be educated about the proper nutrition of their children and how to overcome feeding problems
• Emphasize participation in sports and physical activities whenever the medical condition of the child is good enough.
• Collaborate with the child’s other medical providers and teachers to provide consistent care during the behavior change process.