PWT Tse, SSF Leung, T Chan, A Sien, AKH Chan

Objective This study aims at evaluating the fibre intake of children living in a residential institution for children with severe developmental disabilities (DD), and the clinical effects of dietary manipulations as part of nutritional rehabilitation.

Methods Daily energy, macronutrients and fibre intake of children with severe DD who were fed orally with Dental soft, Blend or Fine-blend diets were estimated. Dietary assessment was performed for 9 days by weighing proportions of raw ingredients, weighing servings of cooked meals by electronic scales to establish a standard serving size, and calculating the nutritional values for a standard serving according to a reference Food Table (from Growth and Nutritional Research Team, Department of Paediatrics, Chinese University of Hong Kong). The daily energy intake, carbohydrate, protein, fat and fibre consumption were then estimated.

A study to evaluate whether increasing fibre intake could improve constipation was performed over a 4 month period in children aged between 3 and 17 years. Fibre intake was increased by phases from 2 gm per day (baseline), to 17 gm per day (first phase), to 21 gm per day (second phase) by adding all-bran and desserts. As a rule, laxatives were prescribed once if there was no spontaneous bowel motion for two consecutive days. The mean number of laxative usage per week per child in the different phases were then compared.

Results 20 children with chronic constipation were recruited. The number of laxatives required per week per child on average decreased from a baseline diet value of 1.22 (about 5 laxatives/month) to 0.90 (about 3.5/month) in the first phase, and 0.71 (about 4/month) in the second phase. Using a paired t-test, the difference was statistically significant when compared with the baseline: p < 0.05 for the first, and p < 0.01 for the second phase. There was, however, no statistically significant difference between the first and second phase.

Discussion and Conclusion The propotion of dietary macronutrients and energy intake in children with severe DD is to a certain extent limited by their ability to take solid food, due to masticatory and swallowing problems. The same quantity of Dental Soft diet has a higher calorie content compared to both Blend diet and Fine-blend diet. Protein intake was found to be in excess while both fat and carbohydrate intake were inadequate. Very low daily intake of fibre of 2 gin! day was documented in the group of children recruited for the baseline study, their diet being essentially that prescribed normally in the hospital. More than 50% of severe DD children had chronic constipation requiring regular use of laxatives. Relief of constipation and reduced usage of laxatives was demonstrated by increasing their fibre intake to 15 gm/day. Increasing their fibre intake further to 20 gm/day, however, was associated with only marginal further improvement.