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Eur J Pediatr (2004) 163: 567568 DOI 10.1007/s00431-004-1490-1
SHORT REPORT
Andreas D. Meyer-Heim Yasmin Khan
Nail dystrophya clinical sign of malnutrition in the disabled child
Received: 9 December 2003 / Revised: 24 May 2004 / Accepted: 25 May 2004 / Published online: 9 July 2004 Springer-Verlag 2004
Malnutrition caused by profound feeding diculties is common among disabled children but often under-recognised. Inadequate nutrient intake is a signicant contributory factor to growth failure and may lead to complications such as increased risk of pressure sores, delayed tissue healing, gastro-oesophageal reux (GOR), constipation, dehydration, osteopenia and other metabolic or trophic implications [4, 5]. Changes in nger- and toenails can be an indication of the nutritional status.
We report an adolescent female patient with severe athetoid cerebral palsy due to perinatal distress. At the age of 6.5 years her weight was 14.75 kg (0.42nd percentile). From the age of 11 years her nutritional status was of increasing concern because of weight plateauing, GOR, recurrent gastrointestinal bleeding and constipation. Her parents were not convinced of the need for caloric supplements (Fig. 1).
At 15 years with a weight of 20 kg (<0.4th percentile) and marked osteopenia on X-ray lms, her parents agreed to orally supplement calories. Her medications were sodium valproate, ranitidine, omeprazole, antacids, lactulose and multivitamin supplements. An iron deciency anaemia (haemoglobin 11.8 mg/l) was treated at the age of 15 years. At the age of 15.5 years and following a femoral neck fracture (treated conservatively with a spica-cast), a trial of nasogastric feeding was introduced with an...