Compared with healthy peers, children with intestinal failure (IF) present with decreased levels of physical activity, lower levels of physical function, and higher levels of fatigue, according to study results published in Journal of Pediatric Gastroenterology and Nutrition. These findings suggest that ongoing development of medical and rehabilitation intervention strategies is essential to optimizing outcomes of children with IF.

Despite improved survival rates, children with IF often present with multiple comorbidities. Previous research has shown that children with IF have lower physical functioning scores than healthy children.

Researchers from the Hospital for Sick Children in Toronto, Canada evaluated physical activity levels, barriers, facilitators to physical activity participation, reported physical function, and fatigue in children with IF. These results were then compared to healthy age- and sex-matched controls (HCs).

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Assessment methods used in this cross-sectional study included: Pediatric Quality of Life (PedsQL) Physical Function subscale, PedsQL Multi-Dimensional Fatigue Scale, and Physical Activity Perceived Benefits and Barriers scale. Physical activity was measured using an accelerometer and medical data was obtained via chart abstraction.

The study included 21 children with IF (14 girls) on parenteral nutrition and 33 HCs (20 boys). The researchers found that 13 children (61.9%) in the IF group were born prematurely and the median length of hospitalization per year of life was 38 (interquartile range [IQR], 18.5-69.5) days.  

The investigators determined that children with IF had lower total steps per day (9709±3975 steps) compared with HCs (13,104±5416 steps; P =.033).

Child and parent proxy scores indicated worse physical function and more fatigue in children with IF compared with the HCs. The HCs did not report any barriers to physical activity. Children with IF reported that their barriers to physical activity were “I am tired”, and “I am worried about my [central venous catheter] line.”

This study had several limitations. The HCs had a higher socioeconomic status, which has been linked to increased participation in organized adolescent sports in Canada. Additionally, data on gestational age for HCs were not collected.  Further, children with IF experienced difficulties with wearing the accelerometer waist belt. Finally, the overall sample size in the study was small.

In spite of these limitations, the study authors concluded that children with IF had decreased levels of physical activity, lower levels of physical function, and higher levels of fatigue compared with healthy children. Intestinal rehabilitation program teams should be aware of physical activity participation challenges in children with IF, and provide rehabilitation, education, and support to enhance their physical function.  


So S, Patterson C, Betts Z, Belza C, Avitzur Y, Wales PW. Physical activity and fatigue in children with intestinal failure on parenteral nutrition. J Pediatr Gastroenterol Nutr. Published online July 2021. doi:10.1097/MPG.0000000000003138