The Importance of Good Nutrition in Children with Cerebral Palsy

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Key points

  • In children with cerebral palsy (CP), undernutrition has significant negative consequences.

  • Poor oral-feeding skills are the primary cause of inadequate nutrition in children with CP.

  • Understanding the causes of poor nutrition guides nutritional intervention.

  • Overcoming the challenges inherent in the physical measurement of children with CP by using heights extrapolated from segmental measures and triceps skin fold, together with weights, weight gain velocity, and monitoring these measures on

Factors affecting nutrition and growth in children with cerebral palsy

The children with CP who are at the greatest risk of having significant nutritional problems are those who present with poor weight gain at a young age,11, 12 who have significant motor impairments,13 and who have feeding and swallowing problems.9, 14, 15 Other factors affecting nutrition are detailed in Box 1.

Undernutrition is a remediable condition

With the increased use of enteral nutrition support has come the understanding that malnutrition is remediable and not intrinsic to CP.6 Weight gain is generally noted early after the introduction of enteral nutrition support in children with CP, although increases in length often lag behind the improvements in weight. Growth is generally better the earlier nutrition is optimized, suggesting a critical window during which nutritional rehabilitation will have the most beneficial effect on growth.

Good Nutrition Improves General Health and Participation

In any child, poor nutrition can negatively affect growth, development, and muscle strength, immune function, and wound healing.6, 7, 34 There is little direct evidence of the relationship between specific health concerns and poor nutrition in children with CP, but its effects on unaffected individuals are also applicable to undernourished children with CP.6 For example, because poor nutrition is associated with decreased muscle strength, poorly nourished children with CP may have respiratory

Assessment of nutritional status

Health care providers can acquire valuable information about the child’s nutrition by obtaining a detailed history of the primary and secondary health conditions affecting the child and specific information related to the child’s feeding, as outlined in Box 4.

Examining the child and observing a typical meal provides valuable insight into the child’s oro-motor skills, aspiration risk, nutritional status, and fat reserves and the feeding interaction and technique. Assessing the children for

Enhancing Oral Nutrition

Once families and care providers decide that a concerted nutritional intervention is required for a child because of poor weight gain, depleted fat reserves, or faltering growth, a plan can be developed that focuses on improving all aspects of oral feeding, incorporates the families’ priorities for feeding, and defines time frames for evaluating the efficacy of the oral nutritional rehabilitation plan (Table 2).

The next step is to establish specific nutrient requirements. The protein and

Case example

Harley was born at 26 weeks’ gestation and experienced a stormy neonatal course and prolonged hospitalization. He eventually transitioned to oral feeding, but his growth and nutrition remained challenging. At 3 years of age he has CP (GMFCS 5) demonstrating spasticity and very limited mobility. Although he remains in good health and free of lower respiratory tract infections, he is falling farther behind on the conventional growth charts. His day care workers are having increasing difficulty

Summary

Children with CP frequently experience challenges with nutrition and growth, which have a negative impact on their health, neurodevelopmental outcome, and survival. Intervention strategies to remediate the poor nutrition in children with CP are shaped by the following:

  • Understanding of the nutritional and non-nutritional factors affecting nutrition

  • Careful assessment of the nutritional status with appropriate anthropometric measures and growth charts

  • Consideration of the multidimensional aspects

Acknowledgments

The author thanks Dr Paul Shelton for his helpful suggestions when reviewing this article.

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    Disclosure: The author has no commercial affiliations or interests that might be perceived as posing a conflict or bias.

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