Providing optimal nutrition to children with cerebral palsy (CP) helps improve their nutritional status and their overall general health.1
Children with CP often require specific nutritional interventions. Indicators that can help you determine if the child is in need of a nutritional intervention include:2
- No weight gain or growth
- A deviation from an established “growth pattern”
- Low body fat-stores with low weight in respect to height or length
- Prolonged or stressful oral feeding
- Signs of pulmonary aspiration or dehydration
- Evidence of micronutrient deficiencies
Once you identify the medical need caregivers play an influential role in providing the recommended nutritional solution. In fact, children with CP are very dependent on the caregivers’ understanding and adherence to your recommendations.1
In the following section, we will provide you with helpful information related to both the nutritional assessment and the nutritional recommendations for children with CP.
The choice of a nutritional strategy, as well as the method of administration, depend on:2
- The child’s nutritional status
- The child’s nutritional requirements
- The child’s ability to consume adequate quantities of food and fluids orally
- The risk of pulmonary aspiration
Before recommending a nutritional strategy, nutritional requirements need to be carefully assessed. Several specialists may take part in this overall assessment to help determine the best nutritional strategy. It is critical to include dietitians and speech language pathologist as part of the team in order to provide a complete nutritional solution.
Nutritional requirements vary depending on physical impairments, feeding difficulties, body composition and physical activity levels.2
Anthropometric assessment is the first step needed to calculate energy requirements. Preferably, weight measurement should be obtained on a digital scale; but, if the child is unable to stand, the use of a wheel chair scale is recommended.3 The height of children younger than two years of age or unable to stand should be obtained through reclining length or through segmental measures.3
For body composition, the best way to estimate it is via the DXA (dual energy X-ray absorptiometry). When this method is too expensive or unavailable, skin fold thickness and bioelectric impedance are suggested.3
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It is advisable to routinely measure and monitor the weight, height, body composition and nutritional status of children with CP in order to adapt nutritional requirements accordingly.3 Following clinical assessment, the child’s nutritional needs should be discussed with their caregivers.
Introducing thickeners if indicated, or oral nutrition supplements (ONS), while ensuring adequate position and physical support during meals, is usually the first approach.2 If, despite these strategies, the child is not gaining weight, then more advanced solutions need to be considered, such as a gastrostomy tube for feeding.
Below we have covered each nutritional strategy in more detail.
- Verrall TC et al. Children with Cerebral Palsy: Caregivers' Nutrition Knowledge, Attitudes and Beliefs. Can J Diet Pract Res. 2000;61(3):128-134.
- Bell KL and Samson-Fang L. Nutritional management of children with cerebral palsy. Eur J Clin Nutr. 2013;67 Suppl 2:S13-6.
- Scarpato E et al. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int J Food Sci Nutr. 2017;68(6):763-770.